Preventing Alcohol-Related Problems through Health Policy Research
Voas, Robert B., Fell, James C., Alcohol Research
The founding in 1970 of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) coincided with a large increase in Federal research funds for studies of alcohol policies related to highway deaths and injuries, as well as injuries flowing from alcohol-related crime and health problems resulting from heavy alcohol consumption. Alcohol-related highway fatalities were at an all-time high in 1970, and there were an estimated 100,000 alcohol-attributable deaths in the United States (Modad et al. 2004; NIAAA 1997). In the 40 years since the founding of NIAAA, those losses have been substantially reduced through the implementation of laws and public health policies growing out of research that has been summarized in Alcohol Research & Health (AR&H). By 2001, alcohol-attributable deaths declined to 75,766 (Centers for Disease Control and Prevention [CDC] 2004).
Health policy research lies at the nexus of the science-to-practice continuum. At the point where science is incorporated into policy or law, theory is tested by reality and programs growing out of research are challenged by the need to respond to specific events embodying previously unmeasured conditions. Moreover, novel and untested concepts bubble up from practitioners, legislators, and advocates vying for attention in forming health and safety programs. Policies develop where there is a need for action not currently identified in any law. Programs may build on those policies, providing an opportunity for researchers to evaluate the concepts embodied in the policies that, given convincing positive results, will lead to the institutionalization of the policy in law.
For example, research and practice became intertwined in the movement leading up to the passage of the Federal minimum drinking-age law. A number of States followed the lowering of the voting age from 21 to 18 during the 1970s by lowering their drinking age to 18 (U.S. General Accounting Office 1987). When research demonstrated that lowering the drinking age increased impaired-driving crashes of the affected age-groups, the trend was reversed and States began to raise their minimum drinking age. When the benefits of this action were confirmed by researchers (Wagenaar 1983; Womble 1989), the Federal Government passed legislation providing a strong incentive for all States to raise the minimum drinking age to 21 (23USC158 1984). Thus, the policy and research groups both reacted to information provided by the other group, building toward a final status that was embodied into Federal law.
Between 1970 and 2010, there was a substantial expansion in the number of laws introduced in State legislatures directed at reducing problems related to the misuse of alcohol, particularly bills related to impaired driving (Dang 2008, p. 9). Impaired driving received special consideration because of the major role that alcohol plays in fatal crashes and because that relationship makes impaired driving and crash records a useful outcome measure for studies of other alcohol policies. The growth in computer technology and evolving analytical methods over the last 40 years has permitted more sophisticated analyses of laws and programs (Fell et al. 2009; Wagenaar et al. 2009).
Although scientific data frequently has less influence than anecdotes and opinions from the voting public, the traffic safety effort benefited from the foundation and growth of community activist groups led by the Mothers Against Drunk Driving (MADD) organization. Initially focused on punishing the impaired driver, MADD developed a sophisticated public policy approach dedicated to supporting only evidence-based programs (Fell and Voas 2006). Thus, in addition to presenting statements from victims, MADD held seminars for legislators and other officials involving presentations from researchers, a practice more recently sponsored by the National Highway Traffic Safety Administration (NHTSA). As a consequence, in many States, decision makers have been giving increased attention to research reports. …