
Alexander C WagenaarEmory University | EU · Department of Behavioral Sciences and Health Education
Alexander C Wagenaar
PhD
About
252
Publications
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Introduction
Dr. Wagenaar is Research Professor at the Emory University Rollins School of Public Health and Professor Emeritus at the University of Florida College of Medicine. He has published almost 200 papers and two books on social and behavioral epidemiology, public health policy, legal evaluations, community intervention trials, alcohol and tobacco studies, traffic safety, and injury control. His research papers are widely cited--over 10,000 citations to date, according to Google Scholar.
Additional affiliations
July 2016 - present
January 2011 - May 2014
January 2005 - June 2016
Education
January 1978 - December 1980
June 1977 - December 1978
August 1973 - May 1977
Publications
Publications (252)
A team of tribe-based behavioral health specialists and university-based researchers partnered to implement a cluster randomized trial for the prevention of drug misuse among adolescents attending public high schools on or near the Cherokee Nation Reservation in northeastern Oklahoma. The conceptual framework, which guided intervention and measurem...
Objectives:
We assess cannabis advertising exposure among adolescents in rural Oklahoma from medical dispensaries.
Methods:
Our mixed-methods study identified medical dispensaries within a 15-minute drive-time of rural Oklahoma high schools. Study staff completed observational data collection forms and took photographs of each dispensary. Quanti...
Background
The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with A...
Background: The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with...
Background: The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with...
Purpose
The U.S. federal Earned Income Tax Credit (EITC) is often considered the most effective antipoverty program for families in the U.S., leading to a variety of improved outcomes such as educational attainment, work incentives, economic activity, income, and health benefits for mothers, infants and children. State EITC supplements to the feder...
Poverty has numerous deleterious effects on health, and the Earned Income Tax Credit (EITC) is the major policy tool used to alleviate poverty in the U.S. We evaluate effects of four distinct changes in earned income tax credit law in Washington, DC on maternal behaviors and infant outcomes. An interrupted time-series design was used with 312 month...
Purpose: Health disparities persist in birth outcomes by mother's income, education, and race in the United States. Disadvantaged mothers may experience benefit from supplements to family income, such as the earned income tax credit (EITC). We examined the effects of state-level EITCs on birth outcomes among women with a high school education or le...
Background:
Research suggests that reduced retail alcohol outlet density may be associated with lower prevalence of HIV and other sexually transmitted infections (STIs). On-premise sale of alcohol for immediate consumption is theorized as increasing social interactions that can lead to sexual encounters.
Objective:
We examined associations betwe...
Objectives:
To evaluate effects of 2 alcohol prevention interventions-Communities Mobilizing for Change on Alcohol (CMCA), a community organizing intervention designed to reduce youth alcohol access, and CONNECT, an individual-level screening and brief intervention approach-on other drug use outcomes.
Methods:
We conducted a community interventi...
Aims:
We evaluated the effects of a community organizing intervention, Communities Mobilizing for Change on Alcohol (CMCA), on the propensity of retail alcohol outlets to sell alcohol to young buyers without age identification and on alcohol acquisition behaviors of underage youth.
Design:
Random assignment of community to treatment (n=3) or con...
Objectives:
To examine the association between Colorado's legalization of recreational cannabis use and opioid-related deaths.
Methods:
We used an interrupted time-series design (2000-2015) to compare changes in level and slope of monthly opioid-related deaths before and after Colorado stores began selling recreational cannabis. We also describe...
The purpose of this paper is to investigate the effects of state-level Earned Income Tax Credit (EITC) laws in the U.S. on maternal health behaviors and infant health outcomes. Using multi-state, multi-year difference-in-differences analyses, we estimated effects of state EITC generosity on maternal health behaviors, birth weight and gestation week...
Objectives:
To evaluate the effectiveness of a multilevel intervention designed to prevent underage alcohol use among youths living in the Cherokee Nation.
Methods:
We randomly assigned 6 communities to a control, Communities Mobilizing for Change on Alcohol (CMCA; a community-organizing intervention targeting alcohol access) only, CONNECT (a sc...
Objectives:
To investigate the effects of state minimum wage laws on low birth weight and infant mortality in the United States.
Methods:
We estimated the effects of state-level minimum wage laws using a difference-in-differences approach on rates of low birth weight (< 2500 g) and postneonatal mortality (28-364 days) by state and month from 198...
Background
About 35 % of non-elderly U.S. adult Medicaid enrollees have a behavioral health condition, such as anxiety, mood disorders, substance use disorders, and/or serious mental illness. Individuals with serious mental illness, in particular, have mortality rates that are 2 to 3 times higher as the general population, which are due to multiple...
