The clusters of health-risk behaviours and mental wellbeing and their sociodemographic correlates: a study of 15,366 ASEAN university students.

BACKGROUND: This study investigated, through cluster analysis, the associations between behavioural characteristics, mental wellbeing, demographic characteristics, and health among university students in the Association of Southeast Asian Nations (ASEAN) University Network - Health Promotion Network (AUN-HPN) member universities. METHODS: Data were retrieved from a cross-sectional self-administered online survey among undergraduate students in seven ASEAN countries. A two-step cluster analysis was employed, with cluster labels based on the predominant characteristics identified within the clusters. The 'healthy' cluster was assigned as the reference group for comparisons using multinomial logistic regression analysis. RESULTS: The analytic sample size comprised 15,366 university students. Five clusters of student-types were identified: (i) 'Healthy' (n = 1957; 12.7%); (ii) 'High sugary beverage consumption' (n = 8482; 55.2%); (iii) 'Poor mental wellbeing' (n = 2009; 13.1%); (iv) 'Smoker' (n = 1364; 8.9%); and (v) 'Alcohol drinker' (n = 1554; 10.1%). Being female (OR 1.28, 95%CI 1.14, 1.45) and being physically inactive (OR 1.20, 95%CI 1.04, 1.39) increased the odds of belonging to the 'High sugary beverage consumption' cluster. Being female (OR 1.21, 95%CI 1.04, 1.41), non-membership in a sports club (OR 1.83, 95%CI 1.43, 2.34) were associated with 'Poor mental wellbeing'. Obesity (OR 2.03, 95%CI 1.47, 2.80), inactively commuting to campus (OR 1.34, 95%CI 1.09, 1.66), and living in high-rise accommodation (OR 2.94, 95%CI 1.07, 8.07) were associated with membership in the 'Smoker' cluster. Students living in The Philippines, Singapore, Thailand, and Vietnam had a higher likelihood of being alcohol drinkers, compared with those who lived in Brunei. CONCLUSIONS: ASEAN university students exhibited health-risk behaviours that typically clustered around a specific health behaviour and mental wellbeing. The results provided support for focusing interventions on one dominant health-risk behaviour, with associated health-risk behaviours within clusters being potential mediators for consideration.

Overall Survival and Survival Time by Palliative Performance Scale: A Retrospective Cohort Study in Thailand.

Objectives: The palliative performance scale (PPS) is a useful tool for predicting the survival time of palliative patients and for multidisciplinary teams in designing an appropriate care plan for patients and their families. This study aimed to (1) assess the survival time of palliative patients, (2) examine the factors associated with survival time and (3) investigate the proportion of patients whose survival time matched the time proposed by existing literature, within the Thai population. Materials and Methods: A retrospective cohort study was conducted with data drawn from five hospitals in one of the north-east provinces in Thailand. The study population comprised patients with a palliative diagnosis (ICD10: Z51.5) who had registered in one of the five hospitals between 1 October 2015 and 30 September 2017. Kaplan-Meier survival analysis was used to assess overall survival time and an extended Cox regression model to identify predictors of survival. Results: Of the 2792 registered patients, 1163 were included in the analysis. Most patients were male (55.62%), with a mean age of 64.59 years (±15.38), and were covered by the universal coverage insurance (77.72%). Approximately half (56.23%) of the participants had cancer and about a quarter (27.13%) had an initial PPS result of 30. The overall median survival time was 14 days (mean = 64.08, 95% CI: 12-16). Three significant predictors for survival included sex, hospital and initial PPS score. Conclusion: The survival time of palliative patients was relatively short. Sex, hospital and initial PPS were significant predictors of survival. The median survival time by PPS was similar to the values reported by the previous study but proportion of correct prediction was low. Therefore, it might be necessary to investigate the survival time of palliative patients by country independently.

Price elasticity of demand for manufactured cigarettes and roll-your-own cigarettes across socioeconomic status groups in Thailand.

