Opinions on the Privatization of Distilled-Spirits Sales in Washington State: Did Voters Change Their Minds?

Cannabis use frequency, route of administration, and co-use with alcohol among older adults in Washington state

Background

The US national surveys and data from legal adult use cannabis states show increases in the prevalence of cannabis use among older adults, though little is known about their manner of cannabis consumption. Here, we examine cannabis use frequency, routes of cannabis administration, and co-use with alcohol, focusing on adults aged 50–64 and ≥65.

Methods

Data come from a general population survey conducted January 2014–October 2016 (N=5492) in Washington state. We first estimate prevalence and trends in cannabis frequency, routes of administration, and co-use with alcohol in gender by age groups (18–29, 30–49, 50–64, ≥ 65). To test associations between cannabis frequency, route of administration, and co-use with alcohol, we then use sample-weighted multinomial regression adjusted for gender, race/ethnicity, marital status, education, employment, and survey year. Sampling weights are used so results better represent the Washington state population. Regressions focus on the 50–64 and ≥65 age groups.

Results

Among men and women 50–64, the prevalence of no cannabis use in the past 12 months decreased significantly (84.2% in 2014 to 75.1% in 2016 for women, 76.8% in 2014 to 62.4% in 2016 for men). Among those who report past-year cannabis use, oral administration and vaping and other routes of administration increased by 70% and 94%, respectively each year. Almost one-third of women aged 50–64 and one-fifth of women aged ≥65 who use cannabis reported daily/near daily use, and more than one-third of men who use cannabis in all age groups reported daily/near daily use, including 41.9% of those ≥65. Among men, the prevalence of edibles, drinks, and other oral forms of cannabis administration went up significantly with age (6.6% among 18–29, 21.5% among ≥65). Vaping and other administration are more strongly related to regular and daily/near daily use than infrequent use among those ≥65. The pattern of associations between cannabis frequency and co-use with alcohol differed for women vs. men.

Conclusions

In a general population representative sample of adults living in a state with legal adult use cannabis, the prevalence of cannabis use increased among those aged 50–64 between 2014 and 2016, the prevalence of daily use is substantial, and oral administration and vaping are increasing.

Washington's liquor license system and alcohol-related adverse health outcomes

BACKGROUND AND AIMS

In June 2012, Washington state (USA) implemented Initiative 1183, privatizing liquor sales. As a result, off-premises outlets increased from 330 to over 1400 and trading hours lengthened. Increased availability of liquor may lead to increased consumption. This study examines the impact of Initiative 1183 on alcohol-related adverse health outcomes, measured by inpatient hospitalizations for alcohol-related disorders and accidental injuries. It further assesses heterogeneity by urbanicity, because outlets increased most in metropolitan-urban areas.

DESIGN

County-by-quarter difference-in-difference linear regression models, estimated statewide and within metropolitan/rural strata.

SETTING AND PARTICIPANTS

Data are from AHRQ Healthcare Cost and Utilization State Inpatient Database 2010-2014 and HHS Area Health Resource File 2010-2014. Changes in the rates of hospitalizations in the 2.5 years following Initiative 1183 in Washington (n = 39 counties) are compared with changes in Oregon (n = 36 counties).

MEASUREMENTS

County rates of hospitalizations per 1000 residents, including all records with any-listed ICD-9 Clinical Classification Software code denoting an alcohol-related disorder, and all records with any-listed external cause of injury code denoting an accidental injury.

FINDINGS

The increase in the rate of accidental injury hospitalizations in Washington's metropolitan-urban counties was on average 0.289 hospitalizations per 1000 county residents per quarter greater than the simultaneous increase observed in Oregon (P = 0.017). This result was robust to alternative specifications using a propensity score matched sample and synthetic control methods with data from other comparison states. The evidence did not suggest that Initiative 1183 was associated with differential changes in the rate of hospitalizations for alcohol-related disorders in metropolitan-urban (P = 0.941), non-metropolitan-urban (P = 0.162), or rural counties (P = 0.876).

CONCLUSIONS

Implementing Washington's Initiative 1183 (privatizing liquor sales) appears to have been associated with a significant increase in the rate of accidental injury hospitalizations in urban counties in that state but does not appear to be significantly associated with changes in the rate of hospitalizations specifically for alcohol-related disorders within 2.5 years.

