Further, 2 of every 5 dollars were paid by federal, state, and local governments, demonstrating that we are all paying for excessive alcohol use. Excessive alcohol use cost states and the District of Columbia D. These estimates update two previous CDC studies that found excessive drinking cost the U. The researchers believe that the study still underestimates the cost of excessive drinking because information on alcohol is often underreported or unavailable, and the study did not include other costs, such as pain and suffering due to alcohol-related injuries and diseases.
Communities can use effective interventions to prevent excessive drinking and related harms and costs. These include:. Overall, ONS statistics would suggest a falling trend in the number of people who binge drink but it is still a sizeable problem — with four in ten young adults consuming up to eight units on at least one day in the week before being interviewed by the ONS.
In a paper we set out to count the costs of binge drinking. Rates of binge drinking were compared during the week and weekend between two different age groups: and those aged over Those aged are more likely to binge drink, particularly during the weekend. Outcomes for these two age groups were then compared during weekend nights. These results were combined to estimate the effect of binge drinking on the outcomes of interest. The cost of these effects is calculated using data available from a number of UK government departments.
Understanding the economic cost of binge drinking can inform the public policy debate on alcohol use and contribute to more effective policy design. Excessive alcohol consumption has been the direct target of health policy interventions worldwide. Common policies such as raising alcohol taxes, setting a minimum unit price for alcohol and restricting availability with minimum legal drinking ages, aim to discourage alcohol misuse and raise income to pay for its burden on society.
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A United Kingdom study reports a significant negative result for price and male bingeing, but it uses a national price index that might pick-up other data trends. Several US studies include a variety of state-level variables including legal drinking age, drink-driving laws, alcohol availability, and state drinking environment. Significant negative effects for average price or fixed-fees are reported in three studies; mixed results in one study; and insignificant results in two studies.
Two studies, Chaloupka and Wechsler [ 54 ] and Wolaver [ 70 ], report insignificant price effects for male and female binge drinkers, regardless of legal age. This is a diverse set of controls, but half of the studies report mixed or null results. Four studies report mixed results: Kenkel [ 78 ] finds a significant effect of price for better-informed drinkers only; Sloan and colleagues [ 82 ] find a significant price effect for binge frequency, but not for participation; and Manning and colleagues [ 31 ] report that price is significant for binge participation, but not for frequency.
Significant price effects are reported for both men and women in studies by Cook [ 75 ] and Kenkel [ 63 ], but Kenkel [ 78 ] also reports insignificant results. In some cases, significant tax elasticities appear to be too large to be credible e. Price measures in adult studies include beer taxes; weighted average or multiple taxes; ACCRA beer prices; weighted price or multiple prices; and price indexes.
Table 2 summarizes results for five natural experiments and six field studies. Natural experiments examine tax reductions on beer and wine Hong Kong , spirits Sweden, Switzerland , and all beverages Finland. A study for Finland by Helakorpi and colleagues [ 91 ] finds mixed effects on binge drinking, while four other studies report null effects on binge drinking and heavy drinking more generally.
In contrast to economic studies, natural experiments contain fewer control variables and do not directly account for price or tax levels.
There are four field studies for the United States, one for Australia, and one for the United Kingdom. A study by Clapp and colleagues [ 87 ] reports null results for free alcohol, but Wagoner and colleagues [ 98 ] find that free drinks increase binge drinking by both genders.
Thombs and colleagues [ 96 ] report that fixed-fees increase chances of intoxication among college students, but other price promotions are not significant. In summary, this is a mixed set of results for pricing methods obtained from field studies.
Overall, null results or mixed results are found in more than half of the studies. For econometric studies, 56 studies contain 30 null results, 12 mixed results, and only 14 studies where a negative relationship with prices is more strongly supported.
Findings also are null in more than half of results by age group or by gender. For example, half of the studies report insignificant results for women. Similar results are obtained for natural experiments: four of five studies find no effect of substantial alcohol tax reductions. Field studies report more mixed results as various price measures have been examined, such as price discounting, fixed fees, and free drinks.
For example, Stockwell and colleagues [ 95 ] p. On the other hand, one field and three CAS studies report that fixed-fee offers are significant in some circumstances. Available evidence for price specials and similar methods is presently mixed and inconclusive. Additional research is required to establish which pricing methods are important for binge drinking, especially for young adults and college students. In economic studies, two potential sources of bias are: 1 measurement errors in price variables; and 2 omitted variable bias from unobserved state-level attributes that are correlated with state alcohol prices or taxes.
As discussed above, price data must be imputed and measurement errors in these data tend to bias estimated coefficients towards zero. A key issue for future research is improved data on prices, where some research efforts have been reported [ 29 , ]. Harvard CAS and field studies also use a variety of self-reported pricing data, yet fail to conclusively support a price-binge relationship. However, omitted variable bias tends to have the opposite effect, with negative coefficients resulting when this bias offsets any measurement errors.
I am grateful to a referee for stressing this point. Whether or not state-level fixed effects are sufficient to overcome this problem is difficult to assess because few researchers have recognized the problem or made efforts to address the issue.
