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Objectives. To assess the exposure of Chinese adolescents to proalcohol advertising and explore its association with alcohol consumption. Methods. A nationally and regionally representative school-based survey was conducted in mainland China in 2021 among students in grades 7 through 12, aged 13 to 18 years. We assessed adolescent exposure to proalcohol advertising and its association with alcohol consumption. Results. A total of 57 336 students participated in the survey, and the exposure percentage of proalcohol advertising was 66.8%, with no difference between boys and girls or between urban and rural areas. The top 3 exposure channels were television (51.8%), the Internet (43.6%), and outdoor billboards (42.0%). The exposure was higher among students who had consumed alcohol in the past 30 days (80.1% vs 65.1%; adjusted odds ratio [AOR] = 1.29) and in the past 12 months (77.3% vs 61.7%; AOR = 1.30). However, no significant correlation was observed between advertising exposure and drunkenness. Conclusions. Approximately two thirds of Chinese adolescents have been exposed to proalcohol advertising in the past 30 days, with television, the Internet, and outdoor billboards being the most prevalent channels. Exposure to proalcohol advertising exhibits a positive correlation with drinking. (Am J Public Health. 2024;114(8):814-823. https://doi.org/10.2105/AJPH.2024.307680).
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Publicidad , Consumo de Bebidas Alcohólicas , Humanos , Adolescente , Masculino , Femenino , China/epidemiología , Publicidad/estadística & datos numéricos , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Alcohol en Menores/estadística & datos numéricos , Encuestas y Cuestionarios , Bebidas Alcohólicas/estadística & datos numéricos , Televisión/estadística & datos numéricos , Internet , Conducta del Adolescente/psicología , Pueblos del Este de AsiaRESUMEN
BACKGROUND: There is a well-published literature on the effectiveness and stringency of alcohol control policies, but not many studies focus on policy implementation, where policies transform into impact. The objective of this study is to create a composite index that measures the capacity for implementing effective alcohol control policies across all provinces in Thailand. METHODS: Based on the international literature, we developed a list of key indicators for tracking the implementation of alcohol policies at the subnational level. To ensure these indicators were relevant to the Thai context, we obtained feedback from Thai experts. We collected primary data according to the developed indicators using questionnaires filled in by key informants at the implementing agencies and gathered secondary data at the provincial level. On this basis, we developed indices that reflect the status of alcohol control policy implementation. We then investigated the association between the indices and the prevalence and pattern of alcohol consumption and alcohol-related harms while adjusting for potential confounders using multiple linear regression and negative binomial regression, respectively. RESULTS: Scores on the Provincial Alcohol Policy Implementation Capacity (PAPIC) Index ranged between 39 and 79. We found that each 1-point increase in PAPIC score was associated with a 1.98 % reduction in the quantity of alcohol consumed in grams per day (coefficient: -0.02; 95 %CI: -0.03, -0.00; p-value<0.05; e-0.02= 0.9802). We also found that for each 1-point increase in PAPIC score, the proportion of regular drinkers reduced by 0.30 per cent (coefficient: -0.30; 95 %CI: -0.55, -0.05; p-value<0.05). However, we did not find any association between the indices and alcohol-related harms. CONCLUSION: The level of implementation of alcohol control policy at the sub-national level is associated with alcohol consumption levels. The findings suggest the value of allocating resources to the implementation of alcohol control policy.
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BACKGROUND: The IAC Policy Index was developed to allow comparison in alcohol policy between countries and within countries over time including in low resource settings. It measures four effective alcohol policies and takes into account stringency of regulation and the actual impact on the alcohol environment, such as trading hours and prices paid. This framework was used to assess policy in Aotearoa New Zealand in a time period covering two relevant legislative changes. This is the first study to use an alcohol policy index to assess and describe legislative change within country. METHODS: Data to calculate the IAC Policy Index was collected for 2013 and 2022. Stringency of policy was assessed from legislative statutes and impacts of policy on the alcohol environment from administrative data and specifically designed data collection. RESULTS: The overall IAC Policy Index score improved over the time period. The scores for the separate policy areas reflected the legislative changes as hypothesised, but also independent changes in impact, given ecological changes including reduced enforcement of drink driving countermeasures and increased exposure to marketing in digital channels. The IAC Policy index reflects the changes in policy status observed in Aotearoa, NZ. DISCUSSION: The IAC Policy Index provided a useful framework to assess and describe change in alcohol legislation contextualised by other influences on policy impact over time within a country. The results indicated the value of assessing stringency and impact separately as these moved independently. CONCLUSIONS: The IAC Alcohol Policy Index, measuring both stringency and actual impact on the alcohol environment with a focus on only the most effective alcohol policies provides meaningful insights into within-country policy strength over time. The IAC Policy Index used over time can communicate to policy makers successes and gaps in alcohol policy.