Reversal of voters' positions since the privatization of spirits sales in Washington State

In 2011, Washington State voters approved Initiative 1183 (I-1183), the privatization of liquor sales. The aim here was to examine how voter support for privatization has changed since I-1183 passed. Data came from five state-representative surveys, with recruitment between 2014 and 2016 (N = 4,290). Primary outcomes were voting on I-1183 (vs. not), voting for (vs. against) I-1183, and changing vote for I-1183 to against among those who voted for it (vs. not changing). Bivariate and multivariable logistic regressions were used for analyses. Results show that voting for (vs. against) I-1183 was related to 2.59 (P < 0.001) times greater odds of wanting to change one's vote. This difference was large enough to have changed the result of the election if voters could know their later opinions. Among those who voted for I-1183, odds of retracting support were positively related to total past 12-month drink volume. Those who agreed that number of stores selling liquor should decrease were more likely to change votes from for to against, while those who considered that youth alcohol abuse has remained the same since privatization were less likely to change votes. Thus, in the years immediately following liquor privatization in Washington State, public opinion has changed enough to shift the result of the election from supporting privatization to rejecting it. Findings are especially relevant for other US states and countries considering privatization.

Washington's privatization of liquor: effects on household alcohol purchases from Initiative 1183

BACKGROUND AND AIMS

Washington Initiative 1183 (I-1183), a 2012 law that privatized liquor retail sales and distribution in Washington State, USA, has had two opposing effects on liquor purchases: it has increased access to liquor and imposed new fees on retailers and distributors. This study aimed to estimate the effect of I-1183 on monthly alcohol purchases during the post-I-1183 period (June 2012-December 2014) compared with the pre-I-1183 period (January 2010-May 2012).

DESIGN

DIFFERENCES-IN-DIFFERENCES STUDY: Setting and participants The study included households participating in the Nielsen Consumer Panel Dataset living in metropolitan and surrounding areas in Washington State and 10 control states. Measurements Outcomes were alcohol purchases by type (ounces of liquor, wine, beer and total alcohol or ethanol). Findings I-1183 was associated with a 6.34-ounce (P < 0.001) and a 2.01-ounce (P < 0.001) increase in monthly liquor and ethanol purchases, respectively, per household in the post-policy period spanning 31 months compared with monthly purchases in control states. In a longitudinal subgroup analysis, low and moderate alcohol purchasers increased monthly purchases of ethanol and high purchasers decreased purchases of ethanol. Conclusions Enacting 'Washington Initiative 1183', a law that privatized sale and distribution of liquor and imposed new fees on retailers and distributors, appears to have been associated with an approximate 82% increase in monthly liquor purchases and 26% increase in monthly ethanol purchases by households in metropolitan and surrounding areas in Washington State, USA.

Race/Ethnicity Differences in Trends of Marijuana, Cigarette, and Alcohol Use Among 8th, 10th, and 12th Graders in Washington State, 2004-2016

Accurate estimates of substance use in the teenage years by race/ethnicity may help identify when to intervene to prevent long-term substance use disparities. We examined trends in past 30-day use of marijuana, cigarette, and alcohol among 8th, 10th, and 12th graders in Washington State, which passed a recreational marijuana law in 2012 and initiated retail marijuana sales in 2014. Data are from the 2004-2016 Washington Healthy Youth Surveys (n = 161,992). We used time series regression models to assess linear and quadratic trends in substance use for the full sample and stratified on race/ethnicity and grade level and examined relative differences in prevalence of use by race/ethnicity. In Washington, across all racial/ethnic groups, marijuana use peaked in 2012. Although there was not a significant overall change in marijuana use for the full sample across the study period, there was a statistically significant increase in use among 12th graders and a statistically significant decrease among 8th graders. Relative to Whites, Asians had a lower prevalence of marijuana use, whereas all other race/ethnicity groups had a higher prevalence of use. Prevalence of marijuana use is particularly high among American Indian/Alaska Native and Black youth and has increased most rapidly among 12th grade Hispanic/Latinx youth. There were large and statistically significant decreases in alcohol and cigarette use across the study period for the full sample, as well as for each race/ethnicity group. These findings highlight the need for continued monitoring of trends in use among these groups and potentially warrant consideration of selective interventions that specifically focus on students of color and that include developmentally-appropriate strategies relevant to each grade.

