The alcohol beverage industry doesn't only face federal and state tax threats next year (see last issue). "Local jurisdictions are increasingly petitioning state legislatures for the right to broaden" their abilities to raise revenues, specifically through alcohol excise taxes, Mark Gorman, senior VP of government relations for the Distilled Spirits Council of the US (DISCUS) told INSIGHTS. Local communities in 7 states already have the power to raise alcohol beverage taxes and more are seeking that power, i.e. in California and Massachusetts. Recall that last year Allegheny County in western Pennsylvania adopted a 10% on-premise alcohol tax. The hospitality industry there "set a terrific example," in "rising up" to beat back the tax, said Gorman, and recently succeeded in convincing the County Council to reduce the tax to 7%. Even so, a few other counties in Pennsylvania are seeking similar hikes, including the Harrisburg and State College areas. On the state level, Gorman points out that most bills won't be introduced until early 2009, but with states facing "huge deficit issues" (states collectively face about a $100 billion in deficits, DISCUS calculates), he anticipates "many battles" next year. Over the last 8-9 years the industry has annually faced 25-35 serious tax threats. In 2009, "I'm looking at the upper end of that number."

Most observers acknowledge there's been nothing specific from the incoming administration to suggest an effort to raise federal excise taxes on alcohol beverages. But Gorman agrees with some of the other government relations folks we've spoken to that incoming President Obama's ambitious agenda for health care, infrastructure and other items may require some changes, including tax increases. At the same time, the incoming administration is also "realistic" enough to put tax increases "on the back burner" in such difficult economic times, Gorman believes. DISCUS is hoping the Obama administration will "stick to its commitment not to raise taxes" on households making over $250,000/year. In any case, these are not new battles for DISCUS or any of the other associations INSIGHTS has spoken to. Excise taxes tend to be one of the few areas that clearly unifies the industry's tiers and beverage types.

In this week's tax developments, the California legislature rejected a proposal from Democratic lawmakers that included the governor's a nickel-a-drink tax hike. (That proposal was apparently off the table, then on the table in the Democrats' bill.) Across the US in NY, Governor David Paterson proposed doubling the beer and wine excise taxes to close that state's budget gap. Spirits taxes were left untouched in the proposal. The Governor also proposed allowing wine sales in grocery stores to boost state revenues.

Federal surveys of 12-20 year olds in 2006 and 2007 raise interesting questions about the most effective and appropriate ways to prevent underage drinking. These surveys showed that less than 1/3 of "current" underage drinkers (at least one drink in the month prior to the survey) paid for their last drink. Perhaps predictably, females (23.6%) were significantly less likely than males (36.8%) to be buyers. Similarly, the younger the drinker, the less likely he or she was to purchase the alcohol. Less than 10% of 12-14 yr olds said they paid for their last drink. (Where are 12-14 yr-olds buying drinks?) These figures are significantly higher than those from a separate federal survey which found that only 5% of high school drinkers "usually" obtained their alcohol from buying it in a store -- the questions are actually quite different. But the policy implication is similar. Efforts to stop underage drinking that focus solely on minor purchases, store stings, fake I.D. and the like are missing over 2/3 of the problem. Meanwhile, efforts focused on those who provide alcohol to minors, be they parents or other adults, are much more on the mark.

But another finding from the same survey suggests a different policy implication. While legal premises were not the main source of alcohol for illegal drinkers, they appear to be a significantly more "dangerous" source than the others. Why's that? Perhaps counter-intuitively, adolescents who bought their drinks drank more heavily than those who got them for free. Those who bought their alcohol consumed 6 drinks on the "last occasion" prior to the survey. Those who drank free consumed of 3.9 drinks. Those figures were fairly consistent across the age groups, especially so for those from age 15 to 20. That finding suggests targeting illegal sales also targets the heaviest drinkers.

But here's yet another twist. Those who obtained alcohol from their parents (or took it from their home without asking) drank the least, about half as much as those who purchased alcohol. Again, that was true across the age groups and probably predictable, given that most parents aren't likely to provide their kids with 6 drinks per occasion. But that's the point, and perhaps the policy implication. Parents who do provide alcohol to their children may be providing safer environments than those who do not. Ref 3

Predictably, MillerCoors came to same decision as AB did back in June. Under investigation and sharp criticism and facing a lawsuit from a group of 13 state attorneys general, MillerCoors reached an agreement to reformulate its alcohol energy drinks Sparks to remove the caffeine, taurine, guarana and ginseng. The brewer will also alter its advertising and website content and "make a $550,000 payment to be distributed among the participating states to pay for the cost of the investigation." AB had paid $200,000, but Sparks sold substantially more volume than AB's caffeinated products. In 2007, Sparks sold approximately 400,000 bbls and was growing at a double-digit rate in 2008. MillerCoors president Tom Long pointed out that the agreement with the AGs contained "no finding that MillerCoors engaged in unlawful behavior or marketed its Sparks brand to people below the legal drinking age," and pointed out that the brewery continued to "strongly disagree with their inaccurate allegations" that the brands had been irresponsibly marketed.