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Consumo de Bebidas Alcohólicas , Nueva Zelanda , Humanos , Consumo de Bebidas Alcohólicas/legislación & jurisprudencia , Consumo de Bebidas Alcohólicas/epidemiología , Política de Salud/legislación & jurisprudencia , Política Pública , Bebidas Alcohólicas/legislación & jurisprudenciaRESUMEN
BACKGROUND AND AIMS: Quantifying the health burden of alcohol has largely focused upon harm to drinkers, which is an underestimate. There is a growing literature on alcohol's harm to others (HTO), but it lacks the systematic transfer of HTO into a comparative risk assessment framework. This study calculated disability-adjusted life years (DALYs) for fetal alcohol spectrum disorder (FASD), interpersonal violence and traffic injury due to another's drinking. DESIGN: This study is a disease burden analysis, using modelling of DALYs for New Zealand in 2018. SETTING AND PARTICIPANTS: The study took place among the Aotearoa/New Zealand population in 2018. MEASUREMENTS: The involvement of others' drinking was obtained from prevalence, alcohol-attributable fraction studies and administrative data. Disability weights (DW) for FASD were adapted from fetal alcohol syndrome (FAS) weights using a Beta-Pert probability distribution; for interpersonal injury, DWs used hospital events linked with injury compensation; for traffic injury, DWs used hospital events. Populations were stratified by ethnicity, age group and gender. A descriptive comparison was made with a previous estimate of DALYs for drinkers. FINDINGS: In 2018, 78 277 healthy life years were lost in Aotearoa/New Zealand due to alcohol's HTO. The main contributor (90.3%) was FASD, then traffic crashes (6.3%) and interpersonal violence (3.4%). The indigenous population, Maori, was impacted at a higher rate (DALYs among Maori were 25 per 1000 population; among non-Maori 15 per 1000 population). The burden of HTO was greater than that to drinkers (DALYs HTO = 78 277; DALYs drinkers = 60 174). CONCLUSIONS: Disability from fetal alcohol spectrum disorder (FASD) appears to be a major contributor to alcohol's harm to others in Aotearoa/New Zealand. Taking FASD into account, the health burden of harm to others is larger than harm to the drinker in Aotearoa/New Zealand, and ethnicity differences show inequity in harm to others. Quantification of the burden of harm informs the value of implementing effective alcohol policies and should include the full range of harms.
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Consumo de Bebidas Alcohólicas , Trastornos del Espectro Alcohólico Fetal , Femenino , Embarazo , Humanos , Consumo de Bebidas Alcohólicas/epidemiología , Trastornos del Espectro Alcohólico Fetal/epidemiología , Años de Vida Ajustados por Discapacidad , Nueva Zelanda/epidemiología , Pueblo MaoríRESUMEN
Alcohol legislation in Aotearoa New Zealand has not been sufficient to minimise the harm and inequities caused by alcohol use, and a comprehensive review of alcohol policies has been postponed. Because of the alcohol industry's vested interests, the World Health Organization notes that industry involvement in public health policy has potential risks that should be minimised. Here we illustrate the significant extent of alcohol industry penetration in Aotearoa and how such influence undermines equity by amplifying the harms of colonisation. The government lacks policies that limit interactions with the alcohol industry, such as political donations and lobbying. We recommend what can be done to limit alcohol industry influence in policymaking, including using experiences in tobacco control to manage conflicts of interest, strengthening rules over political donations and lobbying, enhancing transparency of interactions, promoting non-collaboration with the alcohol industry and advocating for alcohol policies that give effect to Te Tiriti o Waitangi.
