Gregory Bloss, Division of Epidemiology and Prevention Research
Participating IC: NIDA, NCI

Purpose

The purpose of this announcement is to replace a series of recently expired NIAAA-issued Program Announcements (PA-17-132, PA-17-134, PA-17-135) to communicate support for research topics of interest to the Division of Epidemiology and Prevention Research at the National Institute on Alcohol Abuse and Alcoholism and other participating ICs. This announcement will be published as a Notice of Special Interest (NOSI) that will be linked to applicable parent grant notice of funding opportunities (NOFO).

This announcement encourages applications to conduct research on the effects of public policies on health-related behaviors and outcomes associated with alcohol, cannabis, tobacco, prescription drugs, and other substances. The purpose of the Notice is to advance understanding of how public policy may serve as a tool for improving public health and welfare through its effects on behaviors and outcomes pertaining to alcohol and other drugs. This Notice is intended to support innovative research to examine policy effects that have the potential to lead to meaningful changes in public health. Research projects that may be supported include, but are not necessarily limited to: causal analyses of the effects of one or multiple public policies; evaluations of the effectiveness of specific public policies as tools for improving public health through their effects on alcohol-, cannabis-, tobacco-, and other substance-related behaviors and outcomes; and research to advance methods and measurement used in studying relationships between public policies and alcohol-, cannabis-, tobacco-, and other substance-related behaviors and outcomes.

Background

Consumption of alcohol, cannabis, tobacco, and other drugs has important and diverse effects on a wide range of health, social, and economic behaviors and outcomes. In the United States, public policies at all levels of government address a wide range of behaviors associated with alcohol, cannabis, tobacco, illicit drugs, and prescription medications. Findings from policy studies to date suggest that policy tools have the potential to generate improvements in public health on a scale unmatched by other approaches to alleviating the adverse consequences of alcohol, tobacco and other substance use. Additional research is needed to identify and quantify the effects and effectiveness of public policies on public health and specific health-related behaviors and health outcomes for individuals, underrepresented populations and other relevant subgroups, and the general population.

Public policies have broad consequences for behaviors and health outcomes, but these effects typically occur over time and in the context of other economic, social, and cultural changes. Discerning the causal influence of any specific policy or group of policies on specific health outcomes of interest in the presence of numerous confounding factors is one of the main challenges of policy research, in part because randomized controlled experiments are infeasible for most policy interventions. Strong research designs and valid measurement of both the behaviors and health outcomes of interest and the policy interventions that may affect them, as well as relevant mediating and moderating factors, are needed to support meaningful conclusions regarding causal relationships.

Policy effects often vary across population groups defined by race, ethnicity, sex, age, socioeconomic status, or other relevant characteristics. They may also vary in geographic or temporal dimensions. Understanding the nature and determinants of disparities and other aspects of heterogeneity in policy effects is an important area for study.

Policies may generate unintended effects that reinforce, dilute, or are unrelated to the intended effects. Behaviors and outcomes associated with alcohol, cannabis, tobacco, and other substances may also be influenced by policies whose primary intended effects are in other areas. Examples include traffic safety laws, child labor laws, child welfare policies, housing and education programs, import/export regulations, taxation policies, and zoning regulations. Identifying unintended policy effects on substance-related behaviors and outcomes can inform decision-making about those policies and about related needs for enforcement and for prevention and treatment services.

Differences in how policies are implemented can influence the extent to which they achieve desired (or undesired) effects. Key aspects of implementation include the dissemination of public information pertaining to policy changes, the extent of enforcement efforts and publicity about enforcement, and the nature and severity of penalties associated with violations. Implementation and enforcement efforts can also generate unintended effects that differ from those associated with the policy itself. Studies that incorporate measures of enforcement or other aspects of implementation often confront significant challenges in terms of measurement and data availability.

A variety of research designs may be appropriate in assessing the effects of public policies on health-related behaviors and outcomes. Well-designed approaches will be based on strong theoretical foundations and employ appropriate strategies to discern the causal influences of the policy or policies in question from effects that may be attributable to other, possibly unobserved factors. Natural experiments and quasi-experimental designs are valuable approaches for understanding policy effects. Systems science methodologies such as agent-based, microsimulation, network, or system dynamics modeling can complement more traditional analytic approaches to examine simultaneous impacts on multiple outcomes and complexities such as heterogeneous effects, bidirectional relationships (feedback loops), dynamic behavior, non-linear effects, and time-delayed effects.

The reliability and validity of policy data used in studies of policy effects or effectiveness is integral to the overall quality of the research. Researchers should be alert to policy provisions beyond the simple presence or absence of a policy addressing a particular issue. Similarly, policy research should incorporate the dates on which policies became or ceased to be effective. Sources of reliable policy information on aspects of alcohol and drug policy include the Alcohol Policy Information System (APIS; http://alcoholpolicy.niaaa.nih.gov) and the Prescription Drug Abuse Policy System (PDAPS; http://pdaps.org). Other sources of policy information on a range of topics are also available, including from a wide range of government, commercial, and advocacy organizations; the quality of such data should always be scrutinized.

Scope/Research Objectives

Studies that would be responsive to the future Notice include but are not limited to:

• Evaluations of innovative policies that address individual, organizational, or commercial behaviors and outcomes pertaining to alcohol, cannabis, tobacco, and other drugs.
• Analyses of policy effects on behavior and outcomes over the life span using individual-level longitudinal data.
• Advances in methodological tools and approaches for assessing the causal influences of alcohol, cannabis, tobacco, or drug-related policies.
• Systems-based studies of the simultaneous influences of alcohol, cannabis, and tobacco policies on multiple health, behavioral, economic, and social outcomes.
• Effects of changes in the legal status of cannabis on health-related behaviors and outcomes, such as traffic and other injuries in which alcohol, cannabis, other drugs, or combinations of these substances are involved; health care utilization, practice, or health policy; and broader measures of the economic impact on society of alcohol-, cannabis-, and other substance-related behaviors and outcomes.
• Effects of changes in alcohol availability associated with the COVID-19 pandemic on health behaviors and outcomes, including variation in such effects over time and across individual and community characteristics and population groups.
• Effects of policies affecting access to prescription opiates on opiate use, health services utilization, and behaviors and outcomes associated with illicit opiates, alcohol, and other substances.
• Effects of variations in the legal provisions applicable to legalized cannabis, such as days and hours of legal sale, taxation, outlet locations and density, restrictions on who can sell, minimum age for purchase, and restrictions on advertising and marketing, on health-related behaviors and outcomes.
• Effectiveness of warning labels on alcohol, cannabis, and tobacco products and prescription drugs in reducing risks and adverse outcomes.

Justification/Outcome

• Improved understanding of the effects of existing policies on health behaviors, health outcomes, and overall public health.
• Clarification of how policy effects and effectiveness may differ by age, gender, race, and ethnicity.
• Better understanding of the opportunities for innovative policies to improve health outcomes.
• Advances in understanding of the interrelationships among policies addressing different substances and health behaviors and outcomes.
• Advances in methodological tools and approaches for assessing the causal influences of alcohol- or drug related policies.