Changes in spirits purchasing behaviours after privatisation of government-controlled sales in Washington, USA

INTRODUCTION AND AIMS

The privatisation of the Washington Liquor Monopoly in 2012 offered a unique opportunity to study spirits purchasing behaviour changes from a government to licensed system.

DESIGN AND METHODS

Four representative cross-sectional surveys of adults aged 18 and older in Washington state were recruited between January 2014 and October 2015 (Wave 1, N = 1202; W2, N = 804; W3, N = 823; W4, N = 662). Analyses compared spirits purchasing behaviours before privatisation from retrospective reports to current reports in the areas of travel distance, spirits quality, purchase frequency and size of bottle. Respondents also directly reported on changes in convenience, selection and prices.

RESULTS

No significant changes were found in these aspects of purchasing. However, subgroup analyses found that younger drinkers 18-29 reduced travel distance and increased purchase frequency while drinkers aged 50 and older travelled further. Reduced travel distances were associated with grocery and drug stores while increased travel distances were associated with liquor superstores, wholesale stores and government stores in bordering states. Respondents reported that liquor purchasing was more convenient after privatisation but that the selection of spirits was better and prices were lower in the government-controlled stores.

DISCUSSION AND CONCLUSIONS

The government monopoly stores were viewed as offering a wider selection of products and as having lower prices than those in the privatised system. The variety of store types in the licensed system allowed drinkers to select stores based on convenience, selection or prices, so that travel times increased for some buyers, presumably those seeking lower prices or a wider selection.

Washington State Spirits Privatization: How Satisfied were Liquor Purchasers Before and After, and by Type of Retail Store in 2014?

BACKGROUND

In 2012 Washington State ended a wholesale/retail monopoly on liquor, permitting sale of spirits in stores with > 10,000 square feet. Implementation resulted in average price increases, but also five times the stores selling liquor.

OBJECTIVES

As part of a privatization evaluation, we studied pre-post and between-store-type purchase experiences.

METHODS

A 2010 Washington State Liquor Control Board (LCB) survey of liquor purchasers (n = 599), and the 2014 baseline of a repeated telephone survey (1,202 residents; n = 465 purchasers), each included 10 LCB questions on satisfaction with purchase experiences, each attribute with graded response scale A = 4 to D = 1 and F (0 = fail). Analyses used t-tests for satisfaction differences by time and analysis of variance (ANOVA) for 2014 between-store satisfaction-level differences.

RESULTS

Five purchase features were rated more favorably after privatization (ps < .05-.001), including product supply, staff professionalism, location convenience, store hours, and prices (though price rated lowest both times); selection offered, courtesy, and checkout speed were unaltered, and number of staff and staff knowledge declined (both p < .001). Eight consumer experiences differed by store type: five satisfaction aspects (supply, selection, number of staff, operating hours, and checkout speed) were highest for liquor superstores, while location convenience favored grocery and drug stores, and price satisfaction favored wholesale (Costco) stores, with staff knowledge highest at liquor stores.

CONCLUSIONS

Satisfaction with liquor purchases increased after privatization for half the consumer experiences. Availability (location convenience and store hours) was important to liquor purchasers. Such results are relevant to sustained support for the policy of privatizing spirits retail monopolies.

Survey Estimates of Changes in Alcohol Use Patterns Following the 2012 Privatization of the Washington Liquor Monopoly

AIMS

The US state of Washington's 333 state-run liquor stores were privatized on 1 June 2012 and purchases began in ~1500 licensed stores of a variety of types. A regime of taxes and fees was implemented to replace the revenues generated by the state stores and, 1 year later, the beer tax was reduced by two thirds. This study evaluates the impact of these changes on total alcohol and spirits consumption in a retrospective pre-test design.

METHODS

The study sample consists of 2289 adults recruited in three cross-sectional surveys during 2014 and 2015. Retrospective typical past month quantity-frequency measures for before privatization drinking and current past month quantity-frequency measures were compared within subjects, for all alcohol and for spirits only.

