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Regional Alcohol Policy Meeting

Capital Region

November 13, 2024

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Speakers

Haven Battles, PhD. Director, Alcohol Surveillance and Epidemiology Program; Assistant Director, Bureau of Chronic Disease Evaluation and Research, New York State Department of Health.

Sean Haley, MPH, PhD. Co-Founder of the National Alcohol Action Network and Associate Professor of Health Policy and Management. CUNY Graduate School of Public Health and Health Policy.

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Agenda

“Alcohol Consumption and Associated Harms in New York State”- Presented by Dr. Haven Battles, Ph.D.
“Why Policy Matters? Evidence-based Policy Recommendations and Prioritizations” – Presented by Dr. Sean J. Haley, Ph.D.
Breakout Room Discussion – Each group will have a facilitator who will guide discussions on alcohol-related harms, community health, and policy recommendations.
Main Room Discussion Summary – Facilitators of each group will share a summary of the discussion.
Concluding Remarks: Survey, Alcohol Summit Event 2025, Questions/Discussion (optional)

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ALCOHOL CONSUMPTION AND �ASSOCIATED HARMS IN NEW YORK STATE

Haven Battles, PhD

Alcohol Surveillance and Epidemiology Program

Bureau of Chronic Disease Evaluation and Research

New York State Department of Health

Disclaimer: This presentation is partially supported by the Centers for Disease Control and Prevention of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $166,667. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CDC/HHS, or the U.S. Government.

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The Centers for Disease Control and Prevention (CDC) defines excessive alcohol use as including:

BINGE �DRINKING*

HEAVY �DRINKING*

UNDERAGE DRINKING

PREGNANT DRINKING

For Men:

5 or more drinks on one occasion

For Women:

4 or more drinks on one occasion

For Men:

15 or more drinks in a week

For Women:

8 or more drinks in a week

Any alcohol use by those under age 21

Any alcohol use by pregnant people

Source: https://www.cdc.gov/drink-less-be-your-best/facts-about-excessive-drinking/index.html

*Note: People assigned female at birth typically experience greater impairment after drinking less alcohol than people assigned male at birth due to differences in body water content, hormones, body size, and metabolism. Data on gender and sexual identities are becoming more readily available, however these guidelines do not yet consider the complexity of biological characteristics, sex assigned at birth, gender identity, or the interactions among these factors. Therefore, people assigned female at birth, people who are intersex, and transgender people should defer to the more conservative guidelines outlined for women.

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What is considered a “drink”?

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When talking about these guidelines, it’s important to understand what is considered a standard single drink size in the US.�
Here is a depiction of the U.S. standard drink sizes and alcohol by volumes or ABV, which refers to the strength of an alcoholic beverage. �
When we reference “a drink” we’re talking about 12 oz of 5% ABV beer, 8 oz of 7% ABV malt liquor, 5 oz of 12% ABV wine, or 1.5 oz of 40% ABV distilled spirits.

While these standard drink amounts are helpful for following health guidelines, they may not reflect customary serving sizes. For example, a large cup of beer, an overpoured glass of wine, or a single mixed drink could contain much more alcohol than a standard drink which is 14 grams of pure alcohol in the United States. (WHO standard drink size is 10 grams of pure alcohol; the size of a standard drink varies from 8g in Iceland and the UK to 20 grams in Austria)

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Nearly 1 in 5 adult New Yorkers report excessive alcohol use, in the form of either binge or heavy drinking.

Over 8,050 New Yorkers die each year due to excessive alcohol use.

Excessive alcohol use can cause injuries, violence, and chronic disease.

Excessive drinking cost New York $16.3 billion in 2010, or roughly $843 in preventable costs per taxpayer.

Alcohol-related harms disproportionately impact under-resourced areas and people living in them.

