Comparative case study research on events leading to alcohol tax changes in three states

Background: The Community Preventive Services Task Force has recommended raising alcohol taxes as an effective means of reducing excessive use and related harms. Despite this public health recommendation, few states raise alcohol tax rates regularly. We examined the role that research, public health expertise and various stakeholders played in recent alcohol price changes in Illinois, Maryland and Massachusetts through historical comparative case study research. Methods: We analyzed relevant documents including bills and ballot initiatives, voter information materials, and background materials prepared by stakeholders. We conducted key informant interviews regarding the planning, implementation and outcomes of each campaign with more than 30 representatives from various constituencies. We completed a content analysis of approximately 600 newspaper articles from a purposive sample of four newspapers in each state over a two-year period surrounding the passage of the tax increase. Results: We will describe the diversity of reasons for and pathways to alcohol tax increases; the complexity of running a statewide alcohol tax campaign, including strategies used and resources (financial, human and research-related) needed; the nature of key players in the process; and the types of strategic decisions made throughout the campaign. We will present the findings of the newspaper content analysis, elucidating how competing frames were constructed in public discussions about alcohol taxes. Conclusions: Important lessons were learned from the efforts to raise alcohol taxes in Illinois and Maryland, and the 2009 effort to add additional sales tax to alcohol in Massachusetts followed by the 2010 ballot initiative to remove the new tax.