Toben F. Nelson

Alcohol consumption imposes a substantial public health burden in the United States, yet public and political support for alcohol control policies remains limited despite a strong evidence base. This stems partly from methodological challenges, including difficulties measuring policy implementation and enforcement, accounting for local variation, and assessing long‐term effects, and partly from gaps in translating findings into actionable insights for policymakers and the public. In this narrative review, we highlight three methodological approaches that can strengthen policy‐relevant alcohol research: system dynamics modeling, spatial analysis, and artificial intelligence (AI) tools for policy surveillance. Each is illustrated through a policy example (minimum unit pricing, regulating alcohol outlet density, and limiting hours of sale) to demonstrate how these methods can generate actionable insights for policymakers and the public. We conclude with recommendations for conducting policy‐relevant, methodologically rigorous research: codeveloping research questions with stakeholders, grounding research in specific theories of change, accounting for policy restrictiveness and enforcement, aligning methods with research questions, and planning for dissemination from the outset. Together, these strategies can help bridge the gap between evidence and action, ultimately strengthening support for effective alcohol control policies.

Background: Housing mobility impacts adolescent alcohol use, and the neighborhood built environment may impact this relationship. Methods: Moving to Opportunity (MTO) was a multi-site, three-arm, household-level experiment. MTO randomly assigned one of three treatment arms (1994–1997) allowing families living in public housing to (1) receive a voucher to be redeemed any neighborhood (2) receive a voucher to be redeemed in a neighborhood with less than 10% poverty (3) remain in public housing (control). MTO decreased girls’ alcohol use, but increased boys’ alcohol use. Treatment groups were pooled because they are similar conceptually and statistically on our primary outcome. Among youth aged 12–19 in 2001–2002 (N = 2829), we estimated controlled direct effects mediation of MTO treatment effects on youth with housing vouchers (N = 1950) vs. controls (N = 879) on past 30-day number of drinks per day on days drank, using gender-stratified Poisson regression. Mediators were density of on- and off-premises alcohol outlets per square mile at the families’ census tract of residence in 1997. Results: Treatment group youth were randomized to live in 1997 census tracts with lower off-premises, but higher on-premises, outlet density. MTO treatment (vs. controls) decreased drinking for girls via alcohol outlet density, but only at higher levels of outlet density. Treatment was 18% more beneficial when girls moved to high density neighborhoods, compared to controls who stayed living in public housing in high density neighborhoods. Conclusion: Additional social processes unmeasured in the current study may play an important role in the alcohol use and other health risks for girls.

Overservice of alcohol, defined as commercial provision of alcohol to an individual who is obviously intoxicated, is illegal in most states and contributes to motor vehicle crashes and violence. Law enforcement agencies use various strategies that aim to reduce overservice at licensed alcohol establishments (e.g., bars, restaurants). Place of Last Drink (POLD) data collection is an emerging overservice enforcement strategy. POLD identifies patterns of overservice, which can provide support for targeted interventions to prevent overservice at offending establishments. We describe the prevalence of POLD and other overservice enforcement strategies and associations with agency characteristics, which has important implications for public health and safety. We conducted a national survey of 1024 municipal (e.g., town, city) and county law enforcement agencies in 2019 (response rate = 73%). We assessed the use of overservice enforcement strategies conducted by the agencies over the past year. We examined associations of each type of overservice enforcement strategy with agency and jurisdiction characteristics using regression models. 27% of responding agencies reported conducting overservice enforcement and 7% conducted POLD data collection specifically. Municipal (vs. county) agencies and agencies with an officer assigned primarily to alcohol enforcement activities were significantly more likely to conduct overservice enforcement generally but not POLD data collection specifically. Overservice enforcement in general, and POLD data collection specifically, are not widely conducted. Prevention of overservice has the potential to reduce harms related to excessive alcohol consumption. Increased evaluation of overservice enforcement strategies should be prioritized.

4. Sport And The Childhood Obesity Epidemic was published in Child's Play on page 82.

Background: This study tested for differences in personal, social, and environmental correlates of moderate to vigorous physical activity (MVPA) across ethnicity/race in male and female adolescents. Methods: Self-reported MVPA and 47 potential correlates of MVPA were measured in an ethnically/racially diverse cross-sectional sample of adolescents, in Minnesota, who participated in EAT-2010 (Eating and Activity in Teens). Interactions of potential correlates with ethnicity/race on MVPA were tested in linear hierarchical regression models in boys and girls. Results: Boys reported 1.7 more weekly hours of MVPA than girls. White adolescents reported 1.1 to 2.1 more weekly hours of MVPA than nonwhite adolescents. Among girls, neighborhood road connectivity was negatively correlated with MVPA among Hispanic and Asian participants. Among boys, sports participation was positively correlated with MVPA among all ethnicities/races, except Asians. Home media equipment was positively correlated with MVPA among Hispanic boys, but negatively correlated among white boys. Conclusions: A few correlates of physical activity among adolescents differed intersectionally by ethnicity/race and sex. Sports participation and home media equipment may have differing impacts on physical activity across ethnicities and races in boys, whereas neighborhood features like road connectivity may have differing impacts on physical activity across ethnicities and races in girls.

