Increases in alcohol availability have caused crime rates to escalate across multiple regions around the world. As individuals consume alcohol they experience impaired judgment and a dose-response escalation in aggression that, for some, leads to criminal behaviour. By limiting alcohol availability it is possible to reduce crime; however, the literature remains mixed on the best practices for alcohol access restrictions. Variances in data quality and statistical methods have created an inconsistency in the reported effects of price, hour of sales, and alcohol outlet restrictions on crime. Most notably, the research findings are influenced by the different effects of alcohol establishments on crime. The objective of this PhD research was to develop novel quantitative approaches to establish the extent alcohol access (outlets) influences the frequency of crime (liquor, disorder, violent) at a fine level of spatial detail (x,y locations and block groups). Analyses were focused on British Columbia’s largest cities where policies are changing to allow greater alcohol access, but little is known about the crime-alcohol access relationship. Two reviews were conducted to summarize and contrast the effects of alcohol access restrictions (price, hours of sales, alcohol outlet density) on crime, and evaluate the state-of-the-art in statistical methods used to associate crime with alcohol availability. Results highlight key methodological limitations and fragmentation in alcohol policy effects on crime across multiple disciplines. Using a spatial data science approach, recommendations were made to increase spatial detail in modelling to limit the scale effects on crime-alcohol association. Providing guidelines for alcohol-associated crime reduction, kernel density space-time change detection methods were also applied to provide the first evaluation of active policing on alcohol-associated crime in the Granville St. entertainment district of Vancouver, British Columbia. Foot patrols were able to reduce the spatial density of crime, but hot spots of liquor and violent assaults remained within 60m proximity to bars (nightclubs). To estimate the association between alcohol establishment size, and type on disorder and violent crime reports in block groups across Victoria, British Columbia a Poisson Generalized Linear Model with spatial lag effects was applied. Estimates provided the factor increase (1.0009) expected in crime for every additional patron seat added to an establishment capacity, and indicated that establishments should be spaced greater than 300m a part to significantly reduce alcohol-associated crime. These results offer the first evaluation of seating capacity and establishment spacing on alcohol-associated crime for alcohol license decision making, and are pertinent at a time when alcohol policy reform is being prioritized by the British Columbia government. In summary, this dissertation contributes 1) cross-disciplinary policy and methodological reviews, 2) expands the application of spatial statistics to alcohol-attributable crime research, 3) advances knowledge on local scale of effects of different alcohol establishment types on crime, 4) and develops transferable models to estimate the effects of alcohol establishment seating capacity and proximity between establishments on the frequency of crime. / Graduate / 2018-02-27

The purpose of this dissertation is to study the Europeanization of Swedish alcohol policy from 1995-2006. It analyses the development of Swedish and European alcohol policy and answers the following research questions: How has alcohol policy developed on the national and the EU level during this period? What are the Swedish alcohol policy initiatives on the EU level? What does the interplay between Swedish and European policy processes look like? Of interest for this dissertation is also how the Swedish view on alcohol policy has been received on EU level. The dissertation comprises four related articles and an introductory chapter. In the articles official documents and interviews are analyzed in the context of the literature on Europeanization, using the concepts framing, narrative and new modes of governance. Article I explores the history of negotiations between Sweden and the EU on the traveller’s allowances question. Article II and III analyse how Swedish authorities, first through research and later through formal policy-making during the Swedish Presidency, tried to reframe alcohol on the EU-level. Finally, the fourth article is a comparative analysis of the Nordic retail monopolies, analyzing how the monopolies have developed and reacted to national and international pressures on their activities. The dissertation shows that Swedish authorities have influenced the EU level by putting alcohol on the agenda, and offered pressure and economic support to make sure that alcohol as a public health question has become and been kept as a prioritized question. This development is, however, nested inside the changing scope and emphasis of the EU. The emergence of a European alcohol policy as a public health-oriented process has been made possible through a new focus on the EU level, with increased cooperation between member states and a trend toward harmonization of policy and frames when it comes to alcohol.

