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Banning Alcohol
Examination of policy interventions to limit community access to alcohol in extremely isolated locations.
Banning Alcohol is a policy intervention to limit access to alcohol, which was adopted by geographically isolated communities in Alaska. Four studies explored the effects of alcohol policy using existing health data: (1) Chui et al. evaluated enactment of an alcohol ban in 1976, repeal of this policy in 1995, followed by reinstatement in 1996. (2) Landen et al. used death certificate data and medical examiner records to compare alcohol-related injury and mortality rates among wet and dry Alaska villages from 1990 to 1993. (3) Berman et al. utilized Alaska Bureau of Vital Statistics (ABVS) demographic and injury death data from 1980 to 1993, pooled into wet, damp, and dry Alaska villages to compare injury death rates. (4) Serious injury data from Alaska Trauma Registry and ABVS records were analyzed with wet/dry village classifications and police deployment records.
Outcomes
Alcohol bans in isolated Alaska Native villages were associated with decreased alcohol-related outpatient visits, injuries, and deaths.
Chiu et al. reported a significantly higher number of alcohol-related outpatient visits during the non-ban periods relative to the ban periods. Landen et al. reported that the risk of alcohol-related injury death among Alaska Natives was 2.7 times greater in wet than in dry villages, including higher risk ratios for motor vehicle deaths, hypothermia, and homicides. Among decedents from wet villages where blood alcohol concentration (BAC) data were available, the percentage of alcohol-related injury deaths was significantly higher than in dry villages (76% vs. 57%). Injury deaths, especially homicide, were lower in areas with more restrictive alcohol control (Berman, 2000). Wood and Gruenewald (2006) found alcohol prohibition was associated with lower rates of serious injury from assault, motor vehicle collisions, and “other” causes.
Costs
Start-up and ongoing costs would be low.
Start-up: enacting policy change and providing outreach information. Ongoing: maintaining infrastructure around upholding bans (e.g., policing).
Cultural Engagment
No cultural engagement required.
There were no reports of cultural elements as part of the intervention. Some contact or consultation with village or Tribal leaders would be required for the bans on Tribal communities to be enacted and rescinded but were not discussed.
Participants
Adolescent, Young Adult, Adult, Senior; Native, Non-Native; Female, Male
Setting
Community Wide, Rural
Delivery
Large Group
Community-wide implementation among remote, isolated, rural communities.
Alcohol bans were put into effect for entire communities, many predominantly Native Alaskan, in remote areas of Alaska (i.e., areas not readily accessible by state roads).
Staffing Needs
N/A
No specific staffing required.
Intervention does not require staffing beyond resources to enact and uphold bans on alcohol possession and importation (e.g., policing).
Research Design
No pre-intervention data, Pre-/post-intervention data
Developmental stage of research
Early stage due to lack of rigorous design, limited long term follow-up, and potential for confounding.
Findings suggest that a ban on possession and importation of alcohol, thereby significantly reducing community-level access to alcohol, may be highly effective in reducing alcohol-related hospitalizations and death in the context of very remote, isolated communities. Studies are limited in ability to provide strong conclusions due to lack of rigorous design, limited long term follow-up, and potential for other naturally occurring confounds.
Potential
While these policy interventions appear highly effective, it is unlikely that they would be transportable to other Native communities.
While these policy interventions appear to have been highly effective in these selected situations, it is unlikely that this type of policy would be transportable to other Native communities given the uniqueness of these settings. Specifically, they were highly isolated, geographically remote locations where the sale and import of alcohol could be effectively controlled AND where residents could not easily travel outside the community to access alcohol. It is noted that when these types of policies have been enacted in other areas outside of Alaska, increases in mortality have been observed because of injuries thought to have occurred in transit to other locations where alcohol is available.
References
Chiu AY, Perez PE, Parker RN. Impact of banning alcohol on outpatient visits in Barrow, Alaska. JAMA. 1997;278(21):1775-1777. https://jamanetwork.com/journals/jama/fullarticle/419087. https://doi.org/10.1001/jama.278.21.1775.
Landen MG, Beller M, Funk E, Propst M, Middaugh J, Moolenaar RL. Alcohol-related injury death and alcohol availability in remote Alaska. JAMA. 1997;278(21):1755-1758. https://jamanetwork.com/journals/jama/fullarticle/419082. https://doi.org/10.1001/jama.1997.03550210053038.
Berman M, Hull T, May P. Alcohol control and injury death in Alaska Native communities: Wet, damp and dry under Alaska's local option law. J Stud Alcohol. 2000;61(2):311-319. https://pubmed.ncbi.nlm.nih.gov/10757142. https://doi.org/10.15288/jsa.2000.61.311.
Wood DS, Gruenewald PJ. Local alcohol prohibition, police presence and serious injury in isolated Alaska Native villages. Addiction. 2006;101(3):393-403. https://pubmed.ncbi.nlm.nih.gov/16499512. https://doi.org/10.1111/j.1360-0443.2006.01347.x.
Gordis E. Alcohol problems and public health policy. JAMA. 1997;278(21):1781-1782. https://jamanetwork.com/journals/jama/fullarticle/419091. https://doi.org/10.1001/jama.1997.03550210079045.
Muhunthan J, Angell B, Hackett ML, et al. Global systematic review of Indigenous community-led legal interventions to control alcohol. BMJ Open. 2017;7(3):e013932. https://pubmed.ncbi.nlm.nih.gov/28348189. https://doi.org/10.1136/bmjopen-2016-013932.
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