Excessive alcohol use is a public health issue in New York State

Source: Centers for Disease Control Addressing Excessive Alcohol Use: State Fact Sheets

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More than 8,050 New Yorkers die each year due to excessive alcohol use
1 in 6 adult New Yorkers report excessive alcohol use in the form of either binge or heavy drinking
Excessive alcohol use can cause short-term health harms such as injuries and violence and can hurt people other than the person who drinks.²
Excessive alcohol use also contributes to long-term health harms such as chronic diseases and learning and mental health conditions like anxiety and depression.
The impact of excessive alcohol use goes beyond health as it can also have negative social and economic effects on individuals, families, and communities. For example, in 2010, excessive alcohol use cost New York $16.3 billion, or roughly $843 in preventable costs per taxpayer.
These alcohol-related harms are not evenly distributed, with low-income areas and communities of color suffering greater consequences. Social determinants of health such as greater alcohol retailer density, increased availability of alcohol products, and increased marketing of alcohol products to specific population groups, especially when fueled by structural racism, contribute to disparities in the burden of excessive alcohol use and its associated outcomes.

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UNDERAGE DRINKING �AND RELATED HARMS �IN NEW YORK STATE

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1 in 7 New York youth initiate drinking early (having their first drink before age 13)

New York State

United States

13.9%

15.0%

Early initiation of drinking is concerning. People who start before the age of 15 are at a higher risk for developing alcohol use disorder later in life.

For example, adults ages 26 and older who began drinking before age 15 are 3.5 times more likely to report having an alcohol use disorder in the past year then those who waited until age 21 or later to begin drinking.^*

% of high school students who report having their first drink before age thirteen

Data source: NYS Youth Risk Behavior Survey, 2021

*https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/underage-drinking

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1 in 7 NY youth initiate drinking early, defined as having their first drink before age 13
Many people first begin using alcohol during adolescence, and the prevalence of drinking and binge drinking increases dramatically during this time, peaking in the early 20s.
Not only are adolescents at increased risk of injuries and accidents while under the influence, but people who start drinking before the age of 15 are at a higher risk for developing alcohol use disorder later in life. For example, adults ages 26 and older who began drinking before age 15 are 3.5 times more likely to report having an alcohol use disorder in the past year then those who waited until age 21 or later to begin drinking.
Moreover, research indicates that alcohol exposure during adolescence can affect brain development and compromise cognitive function in both the short and long term.
Considering these consequences, a key objective is to prevent, or at least delay, the onset of drinking among youth.

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Alcohol is a widely used substance among NYS youth

Data source: NYS Youth Risk Behavior Survey, 2021

CURRENTLY DRINK

drank at least one drink during the past 30 days

1 in 5 �high school students

BINGE DRINK

drank 4+ drinks (females) or 5+ drinks (males) in a row within a couple hours during the past 30 days

1 in 10 �high school students

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Underage drinking can cause immediate and chronic health effects among youth

Over 100 New Yorkers under the age of 21 die due to alcohol use each year. This includes deaths from causes such as motor vehicle crashes, homicides, alcohol poisoning, and suicides.

Alcohol use impairs judgment and can increase the risk of physical and sexual assault among youth.

Alcohol use can interfere with normal brain development.

Data sources: Alcohol Related Disease Impact (ARDI) application, 2024. Available at www.cdc.gov/ARDI; https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/underage-drinking; https://www.cdc.gov/alcohol/fact-sheets/underage-drinking.htm

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ADULT EXCESSIVE ALCOHOL USE AND RELATED HARMS IN NYS

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Nearly 1 in 5 adults in New York State (18.4%) report excessive alcohol use, in the form of either binge or heavy drinking

Data source: NYS Behavioral Risk Factor Surveillance System, 2022

16.6%�BINGE DRINK

6.1% �HEAVY DRINK

MALES

WHITE, NON-HISPANIC; HISPANIC

YOUNGER ADULTS (Ages 18-34)

HIGHER EDUCATIONAL ATTAINMENT

HIGHER ANNUAL HOUSEHOLD INCOME

FREQUENT MENTAL DISTRESS

ADULTS WHO CURRENTLY SMOKE

Adults who are more likely to report binge or heavy drinking include:

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Among the 2 million NYS adults who report binge drinking…

25% consume�at least 7 DRINKS �per binge drinking �occasion

25% do so at least 4 TIMES�per month

The risk of alcohol-related harms increases with the amount of alcohol one drinks.

However, for some conditions, like some cancers, the risk increases even at very low levels of alcohol consumption.

Data source: NYS Behavioral Risk Factor Surveillance System, 2022; https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm

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Under-resourced communities experience greater harms related to excessive alcohol use, despite lower alcohol use rates.