The agreement itself may not have concluded MillerCoors marketed irresponsibly, and the AGs commended MillerCoors for taking this step. But the AGs also continued to sound off on the products and the marketing in their post-deal comments. "These amped-up alcopops that look like non-alcohol energy drinks are popular with young people who wrongly believe that the caffeine will offset the intoxicating effects of alcohol," said MD AG Douglas Gansler. "The beliefs are fueled by unconscionable aggressive marketing campaigns that target our youth and promise endless nights of fun and enhanced abilities." CT AG Richard Blumenthal thundered: "Sparks is an insidious and insane drink that deservedly is now down the drain -- like all stimulant-spiked alcoholic drinks should be." The AGs calculate that between Sparks and the AB brands "nearly 85% of all alcoholic energy drinks that were available at the start of the year will be eliminated from the market." They vow to continue investigations of alcoholic energy drinks and regulatory, legislative and legal options to address them. It's not clear how or if the AGs will address the very popular Red Bull and other (non-alcoholic) energy drink and liquor combinations.

There's lots of good news about teen drinking rates in the 2008 Monitoring the Future survey results. Key measures of 30-day use, heavy drinking and drunkenness fell to all-time lows among 8th graders, 10th graders and 12th graders. Other drinking and attitudinal measures also suggest continued progress in reducing both drinking rates and tolerance of the habit among teens themselves.

Some of the numbers are quite dramatic, especially longer-term trends. Among high school seniors, the percentage that had a drink in the month prior to the survey dropped to 43.1% in 2008. That was a decrease of nearly 10 points over the last decade, 4 points over the last 5 years and down from a peak of 72% in 1978. Over the last 30 years, the drinking rate among high school seniors fell by more than 40%. Interestingly, cigarette smoking and illegal drug use rates are also down 40%+ among high school seniors over the last 30 years. How many public health "problems" can boast that sort of progress? If teen drinking, smoking and drugging are to be considered "epidemics" now, what were they then?

The MTF data shows steady recent declines across the three grades in 30-day use, being drunk and so-called "binge" drinking: having 5+ drinks at least once during the 2-week period prior to the survey. Each of these drinking and heavy drinking measures in 2008 fell to their lowest levels since the MTF surveys were launched in 1975 for 12th graders, 1991 for the younger grades. While about 1/3 of high school seniors reported binge drinking and drunkenness 10 years ago, those figures are closer to 25% now. Heavy drinking among the 8th graders also declined sharply since 1998.

At the same time, disapproval of binge drinking is also at an all-time high among high school seniors. Thirty years ago, about 56% of high school seniors disapproved of weekend binge drinking; now, nearly 70% disapprove. That trend went in the wrong direction among younger students in 2008, however, one of the few potential causes of concern in the data. Among 8th graders, for example, a smaller percentage "disapproved" of both trying 1-2 drinks and having 5+ drinks once or twice over the weekend in 2008 compared to 2007. And the disapproval rate isn't much different among these younger students than it was in the early 90s, albeit it is still very high at 83%.

Other signs of progress and/or notable data points in the 2008 MTF data:

• Just as 30-day drinking measures show sharp long term declines, so do lifetime and annual drinking rates. For example, while over 70% of 8th graders reported ever having had a drink in 1991, that fell to 38.9% in 2008.



• While drinking rates have declined, vast majorities of these teen groups still say alcohol is easy to obtain: 92% of 12th graders, 81% of 10th graders and even nearly 2/3 of 8th graders say alcohol is "fairly easy" or "easy" to get. Both 8th and graders and 10th graders say that alcohol is easier to get than cigarettes.