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Formulación de Políticas , Industria del Tabaco , Humanos , Nueva Zelanda , Política Pública , Consumo de Bebidas Alcohólicas/epidemiología , Maniobras PolíticasRESUMEN
INTRODUCTION: The price of alcoholic beverages can vary for a range of reasons, including tax. Risky drinkers purchase more low-cost alcoholic drinks than moderate drinkers, contributing to beverage-specific risks for that category. The study aimed to examine the proportion of total alcohol consumption comprised by each beverage type and their correlates. Australian and New Zealand populations were compared, where drinking cultures are similar, but taxation of alcohol differs. METHOD: Data was taken from the International Alcohol Control study in Australia (N=1580) and New Zealand (N =1979), a cross national survey that asks questions on beverage specific alcohol consumption at a range of different locations. Tax rates were obtained from previous analyses run on the dataset. RESULTS: Ready to Drink (pre-mixed) beverages are more popular in New Zealand and the proportion of these drinks consumed out of total alcohol consumption by risky drinkers was correspondingly higher there. Conversely, the proportion of wine consumed by risky drinkers was higher in Australia. The consumption of spirits and beer by risky drinkers was similar in both countries. DISCUSSION: Differences found for the proportion of beverages consumed by risky drinkers between the countries are fairly well aligned with differences in the taxation of each drink type. Future adaptations in taxation systems should consider the impact of taxes on preferential beverage choice and associated harms.
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Consumo de Bebidas Alcohólicas , Bebidas Alcohólicas , Humanos , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Australia/epidemiología , Cerveza , Etanol , ImpuestosRESUMEN
BACKGROUND: Alcohol policies stand out among other noncommunicable disease-relevant policies for the lack of uptake. Composite indicators have been developed to measure the effects of alcohol control policy. We investigated whether drinking patterns among demographic groups from general population samples of drinkers from diverse countries are associated with alcohol control policy as measured by the International Alcohol Control (IAC) Policy Index. METHODS: Representative samples of adult drinkers from 10 countries (five high-income and five middle-income) were surveyed about alcohol consumption, using beverage and location-specific questions. MEASUREMENTS: The IAC Policy Index was analyzed with frequency, typical occasion quantity, and volume consumed. Analyses used mixed models that included interactions between country IAC Policy Index score and age group, gender, and education level. FINDINGS: Each increase in IAC policy index score (reflecting more effective alcohol policy) was associated with a 13.9% decrease in drinking frequency (p = 0.006) and a 16.5% decrease in volume (p = 0.001). With each increase in IAC Policy Index score, both genders decreased for all three measures, but men less so than women. Women decreased their typical occasion quantity by 1.2% (p = 0.006), frequency by 3.1% (p < 0.001), and total volume by 4.2% (p < 0.001) compared to men. Low and mid-education groups decreased their typical occasion quantity by 2.6% (p < 0.001) and 1.6% (p = 0.001), respectively, compared to high education, while for drinking frequency the low education group increased by 7.0% (p < 0.001). There was an overall effect of age (F = 19.27, p < 0.0001), with 18-19 and 20-24-year-olds showing the largest decreases in typical occasion quantity with increasing IAC policy index score. CONCLUSIONS: The IAC Policy Index, reflecting four effective policies, was associated with volume and frequency of drinking across 10 diverse countries. Each increase in the IAC Policy Index was associated with lower typical quantities consumed among groups reporting heavy drinking: young adults and less well-educated. There is value in implementing such alcohol policies and a need to accelerate their uptake globally.
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Consumo de Bebidas Alcohólicas , Política Pública , Adulto Joven , Humanos , Masculino , Femenino , Consumo de Bebidas Alcohólicas/epidemiología , Renta , Encuestas y Cuestionarios , Etanol , DemografíaRESUMEN
INTRODUCTION: Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity. METHODS: FASD prevalence was estimated from self-reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta-analysis of case-ascertainment or clinic-based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation. RESULTS: We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval [CI] 1.0%; 2.7%) in the 2012/2013 year. For Maori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Maori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Maori, from 1.7% to 6.3%. DISCUSSION AND CONCLUSIONS: This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Maori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol-free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure.