Throughout its history, the EU has been centred around economic integration. Today, however, the EU's political ambitions extend to more areas, such as environment and health. How does the legacy of economic integration affect the EU's ability to pursue policy in these areas, especially when it may offset commercial objectives? One such area is alcohol policy. While alcohol policy often involves a trade-off between health and commercial objectives, EU alcohol policy has historically prioritised the latter. This appeared to change with the announcement of Europe's Beating Cancer Plan in 2021. This thesis, using the Advocacy Coalition Framework, studies EU alcohol policy to determine whether or not a policy shift towards a more ambitious public health policy occurred as a result of the plan. The results show that policy change did not happen in the wake of the cancer plan. Instead, policy was delayed or changed to not interfere with commercial goals. The findings also show that two coalitions fought for influence over the policy process. One, centred around public health actors, and one centred around alcohol industry actors. The study shows that the industry coalition was more influential at key stages that affected the outcome of the policy deliberations. The conclusions show that the political culture and commercial structures set up to accommodate single market integration also act as defenders of commercial priorities. Notably, corresponding structures for public health were either limited or non-existent. This suggests that a bias exists that hinder significant political progress on health policy.

Hintergrund. Deutschland gehörte im Jahr 2019 zu den Ländern mit dem weltweit höchsten Pro-Kopf-Alkoholkonsum, welcher wesentlich zur Krankheitslast beiträgt. Fragestellung. In dieser Modellierungsstudie schätzen wir, wie viele alkoholbedingte inzidente Krankheits- sowie Todesfälle in Deutschland im Jahr 2019 hätten vermieden werden können, wenn die derzeitigen Verbrauchssteuern auf Alkohol um 20%, 50% und 100%erhöht worden wären. Methodik. Ausgangspunkt für die Modellierung sind die spezifischen Verbrauchssteuern auf alkoholische Getränke in Deutschland. Drei Szenarien wurden unter der Annahme, dass die resultierende Steuererhöhung vollständig in den Verkaufspreis übertragen wird, und unter Verwendung von getränkespezifischen Preiselastizitäten modelliert. Mittels des sich daraus ergebenden Rückgangs im jährlichen Pro-Kopf-Konsum und der krankheitsspezifischen Risikofunktionen wurde die vermeidbare alkoholbedingte Inzidenz bzw. Mortalität geschätzt. Berücksichtigt wurden alkoholbedingte Erkrankungen des Herz-Kreislauf- und Verdauungssystems, Alkoholabhängigkeit, Epilepsie, Infektionskrankheiten sowie Verletzungen und Unfälle. Ergebnisse. Insgesamt hätten durch eine Verdoppelung der spezifischen Verbrauchssteuern auf Alkohol im Jahr 2019 bis zu 200.400 alkoholbedingte Erkrankungs- und Verletzungsfälle sowie 2800 Todesfälle vermieden werden können. Dies entspricht knapp 7% der berücksichtigten alkoholbedingten Krankheits- bzw. Todesfälle in Deutschland. Diskussion. Alkoholbedingte Erkrankungen und Verletzungen sind vermeidbar und eine Erhöhung der spezifischen Verbrauchssteuern auf alkoholische Getränke in Deutschland könnte die alkoholbedingte Krankheitslast substanziell reduzieren. / Background. In 2019, Germany was among the countries with the highest alcohol per capita consumption in the world, which contributes significantly to the burden of disease. Aim. In this modelling study, we estimate how many alcohol-attributable diseases and deaths in Germany could have been avoided in 2019 if current alcohol excise taxes were increased by 20%, 50%, and 100%. Methods. The starting point for the modelling was the national beverage-specific alcohol taxes. Three scenarios were modelled under the assumption that the resulting tax increase would be fully transferred to the retail prices. Beverage-specific price elasticities were used. Based on the estimated resulting decline in annual per capita consumption and the disease-specific risk functions, we modelled the avoidable incidence and mortality for alcohol-attributable diseases for 2019. Alcohol-attributable diseases of the cardiovascular and digestive systems, alcohol dependence, epilepsy, and infectious diseases as well as injuries and accidentswere considered. Results. Overall, doubling the beveragespecific alcohol taxes could have avoided up to 200,400 alcohol-attributable cases of disease and injury as well as 2800 deaths in Germany in 2019. This corresponds to just under 7% of the modelled new alcohol-attributable cases of disease and death in Germany. Discussion. Alcohol-attributable diseases and injuries are preventable and an increase in the alcohol taxes could substantially reduce the alcohol-attributable burden of disease in Germany.