• While binge drinking rates have fallen steadily over the last decade, perceptions of the practice as posing a "great risk" of harm, have increased only slightly, especially among the younger grades. Ref 2

"The current US recommendation of one drink per day for an older adult, by the National Institute on Alcohol Abuse and Alcoholism, may be restrictive." That's the provocative conclusion of a recent, detailed review of studies on the health effects of moderate drinking among older adults. "Emerging findings," the authors also point out, suggest that those over 65 "who consumed up to two drinks per day had no greater disability or mortality than those who consumed up to one per drink per day." Not only are these older moderate drinkers at "no greater disability," but older moderate drinkers benefit from a wide array of positive health associations, the authors point out. Among those benefits, detailed in the study and familiar to AII readers:

• Data from "more than 100 studies across 25 countries consistently demonstrate" an association between moderate alcohol consumption and reduced risk for coronary heart disease. "The relationship holds for mortality."



• Research suggests "that alcohol/wine can exert protective effects against other diseases such as cancer, diabetes, inflammatory liver disease and lower extremity arterial disease."



• "Reports of positive effects of alcohol/wine intake on bone density in older women."



• "There are emerging data to suggest that moderate alcohol intake is associated with a reduced risk of developing Alzheimer's disease and vascular dementia." Given the number of aging adults in the world population, the authors point out, additional research in this area "could provide important clarification."

The authors also identified two other moderate drinking/health interactions that are especially important to older adults and need further study: diet and mental/social well being. "The potential benefit that moderate drinking may have upon psychosocial functioning is an underappreciated inquiry," the authors point out, "specifically in relation to improved appetite and dietary consumption in older adults." Since many adults report increased isolation and reduced mobility as they age, moderate drinking's traditional links to improved social contact and meals may be especially beneficial. "The relative paucity of literature on the potential benefits of moderate alcohol consumption on mental and social well-being should entice further work in this area." the authors observe.

While the authors detail the benefits of moderate drinking -- which they define as 1-3 drinks/day - among older adults, they also describe the well-known "detriments of immoderate consumption," including liver disease, hepatitis and promotion of some cancers, cardiovascular disease, etc. Given the fast-growing number of aging adults around the globe, sheer numbers suggest "a silent epidemic" of alcohol use disorders "may be emerging." As a result, screening for potential problems, diagnostic criteria and recommendations specific to the elderly "are in need of refinement." A final, common sense observation from the authors also puts a new twist on the alcohol's historically ambivalent place in American culture, the science and the language. Because alcohol is an "energy-yielding molecule that is not physiologically required," the authors point out, "it is often classified as a drug rather than as a nutrient." Neither definition is "incorrect," they add. But: "Perhaps it could be considered a drug when used in immoderate doses and as a nutrient when used in moderation as part of a balanced diet." Hence their overall perspective that alcohol "can be considered either a tonic or a toxin," depending on how much is consumed. Ref 1

Brief interventions during emergency room visits which emphasize the link between a patient's injury and alcohol use/abuse can be an effective tool in reducing further alcohol abuse, concluded researchers from University of Michigan recently. In this study, 525 injured patients were identified as "at risk drinkers." After brief interventions in the emergency room and subsequent 3- and 12-month follow- up interviews (conducted with 85% of subjects) researchers analyzed the change in the subjects' long-term drinking patterns. Patients "who attributed their injury to drinking initially had significant reductions in alcohol use, regardless of intervention type, findings suggested. But "long-term reductions for these participants were best achieved via therapist-delivered," brief interventions. They also found "actual use" of alcohol within 6 hours prior to the incident that caused injury "was not related to intervention effectiveness," but that the perception that alcohol caused the injury "was related to intervention effectiveness." Ref 5

In one of the first formal legislative responses to the Amethyst Initiative, the New Jersey Senate Education Committee held a hearing November 17 to explore the issue of lowering the drinking age. The tone was set by Senate President Richard Codey, who reportedly called Amethyst Initiative "crazy" and declared a lower drinking age is "not going to happen" in the state. AI leader John McCardell spoke at the hearing to make the case that "there are far more effective ways to deal with the reality of the presence of alcohol in the lives of young adults" other than a 21 drinking age. Oddly, none of the 3 presidents of NJ colleges that signed on to the initiative testified. Countering McCardell were representatives of MADD, the state alcohol beverage control commission and the state's highway safety commission. Several speakers pointed to a 78% decline in the number of 18-20 yr-olds who died in car crashes since NJ adopted a higher minimum age in the 1980's. Codey called for stricter penalties for underage drinkers: "They need to know their parents are going to be notified and they may face substantial penalties, both academic and punitive." Codey and committee chair Shirley Turner "said they would draft legislation to study the best practices employed on college campuses to curb drinking by 18-20 year-olds." Sources: AP, Newark Star-Ledger