Introduction:
Sexually transmitted infections are common causes of morbidity and mortality, including infertility and certain types of cancer. Alcohol tax increases may decrease sexually transmitted infection rates overall and differentially across population subgroups by decreasing alcohol consumption in general and prior to sex, thus decreasing...
Major advances in population health will not occur unless we translate existing knowledge into effective multicomponent interventions, implement and maintain these in communities, and develop rigorous translational research and evaluation methods to ensure continual improvement and sustainability. We discuss challenges and offer approaches to evalu...
We comment on the 2015 Society for Prevention Research standards of evidence document, summarizing major changes from the previous 2005 Standards, and point to ways in which the Standards could be further improved. We endorse important new standards, such as those on testing the causal theory and mechanisms of the intervention, improved trial repor...
Access to alcohol among individuals under 21 years of age continues to be a public health concern with approximately 5000 youth deaths attributable to alcohol each year (US Department of Health and Human Services 2007). To date, there is no research on youth access to alcohol from commercial sources within rural communities with large populations o...
Despite advances in prevention science in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youths, especially among vulnerable rural and American Indian communities. The Prevention Trial in the Cherokee Nation is a partnership between prevention/implementation scientists and Cherokee Natio...
We examined the associations among zip code demographics, the state alcohol policy environment, and the retail outlet availability of multiple fruit-flavored alcoholic drinks in a can (MFAC).
In a nationally representative sample of zip codes (n = 872), we merged data from 4 sources: publicly available marketing information from 2 major MFAC produc...
Routine health information systems (RHISs) are in place in nearly every country and provide routinely collected full-coverage records on all levels of health system service delivery. However, these rich sources of data are regularly overlooked for evaluating causal effects of health programmes due to concerns regarding completeness, timeliness, rep...
We examined the effects of a 2009 increase in alcohol taxes in Illinois on alcohol-related fatal motor vehicle crashes.
We used an interrupted time-series design, with intrastate and cross-state comparisons and measurement derived from driver alcohol test results, for 104 months before and 28 months after enactment. Our analyses used autoregressive...
We examined differences in response to self-reported alcohol use items by survey mode, whether self-report differences were the result of modality effects or self-selection, and whether these differences varied across the treatment and control arms of a preventative intervention trial.
Data from an existing alcohol prevention trial were used to est...
Background: Scientific reviews overwhelmingly document the effects of increasing alcohol taxes on reducing alcohol consumption and related problems. To assist translation of this research into public health practice, a research collaborative formed to fill key gaps in the evidence base.
Methods: Teams from four universities used a variety of meth...
We develop the distinction between observational and interventional research methods. Randomized field experiments are often thought to be the "gold standard" for empirical evidence, although they have both advantages and disadvantages. One primary disadvantage is that field experiments are often thought to be infeasible, and one might assume that...
Objectives: This review examines the effects of family economic security policies on child and family health outcomes, formulates a framework for possible mechanisms of effect, and introduces our policy surveillance system to measure changes in state laws affecting social determinants
of health. Methods: We carried out a comprehensive review of the...
Until November 2012, no modern jurisdiction had removed the prohibition on the commercial production, distribution, and sale of marijuana for nonmedical purposes-not even the Netherlands. Government agencies in Colorado and Washington are now charged with granting production and processing licenses and developing regulations for legal marijuana, an...
Despite advances in prevention science and practices in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth, especially among vulnerable rural and American Indian youth. The Prevention Trial in the Cherokee Nation is a partnership between prevention scientists and Cherokee Nation Behavi...
Despite advances in prevention science and practice in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth, especially among vulnerable rural and Native American youth. The Prevention Trial in the Cherokee Nation is a partnership between prevention scientists and Cherokee Nation Behavio...
Alcohol taxes reduce population-level excessive alcohol use and alcohol-related morbidity and mortality. Yet, little is known about the distribution of the effects of alcohol taxation across race/ethnicity and age subgroups. We examined the race/ethnicity- and age-group-specific effects of an excise alcohol tax increase on a common and routinely co...
Empirical evaluation of injury control laws has supported dramatic injury prevention gains in the past few decades. Studies have demonstrated beneficial effects in reduced injury, and facilitated diffusion of effective policies. A limitation of this research has been its a-theoretical stanceshowing a relationship between a law and injury rates, but...
Empirical evaluation of injury control laws has supported dramatic prevention gains in the past decades. Studies have demonstrated beneficial effects in reduced injury, and facilitated diffusion of effective policies. Nevertheless, evaluations continue to use research designs characterized by limitations on internal validitythe strength of confiden...