BACKGROUND: Pricing policies have been proven to be effective in reducing tobacco consumption. However, studies investigating the effectiveness of pricing policies across different types of tobacco products and socioeconomic status (SES) groups are limited, particularly in low-income and middle-income countries. OBJECTIVE: This study aimed to quantify the price elasticity of demand for different types of cigarettes across different SES groups. METHODS: This study used data from a nationally representative survey in Thailand conducted in 2017 and included current smokers aged at least 15 years. To quantify the price elasticity of demand for cigarette consumption, a two-part model was employed for five different types of cigarettes: domestic and imported manufactured cigarettes with a low and high price, and roll-your-own cigarettes. Personal income was used to determine SES. RESULTS: Price elasticity of demand for cigarettes exists for all types of cigarettes. The price elasticity of demand for manufactured and roll-your-own cigarettes was -0.49 (p<0.05) and -0.32 (p<0.05), respectively. People who smoked domestic manufactured cigarettes were more responsive to price change than those who smoked imported manufactured cigarettes. Low-income smokers of manufactured and roll-your-own cigarettes were more responsive to price change than those with high income. CONCLUSION: Smokers with a low income were more responsive to price change than those with higher income. The effectiveness of pricing policy in reducing demand for manufactured cigarettes was greater in domestic cigarettes than imported ones.

Provincial alcohol index and its relationship to alcohol-related harm in Thailand: implications for subnational alcohol policy development.

BACKGROUND: The Provincial Alcohol Index (PAI) is one of the efforts to develop a composite measurement to operationalize the situation of alcohol consumption and related risk behaviors. The index offers a means for national and subnational alcohol control committees to address alcohol-related problems in their responsible jurisdiction areas. The objective of this study is to assess the relationship between PAI scores and alcohol-related problems using Thailand as an example. METHODS: Cross-sectional analyses of PAI scores based on the 2007 National Cigarette Smoking and Alcohol Drinking Behavior Survey (CSAD) and the National Statistical Office data were conducted. CSAD data were collected from 168,285 Thai residents aged 15 years and above in 76 provinces of Thailand (population range 180,787 to 5,716,248). The PAI scores were generated using three different methods based on five indicators: 1) prevalence of adult (≥15 years) drinkers, 2) prevalence of underage drinkers, 3) proportion of regular drinkers, 4) proportion of binge drinkers and 5) proportion of drink-drivers. Alcohol-related injuries and violent events together with provincial level covariates (age, gender, income and region) were assessed. Correlational and linear regression analyses were performed to examine the relationship between PAI scores and alcohol-related problems. RESULTS: The PAI scores generated from the three methods were significantly correlated with one another (r > 0.7, p < 0.05) and significantly related to alcohol-related problems after adjusting for the provincial level covariates. Based on the normalized method, PAI scores had a significant and positive relationship with prevalence of alcohol-related injuries (beta = 562 cases per million population, p = 0.027) and violence (beta = 451 events per million population, p = 0.013). PAI scores were highest in the north and lowest in the south of the country. CONCLUSIONS: The findings of this study illustrate the relationship between the PAI and alcohol-related problems. The PAI scores can be used to benchmark the alcohol situation across jurisdiction areas. Future studies are suggested to develop a scale to measure subnational alcohol policy performances.

Estimated cost of extra work hours from co-workers' drinking in Thailand.

INTRODUCTION: Alcohol's harm to others (AHTO) in workplaces has received little attention. A few studies from high-income countries have estimated the cost of AHTO in workplaces, while data from the low- and middle-income countries are lacking. This study aimed to estimate the cost of AHTO in workplaces and to explore factors associated with the cost of AHTO in workplaces. METHODS: Data were taken from 1392 employed respondents who participated in a survey conducted in Thailand from September 2012 to March 2013. The cost of extra work hours was estimated from the hourly wage and extra hours of work. The hourly wage was computed by converting monthly income to weekly income and dividing weekly income by weekly working hours. The gamma regression with log link was used to determine factors associated with the cost of extra working hours. RESULTS: The past-year prevalence of harm from co-workers' drinking was 17.8% among the employed population. The prevalence of working extra hours was 6.1%. On average, an affected worker worked 16.0 extra hours due to co-workers' drinking. In total, 28.8 million hours of extra work was attributed to co-workers' drinking in 1 year. The cost of these extra work hours was 1.8 billion Thai baht (57.8 million USD). Age, education and type of employment were associated with the cost of working extra hours. DISCUSSION AND CONCLUSIONS: The burden of alcohol in workplaces extends beyond drinking workers. Our findings indicate that alcohol imposes a significant cost on co-workers of drinkers.