"US Hispanics do not differ much from the general population," a recent study of drinking rates and beverage preferences among different Hispanic national groups in the US found. Beer is the preferred beverage among Puerto Rican, Cuban, Mexican and South/ Central-American men and among Puerto Rican- and Mexican-American women. Wine is the first choice among Cuban- and South/ Central-American women. Within these general findings, the authors found that average consumption rates of different beverages varied widely by national group and gender. For example, average weekly consumption was highest among Puerto Rican men (18.2 drinks) and lowest among South/Central American women (4.6). Beer ranged from a low of 52% of male consumption to as high as 72%. Because beer is the most widely preferred and consumed drink among Hispanics it is also "responsible for the majority of binge events reported by respondents in all national groups," the authors found. That's even though "at an individual level, liquor drinkers are more likely to binge than beer drinkers." In fact, Hispanics who drink only liquor were 2X more likely to binge than beer-only drinkers.

Different drinking levels and beverage preferences among various Hispanic groups aside, the authors of this study, from the University of Texas School of Public Health, seem more concerned with drawing implications for public health policy based on their findings about beer and bingeing. And they show their cards early on in their report. Before disclosing their results, the authors point out that the US places greater restrictions on the sale and availability of wine and spirits than on beer. In part, they suggest, that's because of the "general perception that beer is not as bad as liquor because of its lower alcohol content." Beer is taxed lower and is more available, they add, despite "close associations between beer drinking and hazardous drinking." Therefore, "examining specific beverage preference and their association with risky drinking (binge) may help to refute existing myths and bring alcohol availability and taxation control more in line with reality." Why's that important? "Unequal treatment of different beverages may lead consumers to switch to cheaper and more available beverages, thus defeating control efforts." The authors' conclusions support their introductory remarks. The first key "implication for prevention and policy" of the findings: "Although lower in alcohol content, beer consumption is as dangerous as the consumption of liquor or spirits. Alcohol control policies such as taxation and control of sales availability should apply equally to wine, beer and liquor." Ref 4

While the debate over whether pregnant women should drink any alcohol at all is all but closed in the US and all alcohol beverage labels continue to advise pregnant women not to drink, British health officials continue to weigh whether the evidence warrants a strict abstinence message. A new study of approximately 9,000 children in the UK concluded: "There is no increased risk of behavioral problems or cognitive deficits at 3 years for children whose mother drank not more than 1 or 2 units of alcohol per week or on any given occasion." Actually that language understates the actual findings. Elsewhere, the authors point out that "boys born to light drinking mothers were less likely to have conduct and hyperactivity problems" than boys born to non-drinkers, "and these differences remained after statistical adjustment." After adjusting for various socio-demographic factors, including the mother's age, education, occupation, income etc, boys of light drinking moms were 41% less likely than sons of abstainers to score high on measures of conduct problems, 31% less likely to exhibit hyperactivity and 15% less likely to show "emotional symptoms." At the same time, boys born to light drinkers "had higher scores on cognitive ability assessments and for the tests on colors, shapes, numbers and letters."

Girls born to light drinkers were even less likely than boys to score high on the measure of total behavioral difficulties. They were 28% less likely to have conduct problems and 24% less likely to have peer problems. Girls born to light drinkers did not have significantly different scores on the cognitive tests. Boys born to moderate drinkers -- not more than 3-6 units/week or 3-5 units per occasion - also scored better on the behavioral tests than sons of abstainers, but only a very small percentage of the women were moderate drinkers. There was no clear problem pattern among sons and daughters of the few heavy drinkers in the study.

These findings, the authors noted, "are consistent with other studies that did not show increased risks of behavioral and developmental problems in children born to mothers who drank low levels of alcohol." They cited 6 other studies published since 1990. Given these previous findings, "questions arise as to whether the current push for policy to recommend complete abstinence during pregnancy is merited." As noted, no such questions get raised in the United States these days. In 2005, the U.S. Surgeon General expanded its warning in this regard, advising not only pregnant women to abstain from alcohol, but also women "who may become pregnant."

And CSPI and the National Organization on Fetal Alcohol Syndrome recently announced a "renewed joint effort to promote and support the expansion and enforcement of state and local laws that would require point-of-purchase warning posters regarding drinking during pregnancy wherever alcoholic beverages are sold." The groups put together a "State Action Guide" with information on state and local laws that mandate point-of-purchase warning signs and "practical information on how to start and conduct a warning sign campaign." The guide claims that "state and local public awareness prevention efforts