Greater harms include a higher prevalence of alcohol-related diseases including heart disease and hypertension, as well short term health effects like injury and violence.

The higher rates of harm among under-resourced communities may be explained by:

disproportionately greater exposure to alcohol marketing and alcohol environments, and
the collective impact of stress, stigma, and discrimination,
inadequate access to substance use disorder treatment programs.

Mulia N, Ye Y, Greenfield TK, Zemore SE. Disparities in alcohol-related problems among white, black, and Hispanic Americans. Alcohol Clin Exp Res. 2009 Apr;33(4):654-62. doi: 10.1111/j.1530-0277.2008.00880.x. Epub 2009 Jan 15. PMID: 19183131; PMCID: PMC2771773.

Vaeth PA, Wang-Schweig M, Caetano R. Drinking, Alcohol Use Disorder, and Treatment Access and Utilization Among U.S. Racial/Ethnic Groups. Alcohol Clin Exp Res. 2017 Jan;41(1):6-19. doi: 10.1111/acer.13285. Epub 2016 Dec 26. PMID: 28019654; PMCID: PMC5205547.

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Counties are categorized into three groups, with one third of counties in each category.
Lightest color represents the 1/3 of counties with the lowest rates, darkest color represents the 1/3 of counties with the highest rates
County rates range from 8.0% to 22.2%.
Statewide rate is 14.9%

Within NYS, the prevalence of adult binge drinking varies by county from 8.0% to 22.2%

Data source: NYS Behavioral Risk Factor Surveillance System, 2021

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Prevalence of binge drinking, among adults in Capital Region, 2021

Data source: NYS Behavioral Risk Factor Surveillance System, 2021

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Within NYS, the prevalence of adult heavy drinking varies by county from 2.0% to 12.5%

Counties are categorized into three categories, with one third of counties in each category.
Lightest color represents the 1/3 of counties with the lowest rates, darkest color represents the 1/3 of counties with the highest rates
County rates range from 2.0% to 12.5%.
Statewide rate is 5.5%

Data source: NYS Behavioral Risk Factor Surveillance System, 2021

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Prevalence of heavy drinking, among adults in Capital Region, 2021

Data source: NYS Behavioral Risk Factor Surveillance System, 2021

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From 2020-2021, the majority of annual excessive alcohol use-attributable deaths in NYS were from chronic vs acute causes

CHRONIC CAUSES

causes with a longer

duration from the time of

onset to the time of death

such as liver disease due to alcohol use and chronic pancreatitis.

ACUTE CAUSES

2,533

5,560

8,093 �deaths �per year

causes with a very short

duration from the time

of onset to the time of

death such as alcohol

poisoning, motor-vehicle

traffic crashes, and

suicide.

Data source: Alcohol Related Disease Impact (ARDI) application, 2024. Available at www.cdc.gov/ARDI.

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NYS youth and adults are more likely to report alcohol use than use of other substances. Yet, efforts to prevent excessive alcohol use and its related harms receive less resources.

20.0% use alcohol

15.7% use tobacco e-vapor products

14.2% use cannabis

5.0% smoke cigarettes

18.4% binge or heavy drink

5.3% use tobacco e-vapor products

12.8% use cannabis

11.3% smoke cigarettes

Youth Substance Use

Adult Substance Use

Data source: NYS Youth Risk Behavior Survey, 2021; Behavioral Risk Factor Surveillance System, 2022 (binge or heavy drink; smoke cigarettes); Behavioral Risk Factor Surveillance System, 2021 (tobacco e-vapor products); Behavioral Risk Factor Surveillance System, 2020 (cannabis)

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To put excessive alcohol use in context with the use of other substances, we see that NYS youth and adults are more likely to report excessive alcohol use in the form of underage drinking or binge and heavy drinking than use of other substances.�
Alcohol is the most commonly use substance among NYS youth. According to 2021 Youth Risk Behavior Survey data, among high school students, 20% drank alcohol during the past 30 days (compared to 15.7% e-vapor product use, 14.2% cannabis, and 5.0% cigarettes). Likewise, according to 2020 BRFSS data, more adults reported binge or heavy drinking than using cannabis, cigarettes, or e-vapor products. �
We have a lot of work to do to not only make excessive alcohol use prevention a priority for public health but also to help decision makers see the value in providing resources toward the prevention and reduction of these behaviors.