Objective:
Underage alcohol compliance checks conducted by law enforcement agencies can reduce the likelihood of illegal alcohol sales at checked alcohol establishments, and theory suggests that an alcohol establishment that is checked may warn nearby establishments that compliance checks are being conducted in the area. In this study, we examined...
Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supportin...
Although legal interventions are responsible for many sentinel public health achievements, law is underutilized as a tool for advancing population health. Our purpose was to identify critical opportunities for public health lawmaking. We articulated key criteria and illustrated their use with 5 examples. These opportunities involve significant heal...
Objectives:
Medical marijuana laws (MMLs) have been suggested as a possible cause of increases in marijuana use among adolescents in the United States. We evaluated the effects of MMLs on adolescent marijuana use from 2003 through 2011.
Methods:
We used data from the Youth Risk Behavior Survey and a difference-in-differences design to evaluate t...
This book, published in 2013 by Jossey-Bass, describes scientific theory and methods for investigating the development, implementation and effects of public health law. The empirical study of law can be conducted in many disciplines, so there is no special science of public health law research. Epidemiology, economics, physiology, and sociology do...
We examined effects of New York and California’s statewide smoke-free restaurant and bar polices on alcohol-related car crash fatalities. We used an interrupted time-series design from 1982 to 2008, with 312 monthly observations, to examine the effect of each state’s law on single-vehicle-nighttime crashes and crashes involving a driver with a bloo...
Changes in state medical marijuana legislation (MML) have been suggested as potential causes of the recent increasing national trend of non-medical marijuana use among adolescents, sparking a national debate regarding the legal status of marijuana. Initial studies of the effect of MML in California did not find evidence of increases in non-medical...
Theoretically grounded research illuminating mechanisms of legal effect has at least three important benefits for public health law research and practice: Defining the phenomena to be observed, supporting causal inference, and guiding reform and implementation. The choice of what theory or theories to draw upon is a practical one based on research...
Public health approaches dating back to the late 18th century and earlier were primarily focused on economic, social and physical environmental conditions that increase risk of morbidity and mortality. As public health and medical breakthroughs of the early 20th century controlled infectious diseases and expanded life expectancy, public health shif...
Effectively studying the relationship between law and population health requires (1) variation in both the law and health outcomes being studied, preferably over space as well as time, and (2) valid and reliable methods for capturing variation and representing it in forms that allow comparison. A rigorous method for measuring law generates numeric...
State laws limiting the use of mobile communications devices (MCDs) by drivers are being enacted at an accelerating pace. Public health law research is needed to test various legislative models and guide future legal innovation.
To define the current state of the law, facilitate new multi-state evaluations, and demonstrate the utility of systematic...
The serotonin transporter promoter polymorphism (5-HTTLPR) has been linked to a number of human behavioral traits and disorders. The variants of 5-HTTLPR are commonly reported in three forms, L/L, S/L and S/S, with the latter most often associated with emotional distress and/or behavioral dysfunction. Missing from the research literature are invest...
Objectives: To conduct a systematic review of effects of alcohol taxes and prices on alcohol-related morbidity and mortality. Methods: Nine databases plus reference lists were searched for studies providing estimates of the relationship between alcohol taxes and prices and measures of risky behavior or morbidity and mortality. Effect sizes and nume...
Despite an existing body of research on laws related to health outcomes, the science of moving from the written text of laws to numbers in a database is not universally well understood. There are numerous measurement and coding considerations when defining a structure and details of a public health law database. This presentation addresses such cha...
Public health law has received considerable attention in recent years with much less attention to the empirical study of public health law. The National Program Office for Public Health Law Research was funded by the Robert Wood Johnson Foundation starting in 2009 to advance the field of public health law research. We define public health law resea...
Over a hundred studies have established the effects of beverage alcohol taxes and prices on sales and drinking behaviors. Yet, relatively few studies have examined effects of alcohol taxes on alcohol-related mortality. We evaluated effects of multiple changes in alcohol tax rates in the state of Florida from 1969 to 2004 on disease (not injury) mor...
We systematically reviewed the effects of alcohol taxes and prices on alcohol-related morbidity and mortality to assess their public health impact.
We searched 12 databases, along with articles' reference lists, for studies providing estimates of the relationship between alcohol taxes and prices and measures of risky behavior or morbidity and morta...
Evaluations that combine social science and law have tremendous potential to illuminate the effects of governmental policies and yield insights into how effectively policy makers' efforts achieve their aims. This potential is infrequently achieved, however, because such interdisciplinary research contains often overlooked substantive and methodolog...
Public health law has received considerable attention in recent years and has become an essential field in public health. Public health law research, however, has received less attention.