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Trastornos del Espectro Alcohólico Fetal , Efectos Tardíos de la Exposición Prenatal , Humanos , Femenino , Embarazo , Trastornos del Espectro Alcohólico Fetal/epidemiología , Prevalencia , Pueblo Maorí , Nueva Zelanda/epidemiología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Consumo de Bebidas Alcohólicas/epidemiología , EtanolRESUMEN
INTRODUCTION: Alcohol abstinence remains common among adults globally, although low and middle-income countries are experiencing declines in abstention. The effect of alcohol policies on lifetime abstinence is poorly understood. The International Alcohol Control (IAC) policy index was developed to benchmark and monitor the uptake of effective alcohol policies and has shown strong associations with alcohol per capita consumption and drinking patterns. Uniquely, the index incorporates both policy 'stringency' and 'impact', reflecting policy implementation and enforcement, across effective policies. Here we assessed the association of the IAC policy index with lifetime abstinence in a diverse sample of jurisdictions. METHODS: We conducted a cross-sectional analysis of the relationship between the IAC policy index score, and its components, and lifetime abstinence among adults (15+ years) in 13 high and middle-income jurisdictions. We examined the correlations for each component of the index and stringency and impact separately. RESULTS: Overall, the total IAC policy index scores were positively correlated with lifetime abstinence (r = 0.76), as were both the stringency (r = 0.62) and impact (r = 0.82) scores. Marketing restrictions showed higher correlations with lifetime abstinence than other policy domains (r = 0.80), including restrictions on physical availability, pricing policies and drink-driving prevention. DISCUSSION AND CONCLUSION: Our findings suggest that restricting alcohol marketing could be an important policy for the protection of alcohol abstention. The IAC policy index may be a useful tool to benchmark the performance of alcohol policy in supporting alcohol abstention in high and middle-income countries.
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Consumo de Bebidas Alcohólicas , Política Pública , Adulto , Humanos , Consumo de Bebidas Alcohólicas/prevención & control , Estudios Transversales , Mercadotecnía , EtanolRESUMEN
ISSUES: Implementation of alcohol control policy is a global priority as alcohol contributes to negative individual health and societal impacts. However, there are no available reviews that comprehensively provide tools and measurements for assessing the implementation of alcohol control policy. This study reviews tools and measurements for assessing alcohol policy implementation. Policies considered include alcohol pricing and taxation, alcohol marketing control, physical availability control and drink-driving policy. APPROACH: We conducted a scoping review from Scopus, Web of Science and the World Health Organization's website. We included studies on policy implementation for the four most effective prevention policies published worldwide between 2000 and 2021. KEY FINDINGS: The search yielded 11,654 articles and these were narrowed down to 39 included studies. Of these 39 studies, almost half assessed the implementation of a drink-driving policy (n = 19), followed multipolicy (n = 12) and physical availability control (n = 8). There was no single study assessing policy implementation of pricing and taxation or alcohol marketing control. The majority of the studies were conducted in high-income countries (n = 31). Globally, there is no standardised tool or guidelines for measuring the policy implementation of these four policies. The tools for measuring policy implementation mostly focused on a single policy, and few covered multiple policies. IMPLICATIONS: We recommend developing standardised tools and measurements to monitor policy implementation across multiple policies at country levels. CONCLUSION: This review highlighted a lack of comprehensive and standardised tools to assess policy implementation and the limited number of studies on alcohol policy implementation in low- and middle-income countries.
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Consumo de Bebidas Alcohólicas , Política Pública , Humanos , Consumo de Bebidas Alcohólicas/epidemiología , Consumo de Bebidas Alcohólicas/prevención & control , Mercadotecnía , Salud Global , Costos y Análisis de CostoRESUMEN
BACKGROUND AND AIMS: This article summarizes the findings and conclusions of the third edition of Alcohol: No Ordinary Commodity. The latest revision of this book is part of a series of monographs designed to provide a critical review of the scientific evidence related to alcohol control policy from a public health perspective. DESIGN: A narrative summary of the contents of the book according to five major issues. FINDINGS: An extensive amount of epidemiological evidence shows that alcohol is a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. Trends in alcohol products and marketing are described, indicating that a large part of the global industry has been consolidated into a small number of transnational corporations that are expanding their operations in Asia, Africa and Latin America. The main part of the book is devoted to a review of strategies and interventions designed to prevent or minimize alcohol-related harm. Overall, the most effective strategies to protect public health are taxation that decreases affordability and restrictions on the physical availability of alcohol. A total ban on alcohol marketing is also an effective strategy to reduce consumption. In addition, drink-driving counter-measures, brief interventions with at-risk drinkers and treatment of drinkers with alcohol dependence are effective in preventing harm in high-risk contexts and groups of hazardous drinkers. CONCLUSION: Alcohol policy is often the product of competing interests, values and ideologies, with the evidence suggesting that the conflicting interests between profit and health mean that working in partnership with the alcohol industry is likely to lead to ineffective policy. Opportunities for implementation of evidence-based alcohol policies that better serve the public good are clearer than ever before as a result of accumulating knowledge on which strategies work best.