Thus, another key issue for future research is robustness tests that address omitted variable bias, with state fixed-effects high on the agenda. The existing evidence-base therefore has limitations due to these potentially offsetting biases. The evidence does not strongly support an effect of prices on binge drinking, but this reflects measurement and specification errors.
Failing to reject the null hypothesis of no relationship does not prove that such a relationship does not exist. Several other shortcomings of primary studies that underlie this review should be kept in mind. First, most evidence on prices pertains to the United States and a few other higher-income countries. However, natural experiments and field studies for other countries also fail to support alcohol tax increases.
Second, more attention might be given to subsamples by age, gender, race, ethnicity, etc. Third, use of similar measures of drinking outcomes combined with subsamples would in the future permit a quantitative synthesis of the binge drinking literature. This paper presents a comprehensive review of empirical studies of the relationship between alcohol prices or tax surrogates and binge drinking.
Results include 22 studies published since , which updates substantially the available evidence-base compared to earlier summaries and reviews.
The review includes for the first time, a summary of results for youth, young adults, and adults. A variety of survey-based data are employed in econometric studies, while special surveys and interviews are used for natural experiments and field studies. Binge drinking outcomes include participation, intensity, and frequency.
Alcohol price and tax measures include quarterly survey prices, state excise taxes, weighted averages of prices or taxes, price indexes, self-reported prices, and price discounts. For example, Babor and colleagues [26] p. As demonstrated here, a large body of evidence indicates that binge drinkers are not highly-responsive to increased prices. Additional file 1: 46K, docx Table S1.
Young adult binge drinking studies ages 18—26 yrs. Natural experiments and field interview studies for binge drinking. Competing interests. This paper presents the work product, findings, viewpoints, and conclusions solely of the author. National Center for Biotechnology Information , U. Journal List Health Econ Rev v. Health Econ Rev. Published online Feb Jon P Nelson.
Author information Article notes Copyright and License information Disclaimer. Jon P Nelson, Email: ude. Corresponding author. Received Sep 11; Accepted Dec This article has been cited by other articles in PMC. Methods A qualitative systematic review is performed for effects of alcohol prices or tax surrogates on binge drinking for three age groups: youth, young adults, and adults.
Results Fifty-six relevant econometric studies were found, with studies and results distributed equally among three age groups. Conclusions Increased alcohol taxes or prices are unlikely to be effective as a means to reduce binge drinking, regardless of gender or age group.
Electronic supplementary material The online version of this article doi Introduction Understanding the determinants of excessive alcohol consumption, especially binge drinking, is important for informed alcohol policy and evaluation [ 1 , 2 ].
Open in a separate window. Figure 1. Table 1 Frequency of keywords in title or abstract: primary studies. Identification of primary studies and quality criteria Identification of primary studies for review was based on the following quality criteria: 1 examines the relationship between alcohol prices or tax surrogates and binge drinking or other measures of heavy drinking that can be easily interpreted as binge drinking e.
Data collection Data collected from each study include sample population, subpopulations age, gender, race , survey employed, average age or age range of respondents, measure s of binge drinking as outcomes, measure s of alcohol prices or taxes as interventions, statistical method s employed, control variables included in the model e.
Results Primary studies Dropping some duplicate studies, there are 56 econometric results in the database, divided equally among three age groups. MTF, signif. NLSY, not significant Xuan et al. Adult studies Asgeirsdottir et al.
Not significant Byrnes et al. Significant, both genders Kenkel [ 78 ] No. Not signif. Mixed results; signif. Sloan et al. Stout et al. Binge drinking results for youth There are 18 studies or samples for binge drinking by youth, but several are similar in design. Binge drinking results for young adults There are 19 table entries for binge drinking by young adults that can be divided into three groups: 1 five that do not report separate results by gender; 2 seven with results for males or both genders; and 3 seven based on the Harvard College Alcohol Survey CAS , which uses self-reported information for alcohol prices, price discounts, and price promotions that reduce marginal costs to zero fixed fees, free drinks.
Binge drinking results from natural experiments and field studies Table 2 summarizes results for five natural experiments and six field studies. Review Overall, null results or mixed results are found in more than half of the studies. Conclusions This paper presents a comprehensive review of empirical studies of the relationship between alcohol prices or tax surrogates and binge drinking. Additional files Additional file 1: 46K, docx Table S1. Additional file 2: 26K, docx Primary study references.
References 1. Alcohol: is the evidence base guiding public policy? Int Evidence-Based Healthcare. Xu X, Chaloupka FJ. The effects of prices on alcohol use and its consequences. Alcohol Res Health. Anderson P. Binge Drinking and Europe. Department of Justice. Economic costs of excessive alcohol consumption in the United States, Am J Prev Med. Centers for Disease Control and Prevention.
Binge drinking among US adults. National Highway Traffic Safety Administration. Green R, Ross A. The state sets the rate: the relationship of college binge drinking to state binge drinking rates and state alcohol control policies. Department of Health and Human Services. The social consequences of binge drinking among to year-olds in six European countries.
Subst Use Misuse. Binge drinking in Spain. Alcohol Clinic Exp Res. International comparisons of alcohol consumption. Fogarty J. The demand for beer, wine and spirits: a survey of the literature. J Econ Surveys. Gallet CA.
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