BRFSS: Current e-cigarette use is defined as an adult over the age of 18 years who answered ‘yes’ to ever using an e-cigarette or other electronic vaping product and who also now uses e-cigarettes or other electronic vaping products every day or some days
BRFSS: Cannabis – any use in past 30 days
BRFSS: tobacco - BRFSS defines “current smoker” as an adult over the age of 18 who has smoked at least 100 cigarettes in their lifetime and currently smokes on at least some days.
If needed:

YRBS: In 2021, 3.4% of high school youth report ever using heroin
BRFSS: In 2021, 3.9% of adults self-reported prescription pain medication misuse in the past 12 months and 0.4% self-reported heroin use in the past 12 months�

YRBS definitions (if needed):

Drank at least one drink of alcohol on at least 1 day during the past 30 days
Used an electronic vapor product (e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, hookah pens) on at least one day during the past 30 days
Used marijuana one or more times during the past 30 days
Smoked cigarette on at least 1 day during the 30 days before the survey)

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Despite health harms, NYS adults perceive alcohol use to be less serious than other public health substance use related issues

Data source: NYS Division of Chronic Disease Prevention Chronic Disease Public Opinion Poll, 2022

of adults think prescription �opioid misuse

is a serious public health problem

90%

of adults think heroin use �is a serious public health problem

88%

of adults think tobacco use�is a serious public health problem

85%

of adults think� e-cigarette/ vaping use�is a serious public health problem

82%

of adults think �alcohol use �is a serious public health problem

77%

46%

of adults think cannabis use �is a serious public health problem

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New Yorkers’ Support For Policy Solutions

Data source: NYS Division of Chronic Disease Prevention Chronic Disease Public Opinion Poll, 2022

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Thank You��To get in touch with the New York State Alcohol Surveillance and Epidemiology team, �email us at AlcoholData@health.ny.gov

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Why focus on alcohol policy? �

New York State Regional Alcohol Education Meetings:�Local Action, Statewide Solutions

Sean J. Haley PhD, MPH

Capital Region

November 13, 2024

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https://www.healthaffairs.org/do/10.1377/hblog20190115.234942/full/

Treatment

Prevention

Intervention

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Strong evidence that greater alcohol availability is associated with more harms. �Source: Sherk et al. 2018; Bryden et al. 2012��Evidence-based alcohol policies can reduce excessive alcohol use and promote safer and healthier communities

Source: The Community Preventive Services Task Force (CPSTF)

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The current alcohol policy landscape in NYS presents additional challenges to preventing alcohol-related harms

PRE-EMPTIVE STATE

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EVER EXPANDING AVAILABILITY

ALCOHOL �TAXES

To-Go alcohol legislation; Expansion of days and hours of sale

NYS prevents localities from passing laws that differ from the State’s alcohol control policies.

NYS hasn’t increased its beer or wine excise tax since 2009 or its distilled spirits tax since at least 2003.

Pre-emptive State

Alcohol is unlike any other consumer product. The 21st Amendment, which repealed Prohibition, explicitly granted states the authority to regulate alcohol outlet density.
States that prevent, or preempt, local communities from passing laws that are stricter or differ from the state’s alcohol policies are called pre-emptive states.
A state may preempt local alcohol laws in all or only in some categories. NYS is an exclusive or near-exclusive pre-emptive state meaning alcohol is heavily regulated at the state level.

Expanding Availability

NYS legalized the sale of alcoholic beverages for off-premises consumption through 2025. Gov has included permanent to-go legislation in 2025 budget proposal.
This legislation amends the Alcoholic Beverage Control Law to authorize restaurants and bars licensed to sell liquor or wine for on-premises consumption to also sell these products for off-premises consumption, making alcohol more easily available
NYS legalized expanding hours and days of sale (add details)

Alcohol Taxes

Alcohol excise taxes in NYS haven’t kept pace with inflation, effectively making the product cheaper for consumers.
The current NYS taxes on alcohol only cover 7.5% of the total cost of excessive drinking.²⁴

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Increasing alcohol taxes is an effective method of decreasing excessive consumption of alcohol, youth consumption, and related harms such as traffic fatalities. (Blanchette et al. 2020)
The current NYS taxes on alcohol only cover 7.5% of the total cost of excessive drinking. (Blanchette et al. 2019)

TAX: Alcohol excise taxes in NYS haven’t kept pace with inflation, effectively making the product cheaper for consumers.