Expert commentary.
This article explores public health law research, defined as the scientific study of the relation of law and legal practices to population heal...
Alcohol use and the related consequences associated with college football games are a serious public health issue for university communities.
Examining "Extreme Ritualistic Alcohol Consumption" (ERAC), defined as consuming 10 or more drinks on game day for a male, and 8 or more drinks for a female, is the focus of this study.
In the fall of 2006, c...
Research on the impact of public health laws can yield powerful insights into how effective policymakers’ efforts translate into actual improved health outcomes. Such research can also illuminate the unintended health consequences of these policy efforts. Despite this potential, challenges inherent in interdisciplinary research can result in consid...
We conducted a meta-analysis of English-language published studies from 1960 to 2006 examining relationships between beverage alcohol tax or price levels and alcohol sales, consumption, and traffic crash outcomes. We identified 155 papers containing 1137 separate empirical estimates of effect of alcohol taxes on various measures of alcohol consumpt...
To identify antecedents of risk behavior events in college bar patrons.
In this nighttime field study, self-report data and alcohol intoxication readings were collected from patrons immediately upon exiting bars (n = 618).
Multilevel structural equation modeling revealed positive associations between age of drinking onset and both alcohol use inten...
Many population studies find that alcohol prices are inversely related to alcohol consumption and alcohol-related problems, including among college students and young adults. Yet, little is known about the "micro-level" effects of alcohol price on the behavior of individual consumers in natural drinking settings such as college bars. Therefore, we...
Four focus groups involving 26 male and female high school seniors were conducted to provide insight into the context and settings in which alcohol is provided to youth, and why some youth choose certain sources of alcohol over others. Adults over the age of 21 years were the most common source of alcohol used by participants. Participants believed...
We conducted a systematic review of studies examining relationships between measures of beverage alcohol tax or price levels and alcohol sales or self-reported drinking. A total of 112 studies of alcohol tax or price effects were found, containing 1003 estimates of the tax/price-consumption relationship.
Studies included analyses of alternative out...
We evaluated the effects of tax increases on alcoholic beverages in 1983 and 2002 on alcohol-related disease mortality in Alaska.
We used a quasi-experimental design with quarterly measures of mortality from 1976 though 2004, and we included other states for comparison. Our statistical approach combined an autoregressive integrated moving average m...
To evaluate effects of a training program for owners/managers of alcohol establishments-Alcohol Risk Management (ARM)-on: (i) propensity to sell alcohol to obviously intoxicated patrons; and (ii) changing establishment-level policies/practices.
We assigned alcohol establishments randomly to intervention (full-ARM) and delayed-intervention/control (...
We investigated the role of the alcohol environment in explaining disparities in homicide rates among minorities in 10 cities in the United States using 2003 data from the Malt Liquor and Homicide study. We hypothesized that (a) higher concentrations of African Americans would be associated with higher homicide rates, as well as higher alcohol and...
Hundreds of laws have been implemented in the United States over the past few decades designed to reduce alcohol-impaired driving and the crashes that often result. One approach has been to lower the legally allowable alcohol concentration for drivers. We examined the effects of changes in legal BAC limit in 28 U.S. states from January, 1976 to Dec...
We examined effects of state statutory changes in DUI fine or jail penalties for firsttime offenders from 1976 to 2002.
A quasi-experimental time-series design was used (n=324 monthly observations). Four outcome measures of drivers involved in alcohol-related fatal crashes are: single-vehicle nighttime, low BAC (0.01-0.07g/dl), medium BAC (0.08-0.1...
We evaluated the effects of driving under the influence (DUI) mandatory preconviction and postconviction drivers' license suspension laws in each of 46 U.S. states using 1 to 2 decades of long-term follow-up data on fatal car crashes. State-specific results were combined using meta-analytic techniques, and provide a direct test of the concept of ce...
We provide an overview of environmental strategies that may reduce college drinking. The identified environmental strategies fall into three categories: (1) reducing alcohol use and related problems among underage college students, (2) reducing risky alcohol use and related problems among all college students, and (3) de-emphasizing the role of alc...
Drinking by youth remains prevalent. The Reducing Underage Drinking through coalitions (RUD) project funded ten states for 8 years to form coalitions designed to change the policy and normative environment regarding youth access to alcohol. An independent national outcome evaluation of this $21-million effort was conducted.
Using a longitudinal qua...
The goal of this study was to assess the feasibility and effectiveness of two interventions aimed at reducing alcohol-related risks at community festivals--a training program for festival planners and a community organizing campaign. We randomly selected four festivals for each intervention and had 24 comparison festivals. Our assessment included p...