Part I. Community Guide Update and Rationale for Intervention
| Author & Year | Intervention Setting, Description, and Comparison Group(s) | Study Population Description and Sample Size | Effect Measure (Variables) | Results including Test Statistics and Significance | Follow-up Time |
| Stockwell, et al., 2015 | In British Columbia, Canada, this study shows the correlation between an increase in the density of private alcoholic beverage retail stores and along with increases in the price of alcohol on the amount of alcohol-related traffic incidences, crime against other people, and total crime. The density of stores and price of alcohol were studied separately, so correlations refer to each intervention separately. | The population of interest are the citizens of British Columbia, Canada from 2002 to 2010 from 89 local health areas. | The effect measure variables in this study are alcohol-related traffic incidences, person-on-person violations, and total crime rate. | The minimum alcohol sale price had an increase of 10%. The resulting increase led to a 18.81% (95%CI:+ 17.99, p<0.05) decrease in the amount of alcohol-related traffic incidences. This also led to a 9% (95%CI:+ 5.95%, p<0.01) decrease of person on person violations. Total crime rates also decreased by 9.39% (95%CI:+3.80%, p<0.001)
The study found no statistical significance of an increase in the density of privately owned and operated liquor stores on traffic violations, person to person crime, or total crime. |
Annual data were collected from these 89 areas from 2002 to 2010. |
| Zhao, et al., 2013 | This study also takes place in British Columbia, Canada.
Alcohol-attributable deaths are studied as price, outlet density, and socio-demographic changes occur from 2002 to 2009. |
Populations of 16 Health Service Delivery areas participate in this study.
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The dependent variable is alcohol- attributed deaths.
Independent variables are the price of alcohol and the density of alcohol outlets. |
A 10% increase in the average minimum price of alcohol led to a reduction in alcohol-attributed deaths by 31.72% (95%CI:+ 25.73%, P<0.05)
A 10% increase in the amount of privately own liquor stores had increases in acute 2.45%(95%CI:+ 2.39%, P<0.05), chronic 2.36%(95%CI:+1.57%, P<0.05), and total 1.99%(95%CI:+ 1.76%, P<0.05) alcohol-attributed mortality rates. |
From 2002 to 2009 there were 32 annual quarters at which measures were taken. |
| Treno, et al., 2013 | This British Columbia study looks at alcohol outlet density when there is partial privatization of retail alcohol and that relationship to alcohol price | Local Health Area (LHA) densities of bars, restaurants, government liquor stores, private liquor stores.
2 private liquor stores selected from each of 89 LHAs. Prices requested from 33 brands of alcohol |
Variables include price, density of each type of alcohol outlet, and population density. | Increased privately-owned liquor stores density results in lower alcohol prices. The doubling of private stores in each LHA would cause drop of $0.0049 per mL of ethanol, or a 3.7% reduction in ethanol price (p<0.05).
Increased densities of government-run alcohol retail, bars, and restaurants did not result in alcohol price reduction. |
Surveys on price at private liquor stores conducted from June 2010 to October 2010. |
The strategy strongly recommends against privatization of the alcohol retail industry.
The Community Preventive Services Task Force currently recommends against the privatization of alcohol sales that would allow alcoholic beverages to be sold by retail vendors that are not state-owned (Community Guide). The Task Force has found that, in the states that have privatization of alcohol sales, an increase in the alcohol purchases and consumption has taken place.
The Stockwell article suggests there is an inverse relationship between the price of alcohol and the amount of alcohol-related crime: as prices go up, the crime will go down. Price contributes to the access of alcohol for the population.
The Zhao paper shows that decreases in alcohol price leads to an increase in alcohol-related deaths while an increase in density of privately-owned liquor stores contributes to an increase in mortality rates. This paper shows strong evidence that privately-owned liquor retail stores contribute negatively to the population.
The Treno paper exhibits the relationship of privately-owned liquor stores and how competition can lead to decreases in the price of alcohol. A reduction in alcohol price leads to greater access to alcohol. The two other papers show that a lower price of alcohol correlates to negative impacts on the population.
Alcohol privatization will lead to a decrease in alcohol prices. This will make alcohol more accessible for people and lead to increased drinking rates. Drinking has been correlated to increased crime such as alcohol-related traffic violations (Hahn, et al. 2012). Allowing for greater accessibility to alcohol has repercussions on public health and government spending.
The research shows that privatization of alcohol retail sales contributes negatively in many ways. These negative impacts include increases in access to alcohol, increases in alcohol-related crimes, and increases in alcohol-related deaths (Zhao et al., 2013). For these reasons it is suggested that the recommendation be changed from recommended against to strongly recommended against privatization of retail alcohol sales.