14^th LOWEST beer tax �in the nation ($0.14/gallon)

6^th HIGHEST liquor tax �in the nation ($6.44/gallon)

4^th LOWEST wine tax �in the nation ($0.30/gallon)

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In 2022 a temporary state commission was formed to make recommendations to change the state’s alcohol laws and regulations
No representative from a health agency was included.
Published report in 2023.
Out of 18 recommendations, more than half have already become law.

INCREASING AVAILABILITY: Commission to Study Reform of the Alcoholic Beverage Control Law

https://sla.ny.gov/system/files/documents/2023/05/abc-law-commission-report-2022-2023.pdf

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Legislative Updates – Nov 2023

Governor Hochul Signs Legislation Changing Alcoholic Beverage Laws:

Allows for the Retail Sale of Beer on Sundays
Expands Hours of Operation for Liquor and Wine Stores on Sundays
Lengthens duration of a Brewer’s License
Authorizes the Use of a Pressurized Mixing and Dispensing System
Permits the Sale or Promotional Gifting of Certain Complementary Products for Wine and Spirits
Relates to Licensing Restrictions for On-Premises Alcohol Consumption for Manufacturers and Wholesalers of Alcoholic Beverages at Specific Locations

Much of this legislation is counter to prevailing evidence that protects health and communities

Announced 10/14/23

Allows for the sale of beer, mead, braggot (a mead/bear combo) and cider on any day of the week including Sundays
Allows liquor and wine stores to expand their Sunday hours so that they may open at 10am and close at 10pm.
Extends the length of validity of a brewer’s license from one year to three years
Allows for businesses to prepare and keep drinks containing alcohol in pressurized dispensing machines
Allows retail stores to sell complementary gift and promotional items related to wine and spirit sales.
Adds parcels of land to the list of premises which are exempt from the provisions of law which generally restrict manufacturers/wholesalers and retailers from sharing an interest in a liquor license.

This legislation will likely make alcoholic beverages more readily accessible to New Yorkers

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Legislative Updates – May 2024

ABC Commission recommendations continue to be adopted

As part of 2024/2025 budget:

Extension of to-go alcohol sales through 2030
Change in community notification
One-Day event permits
Temporary wholesaler permits

Other “business and guest-friendly” measures:

Allow liquor sales in movie theaters
Making alcohol service for outdoor dining permanent
Expansion of catering permits
Change in Wine/Liquor stores at street level
Allow temporary retail permits

https://sla.ny.gov/news/new-york-state-liquor-authority-announces-expansion-options-businesses-liquor-licenses-enacted

Alcohol To-Go – A 5-year extension will allow for the current “drinks to go” provision to continue through 2030, with those 5 years commencing from 2025.
Community Notification – Allows applicants to simultaneously apply for a license and notify their municipality, and provides the SLA will not act on the application for 30 days in order to allow time for municipal input in the licensing process.
One-Day Event Permits – Expands one-day special event permits to allow for the service of liquor. These one-day permits were previously restricted to beer and wine. This change creates parity for New York craft beverage manufacturers, in addition to providing catering businesses more opportunities by expanding their offerings.
Temporary Wholesaler Permits – Creates a new permit to allow for wholesale applicants to obtain a temporary permit while their license is pending, allowing these businesses to begin operations more expeditiously.

Allowing Liquor Beverage Sales in Movie Theaters – The Budget allows for the service of spirits, in addition to beer and wine, at movie theaters that do not meet the definition restaurants, which required a full kitchen with meals served to guests seated at tables. Previously, movie theaters not operating as restaurants were limited to beer and wine only.
Makes Outdoor Dining Permanent – The budget makes permanent the service of alcohol on contiguous and non-contiguous municipal space, with the authorization of the municipality and the SLA, in addition to addressing service across bike lanes, thereby eliminating statutory ambiguity. This highly successful pandemic-era policy provision was set to expire on July 5, 2025.
Expanding Catering permits – The budget removes the requirement mandating catering permits be issued only for indoor functions or events, expanding opportunities for the hospitality industry and their customers.
Wine/Liquor Stores at Street Level – The budget eliminates a Prohibition era law that required liquor stores to be located at street level in order to qualify for a license.
Temporary Retail Permits – Extends the issuance of temporary retail permits to get businesses open and operating quickly.