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Consumo de Bebidas Alcohólicas , Alcoholismo , Humanos , Consumo de Bebidas Alcohólicas/prevención & control , Política de Salud , Mercadotecnía , ImpuestosRESUMEN
BACKGROUND: This paper analyses input from global interests in the policy process leading up to the passing of alcohol control legislation in Vietnam in 2019. The global alcohol industry now relies on growth in volume in emerging markets in middle-income countries such as Vietnam, a large, rapidly industrialising country with a youthful population and emerging middle class. The industry's role in the alcohol policy process is compared with that of global health interests. METHODS: Document analysis of letters and English language media coverage was supplemented by and triangulated with data from key informants on changes in the content of draft alcohol legislation and participant observation. RESULTS: The alcohol legislation was negotiated in the context of active engagement from the global alcohol industry and some input from global public health interests. The global alcohol industry established a partnership relationship with politicians using CSR and funded a local employee in Hanoi over the decade prior to the draft legislation being considered. Direct lobbying took place over the content of the legislation, which went through six published drafts. Trade and investment agreements provided a supportive environment and were referred to by both politicians and industry. In contrast public health resource was limited and lacked the support of a normative global policy to counter the economic imperatives. Vietnamese Ministry of Health proposals for cost effective alcohol policy were not enacted. CONCLUSION: Global commercial interests employed their considerable resources to engage in corporate social responsibility (CSR) and build partnerships with policy-makers over a long period, contributing significantly to an environment unsupportive of enacting effective alcohol control policy. The absence of structural support from a global health treaty on alcohol and lack of an equivalent level of long-term sustained input from global health actors contributed to the legislative outcome, which excluded proposed cost-effective policies to reduce alcohol harm.
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Salud Global , Salud Pública , Humanos , Vietnam , Política Pública , Maniobras Políticas , Política de SaludRESUMEN
Implementation of effective alcohol control policies is a global priority. However, at the global and national levels, implementing effective policies is still challenging, as it requires commitment from multiple stakeholders. This review provides a synthesis of barriers and facilitators to implementing effective alcohol control policies. We conducted a scoping review from two main databases: Scopus and Web of Science, and the grey literature from the World Health Organization's website. We included any studies investigating barriers and facilitators to implementing four effective policies: Alcohol pricing and taxation, control of physical availability, alcohol marketing control, and drink-driving policy. Articles published between 2000 and 2021 were included. The search yielded 11,651 articles, which were reduced to 21 after the assessment of eligibility criteria. We found five main barriers: resource constraint; legal loopholes; lack of evidence to support policy implementation, particularly local evidence; low priority of policy implementation among responsible agencies; and insufficient skills of implementers. Facilitators, which were scarce, included establishing monitoring systems and local evidence to support policy implementation and early engagement of implementing agencies and communities. We recommend that national governments pay more attention to potential barriers and facilitators while designing alcohol control regulations and implementing effective policies.
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Mercadotecnía , Política PúblicaRESUMEN
This study describes trends in alcohol consumption in the context of an expanding commercial context, current policy responses, and flaws in relation to international best practice for alcohol control in China. We surveyed the literature and other documents in Chinese or English up to December 2020 on policy responses to alcohol consumption and harm, industry structure, and marketing practices in China. Databases searched included PubMed, China National Knowledge Internet, Wanfang Data, Web of Science, and Baidu Scholar. We also scanned the official websites of government organizations and gathered information using snowballing. We analyzed existing alcohol policy against evidence-based, cost-effective policies for reducing alcohol harm. Our findings show that although some restrictive policies have been enacted with potential impacts on alcohol harm, they are not comprehensive, and some are poorly executed. The long history of alcohol use remains an important element in alcohol consumption by the Chinese population. However, alcohol marketing and promotion, ease of access, and affordability have become increasingly prominent. The gaps identified in alcohol policy suggest improved strategies and measures to reduce the harmful use of alcohol are urgently needed in China.