Alcohol control and injury death in Alaska native communities: Wet, damp and dry under Alaska's local option law

Objective: This article tests whether different forms of community-level al cohol control significantly affect injury deaths in a population with extre mely high injury mortality. Method: The 1981 Alaska local option law provid es a natural experiment for studying how implementation of community level controls may be associated with changes in injury deaths, most of which are alcohol-related, among Alaska Natives living in small communities. The stu dy compares population and community-specific death rates under different l evels of alcohol control for the 97 communities that passed restrictions be tween 1980 and 1993 with the death rates in the same communities during per iods when no restrictions were in place. Results: Injury death rates were g enerally lower during periods when alcohol sales, importation or possession were restricted than when no restric-tions were in place (wet). More restr ictive controls (dry) significantly reduced homicides; less restrictive con trol options (damp) reduced suicides. Accident and homicide death rates fel l, on average, by 74 and 66 per 100,000, respectively, for the 89 communiti es that banned sale and importation or possession. A control group of 61 sm all communities that did not change control status under the law showed no significant changes over time in accident or homicide death rates. Conclusi ons: The changes in accidental and homicide death rates are statistically s ignificant, although these reduced rates remain 2.5 to 7 times national dea th rates. The isolated nature of Alaskan villages may explain why alcohol c ontrol has more effect in Alaska than has been found in studies of Native A mericans Living in other states.