The direct and indirect relationships between alcohol prevention measures and alcoholic liver cirrhosis mortality.
OBJECTIVE
The objective of this article is to investigate direct and indirect relationships between prevention measures and alcoholic liver cirrhosis mortality in Canadian provinces from 1968 to 1986.


METHODS
The data base that was assembled included alcoholic cirrhosis mortality rates, alcohol availability measures (rate of licensed premises, year in which the legal drinking age was reduced), per capita consumption of alcohol, rates of AA members and groups, and economic and demographic measures. This article develops a two-equation analytic model based on the availability theory of alcohol problems and prevention (Single, 1988). The distinction between direct and indirect effects of prevention measures can be made explicitly with this model.


RESULTS
Alcohol availability measures, but not AA measures, had a significant direct potential impact on alcohol consumption. AA measures had a significant direct relationship to cirrhosis mortality rates. Alcohol consumption also had a significant direct relationship to cirrhosis mortality, and alcohol availability measures had an important indirect relationship through their influence on per capita alcohol consumption.


CONCLUSIONS
While these observations need to be interpreted cautiously, the two-equation model shows promise as an approach to understanding direct and indirect influences on alcohol problems. As expected, AA measures and per capita alcohol consumption demonstrated significant direct relationship to cirrhosis mortality. In addition, important indirect influences of drinking-age changes and rates of licensed premises on cirrhosis mortality were observed through their relationships to per capita alcohol consumption.
Xie
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Department of Finance, Ottawa, Ontario, Canada.
Mann
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Smart
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D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000191:economics / Q000517:prevention & control*; D000434:Alcoholic Beverages / Q000600:supply & distribution; D000436:Alcoholics Anonymous / Q000191:economics*; D002170:Canada / Q000453:epidemiology; D004467:Economics; D006801:Humans; D016018:Least-Squares Analysis; D008104:Liver Cirrhosis, Alcoholic / Q000191:economics / Q000401:mortality* / Q000517:prevention & control*; D008875:Middle Aged; D018803:Models, Economic; D012044:Regression Analysis; D012959:Socioeconomic Factors