A composite index of provincial alcohol control policy implementation capacity in Thailand.

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.

Quantitative tools and measurements for assessing the implementation of regulatory policies in reducing alcohol consumption and alcohol-related harms: A scoping review.

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.

Provision of primary care pharmacy operated by hospital pharmacist.

A primary care pharmacy (PCP) is operated by hospital pharmacists in Thailand. This study aims to explore the level of PCP provisions operated by hospital pharmacists, to identify health service components that affect PCP operation and to collect opinions from pharmacists regarding factors influencing PCP operation. A postal survey was conducted in northeastern Thailand. A questionnaire included: (1) the PCP checklist (36 items), (2) questions investigating the health service components required for PCP operation (13 items), and (3) queries to pharmacists concerning factors influencing PCP operation (16 items). Questionnaires were mailed to 262 PCP pharmacists. The PCP provision score was calculated with a max score of 36, and reaching at least 28.8 points was deemed as having 'met expectation'. Multivariate logistic regression with a backward approach was used to determine health service components which affected PCP operation. Most respondents were female (72, 60.0%), aged 36.0 years (IQR 31.0-41.0) and PCP work experience of 4.0 years (IQR 2.0-10.0). Overall, the PCP provision score had met expectation (median = 29.00, Q1-Q3 = 26.50-32.00). Tasks that met expectation involved managing the medicine supply, a home visit with a multidisciplinary team and protecting consumer health. Improving medicine dispensary and promotion of self-care and herbal use were below expectation. PCP operation depended on doctor involvement (OR = 5.63 95% CI 1.07-29.49) and public health practitioner involvement (OR = 3.12 95% CI 1.27-7.69). The pharmacist's responsibility, i.e., a good relationship with the community, likely increased PCP provision. The PCP has been widely instituted in Northeast Thailand. Doctors and public health practitioners should get involved regularly. Further research is needed to monitor the outcomes and value of PCPs.

Effective alcohol policies are associated with reduced consumption among demographic groups who drink heavily.

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.

Multilevel factors associated with physical activity participation among Thai university students.

This study investigated physical activity (PA) levels in Thai university students and their associated factors at multiple levels. Data of 3,930 university students age ≥18 years analyzed in this study were retrieved from a cross-sectional online survey, namely the ASEAN University Network - Health Promotion Network (AUN-HPN) health behavioral survey. The hierarchical generalized linear model considering clustering effects was applied to examine factors associated with sufficient PA across multiple levels. At the individual level, being female, underweight, and overweight had significantly lower odds of having sufficient PA. Sophomores had 22 % greater odds compared with freshmen. Students engaging in 1-3 and 4-6 sports activities had 3 and almost 4 times respectively higher odds of having sufficient PA. Students engaged in >8 h of sedentary time, and consumed adequate amounts of fruit/vegetables had 70 % and 59 % respectively higher odds of having sufficient PA. At the environmental level, students who traveled inactively to/from university, attended a university with private recreational facilities, and a university that adopted the healthy university framework (HUF) had significantly greater odds of having sufficient PA. A majority of university students were sufficiently physically active, despite gender disparity. When promoting PA among them, focus may be targeted at females and sophomores, and consider addressing the number of sports activities engaged, fruit/vegetable consumption, availability of private university recreational facilities, and adoption of the HUF. The results support the implementation of the AUN-HPN HUF, and future initiatives within the country and the wider network for health and PA promotion.

Effective alcohol policies and lifetime abstinence: An analysis of the International Alcohol Control policy index.

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.

The International Alcohol Control (IAC) study-evaluating the impact of alcohol policies.