Part II. Theoretical Framework/Model
The theory needs to be at the community level because policy change at the state level is the suggested mode of action. The theory of community organization and other participatory models is appropriate for having alcohol sales regulated by the state of Georgia. This community approach allows for control of excessive drinking and excessive crime. The increased price of alcohol maintained will make alcohol less accessible for many people. This will lead to decreases in alcohol-related traffic violations and crime. This is considered a social action theory because it is both process and task oriented.
Constructs:
Empowerment is a social action process through which people gain mastery over their lives and their communities (Rimer, et al. 2005). Ultimately, people will be in charge of whether or not they decide to spend money on alcohol. This policy should push them toward not spending it on alcohol because the price will be increased. There will also be less stores to purchase alcohol so people will need to understand the lesser convenience.
Attrition, for social action theory purposes, is defined as a reduction in the amount of entities that could negatively impact others. In other words, the goal is to increase the barrier to alcohol. The access to alcohol will be greatly reduced with a state-run monopoly because there will be less access to stores and prices will increase.
Social norms are the rules and behaviors that are considered acceptable by society (Rimer, et al. 2005). The overall goal is more than reducing crime rates attributed to alcohol. Abstaining from excess drinking and alcoholism should become more of a social norm. Many people accept the fact that people will become alcoholics when we should try to deter this behavior in a bigger way.
CONCEPTUAL MODEL
Part III. Logic Model, Causal and Intervention Hypotheses, and Intervention Strategies
The target population will be the citizens of the state of Georgia that are of legal drinking age. Georgia, as well as all other states, have groups that suffer with health disparities. The measure of privatization of alcohol retail stores would most likely have an adverse impact on groups that suffer with low incomes and may have become reliant on alcohol. However, our purposes will look at the Georgia population as a whole. Changes in behavior, such as alcohol-related crimes, are measured to determine the effects of alcohol retail changes. Access to the population has increased with privatization, and behavior changes will occur as a consequence.
| Intervention Method | Alignment with Theory | Intervention Strategy |
| Increase Empowerment / Attrition | The process change of modifying the law to make privatization illegal will effect many people in the state of Georgia. They will need to make personal decisions about whether alcohol should be as integral to their lives after access has decreased. These individual decisions will affect the community with regard to crime and overall health. | The change in the law will increase barriers through reduction of stores and increase in prices. Overall access is decreased with the state-run alcohol retail system.
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| Reduce Alcoholism as a Social Norm | Social norms are acceptable behaviors from the public. Social action theory is a community based theory where social norms are integral. | The change in law will contribute to alcoholism becoming less of a social norm. Access to alcohol will be reduced and the goal is for alcohol to be less a part of people’s lives. If most can reduce their amount of drinking, society as a whole will become less reliant on alcohol. |
| Inputs/Resources | Activities | Outputs | Short-term Outcomes | Intermediate Outcomes | Long-term Outcomes |
| Legislative support to end privatization of retail alcohol system. | Voting in state legislator results in a new system where states now have a monopoly on alcohol retail sales. Privatization will end. | After the elimination of private retail alcohol stores and opening of state-run stores, their will be a 25% decrease in total amount of stores where alcohol can be purchased.
The lack of competition will drive alcohol prices up by 5% as consequence of the new legislation. |
The reduction in total amount of stores combined with the increased price of purchase will decrease access to alcohol and also decrease consumption of alcohol. | Decreased access to alcohol and consumption rate will reduce alcohol-related crime and death. | Overall community health will improve as a result of less access, less consumption, and less crime. |
| Intervention Hypothesis
The passing of this legislation will eliminate any and all privately owned retail alcohol outlets. State-run retail will take over in place of these privately owned stores. With a state-run system, there will be less stores overall. Causal Hypothesis Decreasing the access to alcohol and decreasing the amount consumed in the population will decreased the amount of alcohol-related crimes and deaths. Obviously, less of these incidents will occur when the population consumes less alcohol. SMART Objectives Goal 1: Reduction in the amount of retail stores where alcohol can be purchased. Objective 1: The law will take a year to transition from a private market to a state-run market. After that year is up there will be zero privately-run retail stores. State-run stores will be opened to replace the privately owned stores, but the amount of total stores will be reduced by 25% from the privately-owned system after one year. Goal 2: Increase the price per unit of alcohol sold at state-run retail stores. Objective 1: The abundance of competition that the privately-run market made will no longer exist. All store will be run by the state, so there will be no comparison from store to store with regard to price. Prices will be increased by 5% per unit of alcohol after one year. Part IV. Evaluation Design and Measures
Evaluation Design: Quasi-experimental The study will use two groups in its design. The first group is the privatized retail liquor group before intervention and the last group is the state-run retail liquor system after the intervention has taken place. O2 X O1 X=intervention, O1=assessment before intervention, O2=assessment after intervention The intervention taking place is a state-run retail alcohol system in place of a privatized system. Data will be collected from privately owned stores to determine the price per unit alcohol for the initial assessment. The assessment for the intervention will take place one year after the intervention is put into place. This will account for time for the new law to take place and collection of alcohol-related crime data. Major threats to internal validity: –Interaction Effect: Monopolizing the retail alcohol industry will cause an increase in the cost of alcohol (Treno, et al. 2013). This has the potential to effect the lower class of people who have difficulty affording alcohol. Middle and upper class families may continue to purchase and consume the same amount of alcohol after the intervention because they will still be able to afford it. Criminal activity may only decrease in the lower class. This study will look at demographics to determine whether this is, in fact, the case. -History: Changes in attitude and behavior with regard to alcohol may have changed while the intervention is taking place. Many have turned to a healthier lifestyle and now purchase and consume less alcohol than before. Therefore, less alcohol-related crimes will occur without the intervention. The study will attenuate for that by examining the overall health of the community before and after the intervention by looking at lifestyle changes. -Attrition Bias: This refers to differences between the privatized alcohol stores and the state-run stores, in that the privatized group will not be available for comparison because they will no longer be present after the intervention. The state-run stores can only be compared to the privatized stores that were present before the intervention takes place.
