Aims: To examine state alcohol control policy implementation by policy efficacy and intent. Design: A descriptive longitudinal analysis of policy implementation. Setting: The United States, 1999-2011. Participants: Fifty states and the District of Columbia. Measurements: Twenty-nine state-level policies were rated based on an implementation rating (IR; range=0.0-1.0) gathered from the Alcohol Policy Information System, government and industry reports and other sources; and expert judgment about policy efficacy for addressing binge drinking and alcohol-impaired driving among the general population and youth, respectively. Findings: On average, implementation of the most effective general population policies did not change [mean IR=0.366 in 1999; 0.375 in 2011; slope for annual change=0.001; 95% confidence interval (CI) for the slope -0.001, 0.002]. In contrast, implementation increased over time for less effective policies (mean IR=0.287 in 1999; 0.427 in 2011; slope for annual change compared with most effective policies=0.009; slope 95% CI=0.002-0.007), for youth-oriented policies (mean IR=0.424 in 1999; 0.511 in 2011; slope for annual change compared with most effective policies=0.007; slope 95% CI=0.005-0.009), and for impaired driving policies (mean IR=0.493 in 1999; 0.608 in 2011; slope for annual change compared with most effective policies=0.0105; slope 95% CI=0.007-0.014). Conclusions: Implementation of politically palatable state alcohol policies, such as those targeting youth and alcohol-impaired driving, and less effective policies increased during 1999-2011 in the United States, while the most effective policies that may maximally protect public health remained underused.
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- Public health