BACKGROUND: This paper describes a new multicountry collaborative project to assess the impact of alcohol control policy. Longitudinal surveys of drinkers in a number of participating countries and analysis of the policy context allow for the assessment of change over time within countries and comparison between countries. The design of the study is modeled on the International Tobacco Control study and aims to assess the impact of alcohol policies in different cultural contexts on policy-related behaviors and alcohol consumption. A survey instrument and protocol for policy analysis have been developed by the initial participating countries: England, Scotland, Thailand, South Korea, and New Zealand. The first round of data collection is scheduled for 2011-2012. MEASUREMENTS: The survey instrument (International Alcohol Control [IAC] survey) measures key policy relevant behaviors: place and time of purchase, amounts purchased and price paid; ease of access to alcohol purchase; alcohol marketing measures; social supply; perceptions of alcohol affordability and availability and salience of price; perceptions of enforcement; people's experiences with specific alcohol restrictions; support for policy and consumption (typical quantity, frequency using beverage and location-specific measures). The Policy Analysis Protocol (PoLAP) assesses relevant aspects of the policy environment including regulation and implementation. RESULTS: It has proved feasible to design instruments to collect detailed data on behaviors relevant to alcohol policy change and to assess the policy environment in different cultural settings. CONCLUSIONS: In a policy arena in which the interest groups and stakeholders have different perceptions of appropriate policy responses to alcohol-related harm, a robust methodology to assess the impact of policy will contribute to the debate.

Estimated Impacts of Alcohol Control Policies on NCD Premature Deaths in Thailand.

Background: This study aimed to assess the impacts of achieving a 10% alcohol reduction target and different alcohol policy interventions on NCD premature deaths during 2010-2025 in Thailand. Methods: The researchers estimated the impacts on three main NCDs: cancers, cardiovascular diseases, and diabetes. These represent two ideal scenarios, which are the target reduction and five intervention scenarios. These intervention scenarios comprise taxation with 50% price increases, a total ban on advertisements, availability restriction by shortening sales times, early psychological intervention, and combined interventions. Consumption data and mortality trends were obtained from available national data. Relative risks and intervention effects were derived from the literature. Results: Achieving a 10% reduction target would lead to 3903-7997 avoidable NCD deaths. Taxation was the most effective intervention, with the highest number of avoidable NCD deaths, followed by early psychological intervention, availability restriction, and an advertisement ban. A combination of these four interventions would reduce 13,286 NCD deaths among men and 4994 NCD deaths among women, accounting for 46.8% of the NCD mortality target. Conclusion: This study suggests using Thailand as an example for low- and middle-income countries to enhance implementation and enforcement of the recommended effective alcohol policies for achieving the global targets.

Barriers and Facilitators to the Implementation of Effective Alcohol Control Policies: A Scoping Review.

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.

The effects of others' drinking on the harms to children in Thailand: Lessons from the WHO-ThaiHealth project.

BACKGROUND: Many knowledge gaps exist in the area of alcohol-related harms in children research such as the potential impact of other's drinking and their social demography. Thus, this study aims to evaluate the effects of characteristics of household members and others' alcohol drinking on harms to children in Thailand. DATA AND METHODS: This study examined 952 parents caring for children and adolescents under 18 years of age, using the questionnaire (i.e., The Harm to Others from Drinking under the WHO/ThaiHealth International Collaboration Research Project). They were interviewed between September 2012 and March 2013. RESULTS: The study found that 15.89% of children and young people were affected by someone's drinking in at least one category of harms. People over 60 years of age were less likely to cause alcohol-related harm to children than those aged 18 to 29 (adjusted odds ratio [AOR] 0.19, 95% confidence interval [Cl]: 0.06-0.58). Households with a binge drinker or regular drinker (≥1 time/week) were more likely to have children at higher risk of suffering alcohol-related harm in comparison to households without alcohol drinker (AOR 4.75 and 1.92, respectively). CONCLUSION: This study found that children whose family members are young adult or consume alcohol (i.e., weekly drinker or binge drinker) were significantly adversely affected. The most common problems were domestic violence and verbal abuse. Most of the problems, affecting children, were caused mostly by their parents.