RESULTS

No change in alcohol volume was seen across privatization while spirits volume was found to decrease, suggesting a shift from spirits to beer. This decline in spirits volume came from a reduction in drinking days while overall drinking days were found to increase. This was offset by a reduction in drinks per drinking day and in heavy occasions.

CONCLUSIONS

These findings accurately mirror the overall flat trend in per capita alcohol sales but seem to exaggerate the very small shift towards beer seen in sales data. Effects of increased spirits availability appear to have been countered by increased spirits prices and a decreased beer tax, leading to a shift to beer consumption.

SHORT SUMMARY

Survey-based analyses of alcohol use across Washington's spirits privatization, beer tax reduction and marijuana legalization found no change in alcohol volume, a reduction in spirits volume and a shift to more moderate drinking patterns. Reductions in drinking occurred among marijuana users and those with lower educational attainment reduced spirits volume.

Changes in Marijuana Use Across the 2012 Washington State Recreational Legalization: Is Retrospective Assessment of Use Before Legalization More Accurate?

OBJECTIVE

The purpose of this study was to evaluate changes in marijuana use prevalence and user characteristics across the 2012 recreational legalization in Washington State. Differences in change estimates between retrospective and contemporaneous pre-legalization measures are compared and considered in relation to potential social acceptability and illegality effects on reporting.

METHOD

Four representative surveys of the Washington State population 18 years and older were conducted by telephone, two in 2014 and two in 2015, which are combined by year for analyses (N = 3,451). Respondents reported their current past-year use frequency and retrospective frequency of use in 2012 before the election in which legalization was passed. They also provided demographic information and details of alcohol use, including simultaneous use with marijuana.

RESULTS

A small and not statistically significant increase of 1.2 percentage points in past-year use prevalence, from 24.3% (22.3-26.5) to 25.6% (23.6-27.6), was found when combining the surveys. No statistically significant change was found in the prevalence of simultaneous use with alcohol, which decreased from 12.9% (11.3-14.7) to 12.6% (11.0-14.4). In contrast, estimates from the National Survey on Drug Use and Health (NSDUH) indicate substantially increased prevalence, from 15.5% (13.8-17.3) in 2010-2012 to 19.1% (16.9-21.4) in 2013-2014, although this change is not statistically significant. Other findings of interest from the Washington State surveys include new users after legalization tending to be older, White, and moderate drinkers who do not use marijuana simultaneously with alcohol.

CONCLUSIONS

A retrospective pre-legalization measure showed only a small increase in marijuana use prevalence in contrast to larger changes found in prospectively assessed use in the NSDUH. Changes in the social acceptability and legal status of marijuana after legalization may have increased reporting of pre-legalization use compared with concurrent assessments.

Marijuana policy opinions in Washington state since legalization: Would voters vote the same way?

BACKGROUND

In 2012, voters in Washington state approved Initiative 502 (I-502) which legalized recreational marijuana use at the state level. This study examines the relationship between demographics, marijuana and alcohol use, and voting outcomes, as well as how these variables relate to (i) whether voters would still vote the same way (a reflection of satisfaction with the new policy) and (ii) the likelihood of using marijuana purchased from legal retail stores.

METHODS

The sample consists of 2,007 adult Washington state residents recruited through Random Digit Dial between January and October 2014. Bivariate tests and multivariable regressions were used for analyses.

RESULTS

Less than five percent of those who voted for marijuana legalization would change their votes, whereas 14% of those who voted against legalization would change their votes. In multivariable models controlling for demographics, substance use, and marijuana-related opinions, those who voted for legalization had half the odds of changing their votes than those who voted against it. Among past-year non-marijuana users, almost 10% were somewhat/very likely to use marijuana if they could buy it from a legal store. Past marijuana use, the belief that adults should be allowed to grow marijuana for personal use, and the belief that marijuana is not very risky for health were all related to increased likelihood of using marijuana purchased from legal stores.

CONCLUSION

Since November 2012, support for marijuana legalization in Washington state has increased; accounting for the proportion of voters who would change their votes suggests that I-502 would pass today with even more votes in favor.