Differential Effects of Alcohol Policies Across Race/Ethnicity and Socioeconomic Status.

Abstract

Purpose: Sociocultural characteristics, including race/ethnicity and socioeconomic status (SES), may affect individuals' attitudes and norms regarding alcohol use and treatment as well as their access to emerging health knowledge, innovative technologies, and general resources for improving health. As a result of these differences, as well as social determinants of health such as stigma and uneven enforcement, alcohol policies may not benefit all population subgroups equally. This review addresses research conducted within the last decade that examined differential effects of alcohol policies on alcohol consumption, alcohol harm, and alcohol treatment admissions across racial/ethnic and socioeconomic groups.

Search methods: The authors used the following Boolean phrase search terms to assess the association between race/ethnicity and outcomes: ("alcohol policy" OR "alcohol policies") AND ("race" OR "ethnicity" OR "first nations" OR "African American" OR "Hispanic American" OR "Latino American" OR "Asian American" OR "Native American"). Association with SES was assessed using these terms: ("alcohol policy" OR "alcohol policies") AND ("socioeconomic" OR "class") AND ("effect" OR "impact" OR "outcome"). Both searches were conducted on August 28, 2023, using advanced search in seven EBSCOhost research databases: (1) EBSCO Biomedical Reference Collection: Corporate; (2) EBSCOhost E-Journals; (3) EBSCO MEDLINE Complete; (4) SocINDEX with Full Text; (5) APA PsycInfo; (6) LISTA (Library Information Sciences and Technology Abstracts); and (7) GreenFILE. Inclusion criteria for both searches were: (1) publication dates between 2014 and 2023; (2) peer-reviewed research articles; (3) data disaggregated by racial/ethnic and/or SES subgroups; and (4) English language only.

Search results: The racial/ethnic search produced 64 articles, of which 14 were reviewed as relevant to this study and 50 were excluded. The SES search generated 100 articles, of which 18 were reviewed as relevant to this study and 82 were excluded. Eight of the studies identified by these two searches overlapped (i.e., included both racial/ethnic and SES outcomes), resulting in a total of 24 articles included in this review.

Discussion and conclusions: Relying upon data from both U.S. and international research, the identified studies focused on differential effects of financially focused alcohol control policies (e.g., taxation and minimum unit pricing policies) as well as access/availability reduction policies (e.g., those governing outlet density, on-/off-premise sales, and establishment licensing). Several studies concluded that price increases via taxes or minimum unit pricing might be particularly effective in reducing the risk of alcohol-related harms in low-income/low-SES populations. Limitations of the present review include lack of standardization in the ways that SES was measured and the difficulty of measuring policy enforceability. Studies focused on differential effects of alcohol control policies across racial/ethnic groups demonstrated complex associations and the need to conduct further research that identifies better ways to reduce policy-induced health disparities across diverse populations.