Prevalence of Health-Risk Behaviors and Mental Well-Being of ASEAN University Students in COVID-19 Pandemic.

The prevalence of epidemiological health-risk behaviors and mental well-being in the COVID-19 pandemic, stratified by sociodemographic factors in Association of South East Asian Nations (ASEAN) university students, were examined in the research. Data were collected in March-June 2021 via an online survey from 15,366 university students from 17 universities in seven ASEAN countries. Analyzed data comprised results on physical activity, health-related behaviors, mental well-being, and sociodemographic information. A large proportion of university students consumed sugar-sweetened beverages (82.0%; 95%CI: 81.4, 82.6) and snacks/fast food daily (65.2%; 95%CI: 64.4, 66.0). About half (52.2%; 95%CI: 51.4, 53.0) consumed less than the recommended daily amounts of fruit/vegetable and had high salt intake (54%; 95%CI: 53.3, 54.8). Physical inactivity was estimated at 39.7% (95%CI: 38.9, 40.5). A minority (16.7%; 95%CI: 16.1, 17.3) had low mental well-being, smoked (8.9%; 95%CI: 8.4, 9.3), and drank alcohol (13.4%; 95%CI: 12.8, 13.9). Country and body mass index had a significant correlation with many health-risk behaviors and mental well-being. The research provided important baseline data for guidance and for the monitoring of health outcomes among ASEAN university students and concludes that healthy diet, physical activity, and mental well-being should be key priority health areas for promotion among university students.

Benchmarking alcohol policy based on stringency and impact: The International Alcohol Control (IAC) policy index.

This study developed a measurement tool to assess stringency and 'on-the-ground' impact of four key alcohol policy domains to create an alcohol policy index suitable for benchmarking alcohol policy and assessing change over time in middle- and high-income countries. It involved a collaboration between researchers in 12 diverse countries: New Zealand; Australia; England; Scotland; Netherlands; Vietnam; Thailand; South Africa; Turkey; Chile; Saint Kitts and Nevis and Mongolia. Data on the four most effective alcohol policy domains (availability, pricing policy, alcohol marketing, drink driving) were used to create an alcohol policy index based on their association with alcohol per capita consumption (APC) of commercial (recorded) alcohol. An innovation was the inclusion of measures of impact along with the stringency of the legislation or regulation. The resulting International Alcohol Control (IAC) Policy Index showed a very high negative correlation (-0.91) with recorded APC. Greater affordability of alcohol, an impact measure taking into account prices paid and countries' Gross Domestic Product, was predictive of higher APC (-0.80). Countries in which more modes of alcohol marketing are legally allowed and used had higher APC. Legislation on outlet density and drink driving predicted APC whereas trading hours did not. While stringency and impact measures varied between domains in terms of relationship with APC, overall, there was a strong correlation between impact and stringency (0.77). The IAC Policy Index, which includes measures of policy stringency and 'on-the-ground' impacts in relation to four key policy areas, was found to be strongly associated with commercial alcohol consumed in a number of diverse country settings. It showed a larger relationship than previous indices that include more policy dimensions. The index provides a relatively simple tool for benchmarking and communication with policy makers to encourage a strong focus on uptake of these four most effective alcohol policies.

Harmful drinking occurs in private homes in some high- and middle-income alcohol markets: Data from the International Alcohol Control Study.

