SALT LAKE CITY — If you drink alcohol in Utah, Anna Buckner is tracking you and will be for the next four years.
But don’t look for her at a state liquor and wine store or in your neighborhood bar; most days she’s in her cubicle on the second floor at the state Department of Health, where she studies what and where Utahns are drinking and what it does to their health — part of research that could ultimately change how alcohol is sold in the state in coming years.
Buckner is an epidemiologist — Utah's first to solely focus on alcohol — and she's beginning her second year in a position funded for five years by the U.S. Centers for Disease Control and Prevention.
Utah was one of five states awarded grants to study alcohol consumption and evidence-based strategies to combat disease and death associated with alcohol. (The others are Minnesota, Michigan, New Mexico and Colorado.) But it's not, Buckner points out, because Utah has an alcohol problem that exceeds that of other states.
Utah’s overall consumption is lower than most states, in part because of strict state governance of sales and a predominantly Mormon population that eschews alcohol.
But when Utahns do drink, many of them drink a lot at one time — up to seven or eight drinks in a single session of what's known as binge-drinking.
Also, in Utah, alcohol consumption is rising, as it is across the U.S., a trend that the authors of one recent study said comprises a public health crisis for the nation. In 2007, Utah's alcohol consumption was 2.076 gallons per capita; in the fiscal year ending June 30, 2017, it was 2.941.
Nationwide, alcohol use rose in almost every U.S. demographic between 2001 and 2013, a troubling development that has been overshadowed by the opioid epidemic, according to the report published in the journal JAMA Psychiatry in September.
More people die each year from alcohol and its effects than from drug overdoses, however.
In December, the CDC said that 63,600 Americans died from drug overdoses in 2016. In 2014, the latest year for which federal statistics are available, alcohol was responsible for 88,000 deaths, the CDC says. Utah ranks 35th in the nation for alcohol-induced deaths.
Moreover, alcohol use contributes to a range of illnesses and chronic diseases, ranging from fetal disorders to hypertension, stroke, cardiovascular and liver disease and cancer.
The authors called for greater efforts to address factors that contribute to drinking and to develop intervention and prevention strategies to forestall the projected increases in chronic disease, especially among women, older adults, racial and ethnic minorities and the socioeconomically disadvantaged.
Enter Buckner, who was already on the job when the study was published. Here’s what she’s learned in her first year on the job, and how her work might affect every Utahn who drinks.
Frequent and intense
Buckner, 33, earned two master’s degrees from the University of Montana (one in economics, one in public health) and was working as a Medicaid analyst for the state of Montana before moving to Salt Lake City one year ago.
The timing of the CDC grant was fortuitous: Her husband had just gotten a new job as an instructional designer at a community college and she was scanning jobs on the Utah government website when the epidemiologist opening was posted. Her supervisor, Anna Fondario, said Buckner stood out among a handful of candidates because of her education, government experience and stellar interview. She started the job Jan. 30, 2017.
Buckner is the only person at the Department of Health whose whole focus is alcohol. Her initial mission, as defined by the grant, is to “build capacity” — that is, to collect and review data already available about alcohol use in the state, and to determine if more should be collected.
Additionally, she will review evidence-based policies on reducing excessive alcohol use, to see which ones are currently used in Utah, and, when possible, to explore the possibility of implementing more. She is also to serve as a resource for any groups or individuals who need information on alcohol or alcohol-related harm in Utah.
Anna Fondario, epidemiology manager for the Department of Health, said Buckner is a conduit between her department, the Alcoholic Beverage Commission and the Department of Substance Abuse and Mental Health, all of which study different aspects of alcohol use.
“In Utah, we have a lot of different agencies that collect data related to alcohol, but we didn’t really have one specific designated person that could help bring all of that information together, to look at trends and also provide some of the best practice recommendations of how we want to approach it,” Fondario said.
Buckner's research may inform policymakers as they grapple with two issues expected to come before the Legislature this year: Whether to amend penalties for driving under the influence once the new blood alcohol content law takes effect on New Year’s Eve of this year. That law, which lowers the bar for a DUI violation to .05 blood alcohol, will be the most stringent in the nation. And, lawmakers may debate what to do about 3.2 percent beer sold in grocery and convenience stores if, as expected, major manufacturers stop making it.
Utah may seem like an odd state for the CDC to send dollars to study alcohol. In 2016, 31.7 percent of Utah adults reported current alcohol use and 12.5 percent reported binge drinking, compared to 55 percent and 16.9 percent of all U.S. adults, according to the Behavioral Risk Factor Surveillance System Survey, a telephone survey conducted in all 50 states.
But, Buckner said, “Because we do have these lower use rates, as you would expect with a large population that abstains from alcohol, we still have some issues that we need to be aware of, because of the people who are drinking, they are doing so at a rate that puts them at an increased risk.”
She is speaking of people who are considered binge drinkers — generally defined as men consuming five or more drinks at a time, four for women — and people considered heavy drinkers, men who consume 15 or more drinks in one week, eight or more for women.
When it comes to these categories — and the frequency (how often one drinks) and intensity of drinking (how much one drinks in a single sitting) — Utah looks less like Utah, and more like the rest of the nation.
Utahns who engaged in binge-drinking last year did so more frequently than other Americans: 4.7 times per month compared to the national average of 4.4. They also drank more during a binge: 8.2 drinks during a binge, compared to 7.4 nationally.
“Here, those rates are much higher than you would expect. For frequency, we’re very close to the national average, and for intensity, we’re actually just above the national average,” Buckner said. “We also see, probably related to that, we have had in the past 10 years, we have seen an increase in alcohol poisoning deaths as well.”
Utah ranked seventh in the nation for alcohol poisoning deaths, according to the CDC.
'A variety of health harms'
Coming from a state where drinking rates are much higher than Utah, Buckner said she was surprised by the frequency and intensity of some Utah drinkers. But she was also interested to learn in her first year on the job that 9 out of 10 binge drinkers are not people with alcohol use disorders.
“To my mind, that gets at the issue. A lot of people who engage in this type of behavior don’t think they’re at risk for increased health harm. They think it’s only people who have an alcohol use disorder who are going to be negatively affected.
“But really, when you engage in this type of behavior, you are at risk for a variety of health harms such as cancer and heart disease. It’s not just motor vehicle crashes or liver disease. It’s much wider than that.”
The World Health Organization considers alcoholic beverages a "known carcinogen."
“Nationally, it’s estimated that about 90,000 people die of alcohol attributable causes every year. That’s a big number. But there’s not a realization that it puts as many people at risk as it does,” Buckner said.
Looking ahead, Buckner plans to study the density of alcohol outlets in Utah and to learn if the presence of stores and establishments that serve alcohol are associated with higher rates of motor vehicle crashes, underage sales and violent crime.
That’s one of the evidence-based strategies that the CDC recommends to reduce harm from alcohol consumption, along with limiting hours and days of sale, and increasing alcohol excise taxes.16 comments on this story
Utah operates 44 retail stores that sell spirits and wine; 20 of them are in Salt Lake County, according to the Department of Alcoholic Beverage Control.
Buckner, who is married to a marathon runner, is health conscious, but confesses to taking the occasional social drink — although, she says, that’s been happening less frequently since she took this job. “Being in this position does make you re-evaluate your behaviors and how you think about alcohol; it definitely has changed my personal perspective,” she said.