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Legislative Updates – Aug 2024

Governor Hochul Signs Legislation Allowing Direct-to-Consumer Shipping for NY Spirits and Cider

Expands market access for small craft producers-temporary during COVID, made permanent through S.2852A/A.3132A

“NO MORE THAN THIRTY-SIX CASES (NO MORE THAN NINE LITERS EACH CASE) OF LIQUOR PRODUCED BY SUCH LICENSE HOLDER PER YEAR DIRECTLY TO A RESIDENT OF NEW YORK WHO IS AT LEAST TWENTY-ONE YEARS OF AGE, FOR SUCH RESIDENT'S PERSONAL USE” (9x36= 324 liters of spirits a year or 6.2 liters a week)

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And just last month….

Legislation S.8203/A.8427-A removes the previously-set, two-year restriction, allowing businesses to open months earlier with a temporary permit while their full application is pending.
Legislation S.9685/A.7116 extends the duration of temporary retail permits from 90 to 180 days.
https://sla.ny.gov/news/governor-hochul-signs-legislative-package-support-new-yorks-hospitality-industry
https://www.governor.ny.gov/news/governor-hochul-signs-legislative-package-support-new-yorks-hospitality-industry

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Not Since Prohibition have we seen so many government sanctioned increases in availability ……..

Strong association between an increase in alcohol availability and harms (including cancer)

What if this was tobacco?

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Considerations

To Reduce Alcohol Related Harms

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Step 1: Immediate Actions to Reduce Harms and to Establish Infrastructure

Place a moratorium on any NY state laws that expand alcohol availability or otherwise loosen alcohol regulations across NY State, especially but not limited to recommendations from the 2023 SLA Commission
Create NY State Public Health and Safety Alcohol Commission
Establish a full statewide alcohol public health program (similar to what exists for tobacco) to:

1) fund widespread community education about alcohol’s contribution to health, policy strategies to reduce alcohol related harms;

2) create stronger alcohol surveillance systems to assess alcohol availability, use, and related harms across populations, but especially youth;

3)conduct media surveillance to identify youth exposure and impact;

4) fund counter marketing to prevent youth initiation and

5) support program evaluation to optimize use of public resources

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Step 1 (continued): Immediate Actions to Reduce Harms and to Establish Infrastructure

Secure a commitment from a NY based foundation to make reducing excessive alcohol use a funding priority
Educate elected officials on county and district levels about health and economic costs of excessive alcohol use
Add a public health liaison position to the NY SLA

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Step 2: Evidence-Based Policy Changes to Reduce Alcohol-Related Harms

Increase alcohol taxes
Make alcohol awareness training programs mandatory for servers and outlets
Restrict alcohol marketing and branding to reduce youth exposure, especially within already oversaturated BIPOC communities
Reduce alcohol outlet density in residential communities with disproportionate burden
Reduce hours of alcohol availability
Lower New York State's legal blood alcohol limit from .08 to .05.

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Breakout Room Discussion

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Agenda

You will be placed in a breakout room where a facilitator will guide the discussion on alcohol related harms and policies.
You will have 20 minutes to discuss
After joining the main room, each facilitator will summarize the discussion (2-3 min per group)

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Summary and Next steps

We will gather your feedback and integrate it into the alcohol prevention framework
Please complete the Qualtrics survey to prioritize alcohol policy prevention strategies for NY State. See the link in the chat, if you do not have time now, please check your email.
Please join us for the virtual NY Alcohol Policy Summit II on January 14 (info to follow)
Thank you for joining us. For questions, please email Ira Memaj at ira.memaj@sph.cuny.edu (see chat)
Optional: If your time permits and you have questions or want to share thoughts about alcohol-related policy, we will remain on Zoom for an additional 30 minutes.

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Thank You