Part V. Process Evaluation and Data Collection Forms
Privately-owned liquor stores will receive a letter before the intervention requesting that they provide information about price per unit alcohol and amount purchased. The state-owned liquor store will be given a similar letter one year after the intervention has taken place: Price per Unit of Alcohol and Number of Units Purchased Dear _____________, The College of Public Health at UGA is conducting a study on the price of alcohol per unit alcohol and the amount of units sold. This research is being conducted to compare the prices of the private alcohol industry with the state-run system. Privately-owned stores are asked to take part in this survey before new legislation takes effect and the system becomes state-owned. State-owned store will be asked to take this survey one year after the law has changed. If you are willing to participate in this survey, please respond via email to bbm56232@uga.edu. Please indicate if you will be participating as a privately owned store or a new state-owned store. Sincerely, Brooks Moeller UGA College of Public Health
2. Attrition Privately owned stores will not be asked for a follow-up because they will no longer exist after the intervention. A letter will be written to state lawmakers asking for mandatory participation in an annual survey: Dear ___________, The UGA College of Public Health is doing extensive research in the state-owned alcohol retail system to determine the health effects of the newly run system compared to the former privately-owned system. Participation from each store is vital to our research, and we would like to ask you to require these stores to put effort in our surveys. Please email me at bbm56232@uga.edu with any questions regarding our research. Thanks. Sincerely, Brooks Moeller UGA College of Public Health
To ensure fidelity of the program, each store will be given the following survey:
References Centers for Disease Control and Prevention (CDC). About the Behavioral Risk Factor Surveillance System (BRFSS) (2014). http://www.cdc.gov/brfss/about/about_brfss.htm. Accessed June 7th, 2016. Community Guide. Preventing Excessive Alcohol Consumption: Privatization of Retail Alcohol Sales. http://www.thecommunityguide.org/alcohol/privatization.html. Access May 17th, 2016. Hahn, R., Middleton, J., Elder, R., Brewer, R., Fielding, J., Naimi, T., Toomey, T., Chattopadhyay, S., Lawrence, B., Campbell, C. Effects of Alcohol Retail Privatization on Excessive Alcohol Consumption and Related Harms. (2012). American Journal of Preventive Medicine. 418-427. Rimer, B., Glanz, K. Theory at a Glance: A Guide for Health Promotion Practice (2005). National Institute of Health. 2nd Edition. 1-52. Stockwell, T., Zhao, J., Marvell, M., Greenwald, P., MacDonald, S., Panicky, W., Martin, G. (2015). Relationship Between Minimum Alcohol Pricing and Crime During the Partial Privatization of a Canadian Government Alcohol Monopoly. Journal of Studies on Alcohol and Drugs. 628-634. Treno, A., Panicky W., MacDonald S., Greenwald, P., Zhao, J., Martin, G., Greer, A. (2013). Alcohol Outlet Densities and Alcohol Price: The British Columbia Experiment in the Partial Privatization of Alcohol Sales Off-Premise. Alcoholism: Clinical and Experimental Research, 37(5). 854-859. Zhao. J., Stockwell, T., Martin, G., Vallance, K., Trejo, A., Panicky, W., Tu, A., Buxton, J. (2013). The Relationship Between Minimum Alcohol Prices, Outlet Densities and Alcohol-Attributable Deaths in British Columbia, 2002-2009. Society for the Study of Addiction. 1059-1069.
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