OBJECTIVES: To describe how for some high- and middle-income countries, the total volume of alcohol, including volume consumed in harmful drinking occasions, is distributed across drinking locations in each country. METHODS: Population surveys of drinkers were conducted as part of the International Alcohol Control Study in New Zealand, Australia, Vietnam and Thailand. Consumption data were collected using a beverage- and location-specific measure that also allows for the measurement of unrecorded alcohol. RESULTS: In the high-income countries, the percentage of absolute alcohol consumed in harmful drinking occasions was 44% in New Zealand and 51% in Australia. In the middle-income countries, the proportions were 55% in Vietnam and 66% in Thailand. The vast majority of alcohol was consumed in private homes (67% or above in all four countries). Private homes were also the location where the highest percentage of alcohol was consumed in harmful drinking occasions (range 33% in New Zealand to 44% in Vietnam). Unrecorded/untaxed alcohol was of considerable importance for heavier drinking occasions in private homes in Vietnam. Bars and nightclubs were more likely locations for harmful drinking in the high-income countries relative to the middle-income countries. CONCLUSIONS: As the majority of alcohol consumed in each country, including in harmful drinking occasions, was consumed in private homes, these findings make take-away alcohol a focus for alcohol policy including trading hour and pricing policies. Unrecorded alcohol was also of considerable importance in Vietnam, highlighting the importance of the policy responses being developed to address unrecorded alcohol.

Associations between alcohol consumption trajectory and deaths due to cancer, cardiovascular diseases and all-cause mortality: a 30-year follow-up cohort study in Thailand.

OBJECTIVES: This study examined the association between alcohol consumption trajectory and deaths due to cancer, cardiovascular diseases (CVDs) and all-cause mortality in Thailand. DESIGN: Data were obtained from a Thai prospective cohort study with more than 30 years of follow-up (n=1961). SETTING: All participants resided in Bangkok and its vicinity. PARTICIPANTS: Employees from the Electricity Generating Authority of Thailand aged between 35 and 54 years old were randomly selected. MAIN OUTCOME MEASURES: Exposure was alcohol consumption trajectory over the study period from 1985 to 2012. The main outcomes were all-cause mortality, and deaths due to cancer and CVDs recorded in national vital registries between 2002 and 2015. Cox's proportional hazard regression was used to determine the associations between alcohol consumption trajectory and each outcome adjusting for sample characteristics, health behaviours and health conditions. RESULTS: From a total of 59 312 person years, 276 deaths were observed. Compared with drinkers who drank occasionally or most occasional over their lifetime, consistent regular or mostly consistent-regular drinkers had higher rates of all-cause mortality (HR: 1.53; 95% CI 1.09 to 2.16) and cancer mortality (HR: 2.05; 95% CI 1.13 to 3.74). The study did not find a significant association between trajectory of alcohol consumption and deaths due to CVDs. CONCLUSIONS: Regular drinking of alcohol increased risk for all-cause and cancer mortality. Effective interventions should be implemented to reduce number of regular drinkers in order to saves life of individuals.

Alcohol's harm to others and subjective well-being: Cross-sectional studies in Lao People's Democratic Republic and Thailand.

INTRODUCTION AND AIMS: Previous studies have confirmed that the number of heavy drinkers in a household negatively correlates with the subjective well-being of individuals in the household. However, limited studies have investigated the experiences of alcohol's harm to others (HTO) and subjective well-being, particularly in low- and middle-income countries. The purpose of this study was to investigate the associations between experiences of HTO and subjective well-being in two selected low- and middle-income countries. DESIGN AND METHODS: We analysed population survey data on 1205 and 1491 individuals aged 18-64 years from Lao People's Democratic Republic (Lao PDR) and Thailand, respectively. The respondents' experiences of HTO and their subjective well-being were measured using face-to-face interviews. The association between experiencing HTO and subjective well-being was investigated using Tobit regression models. RESULTS: A significant association between experiencing HTO and subjective well-being was found in Thailand, but not in Lao PDR. Those who had ever experienced HTO had a 2.77-point lower score of subjective well-being than those who had never experienced HTO (95% confidence interval -4.67, -0.88; P-value <0.05) in Thailand. In Lao PDR, the physical harm dimension showed the strongest association with subjective well-being compared to other types of harm, while in Thailand, financial harm was the dimension most strongly associated with the outcome. DISCUSSION AND CONCLUSIONS: There was a significant association between HTO and subjective well-being, particularly physical harm in Lao PDR and financial harm in Thailand. The study suggests that services to mitigate the impacts of HTO on well-being should focus on physical harm in Lao PDR and financial harm in Thailand.