Background: Policy restrictions on malt liquor sales have been adopted in several cities throughout the United States in an effort to reduce crime around off-premise alcohol outlets. Although California has implemented the most restrictions on malt liquor sales, no studies in the published literature have evaluated the effects of these policies on reducing crime. Objectives: We evaluated the effectiveness of malt liquor restrictions on reducing crime around off-premise alcohol outlets in six California cities. We hypothesized that adoption of malt liquor policies would be significantly associated with decreases in crime within areas surrounding targeted outlets. Methods: We used an interrupted time-series design with control areas to examine the relationship between malt liquor policies and crime reduction. We compared crime rates three years prior and following adoption of malt liquor policies. Results: Malt liquor policies were associated with modest decreases in crime, largely Part II or less serious crimes such as simple assaults. The effectiveness of malt liquor policies varied by city, with reductions in crime greatest in Sacramento where policies were more restrictive than in other cities. Malt liquor policies were also associated with small increases in nuisance crime, especially in San Francisco. Conclusion: Results suggest that malt liquor policies may have modest effects on reducing crime when they include strong restrictions on the sale of malt liquor products. Results may be informative to other cities considering whether to maintain or change their malt liquor policies as well as cities considering placing restrictions on other high content beverages.

Purpose The goal of this study was to assess whether different types of communities (ie, urban, suburban, small town, and rural) vary in the alcohol enforcement activities they conduct. Methods We conducted a cross‐sectional study using data from a national survey of local law enforcement agencies. Data The survey assessed enforcement of a range of alcohol policies at 1,082 law enforcement agencies. U.S. Census data were used to categorize agencies based on community type. Results Agencies in urban areas conducted more enforcement activities than agencies in other community types. Urban agencies were more likely than rural agencies to conduct underage compliance checks (prevalence ratio [PR]: 0.42; CI: 0.34‐0.53), saturation patrols (PR: 0.80; CI: 0.67‐0.95), sobriety checkpoints (PR: 0.68; CI: 0.53‐0.86), and enforcement aimed at illegal sales to intoxicated patrons (PR: 0.59; CI: 0.42‐0.81). Urban agencies were also more likely than small town agencies to do compliance checks (PR: 0.66; CI: 0.56‐0.79) and sobriety checkpoints (PR: 0.75; CI: 0.61‐0.91), and they were more likely than suburban agencies to do compliance checks (PR: 0.67; CI: 0.57‐0.78) and enforcement actions around the sale of alcohol to intoxicated patrons (PR: 0.64; CI: 0.45‐0.90), provision of alcohol to minors (PR: 0.77; CI: 0.65‐0.92), and consumption by minors (PR: 0.90; CI: 0.82‐0.99). Conclusions Enforcement of alcohol laws differs by community type. Future research is needed to identify mechanisms to increase enforcement by agencies in different types of communities.

Medical amnesty policies aim to encourage individuals to help their peers who have been drinking too much by providing immunity for alcohol policy violations. We examined college students’ decisions to intervene or not intervene when someone was drinking too much and reasons for not intervening. We conducted secondary analyses using data from college students ages 18–25 who participated in the Healthy Minds Study, a national survey of mental health and substance use (N = 30,785; 65% female). We examined the prevalence of reasons for not intervening and estimated a multilevel multinomial logistic regression to answer our research questions. Nearly half (46.5%) of students reported being in at least one situation in the past year when someone was drinking too much. Among these students, 46.7% consistently intervened, 27.7% inconsistently intervened, and 25.6% did not intervene in these situations. The most common reasons for not intervening were: “I felt it was none of my business” and “I didn’t know what to do.” “I was afraid I’d get in trouble” was the least common reason for not intervening. Intervening differed by student characteristics, including age, gender, race/ethnicity, residence, international student status, and binge drinking. Fear of getting in trouble, the basis for amnesty policies, was not a major barrier preventing intervention behavior in our study. Our findings suggest that implementing amnesty policies may not lead to intervention behavior. Strategies that empower and compel students to help their peers and provide them with skills needed to help may lead to more intervention behavior.

Introduction: Common life events, such as getting married or gaining employment, may be opportunities to intervene on health behaviors like physical activity. The purpose of this study was to determine the changes in moderate-to-vigorous physical activity (MVPA) associated with several common life events from adolescence to young adulthood. Methods: Participants in Project EAT (ages 11 to 18 yr at baseline and 25 to 36 yr at wave 4) were surveyed at four timepoints from 1998 to 2016. Questions included marital status, employment status, postsecondary education completion and enrollment, and living situation between each wave. Linear regression was used to model the effect of each life event on change in self-reported MVPA. Post hoc mediation analysis was conducted to examine whether having a child mediated the effect of getting married on the change in MVPA. Results: Average MVPA declined from 6.5 h·wk ⁻¹ at baseline to 4.3 h·wk ⁻¹ at wave 4. Having a child was associated with a significant decrease in MVPA between waves 2 and 3 and between waves 3 and 4. Getting married and leaving parents’ home were associated with significant decreases in MVPA between waves 3 and 4. Having a child both mediated and moderated the effect of getting married on MVPA. Conclusions: This study provides evidence that MVPA declines both after getting married and after having a child and that these effects are not independent. Interventions to maintain or increase MVPA could profitably target couples planning to get married or have a child.

Objectives: The fit of measured variables into a social-ecological model of correlates of physical activity is rarely tested. In this study, we examined the factor structure of correlates of moderate/vigorous physical activity (MVPA) within a hypothesized social-ecological model. Methods: We measured 46 possible personal, social and environmental correlates of MVPA in 2779 adolescents participating in the Project EAT-2010 study. Confirmatory (CFA) and exploratory factor analyses (EFA) were used to determine the factor structure. Associations of factor scores with self-reported MVPA were calculated with linear regression. Results: A 6-factor CFA model did not show adequate fit. Eight factors were identified using EFA (Root Mean Square Error [RMSEA] 90% CI: 0.053 to 0.055; CFI = 0.82). A factor representing the mix of personal and social correlates showed the strongest association with MVPA. Conclusions: The 8-factor model supports independent clustering of possible environmental correlates of MVPA, but indicates that social and personal correlates may not cluster independently. The factor most strongly correlated with MVPA represented a mix of personal and social correlates. Future work will be needed to better understand how mechanisms for developing physical activity work within and across levels of the social-ecological framework.