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Rehm J, Neufeld M, Room R, Sornpaisarn B, Štelemėkas M, Swahn MH, Lachenmeier DW. The impact of alcohol taxation changes on unrecorded alcohol consumption: A review and recommendations. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 99:103420. [PMID: 34456119 PMCID: PMC9429812 DOI: 10.1016/j.drugpo.2021.103420] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/07/2021] [Accepted: 08/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND The diverse forms of unrecorded alcohol, defined as beverage alcohol not registered in official statistics in the country where it is consumed, comprise about one fourth of all alcohol consumed worldwide. Since unrecorded alcohol is usually cheaper than registered commercial alcohol, a standard argument against raising alcohol excise taxes has been that doing so could potentially result in an increase in unrecorded consumption. This contribution examines whether increases in taxation have in fact led to increases in consumption of unrecorded alcohol, and whether these increases in unrecorded alcohol should be considered to be a barrier to raising taxes. A second aim is to outline mitigation strategies to reduce unrecorded alcohol use. METHODS Narrative review of primary and secondary research, namely case studies and narrative and systematic reviews on unrecorded alcohol use worldwide. RESULTS Unrecorded alcohol consumption did not automatically increase with increases in taxation and subsequent price increases of registered commercial alcohol. Instead, the level of unrecorded consumption depended on: a) the availability and type of unrecorded alcohol; b) whether such consumption was non-stigmatized; c) the primary population groups which consumed unrecorded alcohol before the policy change; and d) the policy measures taken. Mitigation strategies are outlined. CONCLUSIONS Potential increases in the level of unrecorded alcohol consumption should be considered in the planning and implementation of substantial increases in alcohol taxation. However, unrecorded consumption should not be considered to be a principal barrier to implementing tax interventions, as evidence does not indicate an increase in consumption if mitigation measures are put in place by governments.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, Canada, M5S 2S1; Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada; World Health Organization / Pan American Health Organization Collaborating Centre, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, Canada, M5S 2S1; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, Ontario, Canada, M5T 2S1; Faculty of Medicine, Institute of Medical Science, University of Toronto, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, Ontario, Canada, M5S 1A8; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario, Canada, M5T 1R8; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya str., 8, b. 2, 119992, Moscow, Russian Federation.
| | - Maria Neufeld
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, Canada, M5S 2S1; Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany; WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Leontyevsky Pereulok 9, 125009 Moscow, Russian Federation
| | - Robin Room
- Centre for Alcohol Policy Research, Building NR-1, La Trobe University, Plenty Rd. x Kingsbury Rd., Bundoora, Victoria 3086, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, 3rd floor, Sveavägen 160, 113 46 Stockholm, Sweden
| | - Bundit Sornpaisarn
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON, Canada, M5S 2S1; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada; Faculty of Public Health, Mahidol University, Thailand, 420/1 Ratchawithi Road, Thung Phaya Thai, Ratchathewi, Bangkok, Thailand, 10400
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės str. 18, 47181 Kaunas, Lithuania; Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Tilžės str. 18, 47181 Kaunas, Lithuania
| | - Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, 520 Parliament Garden Way NW, Room 4103, MD 4101, Kennesaw, GA, USA, 30144
| | - Dirk W Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Strasse 3, 76187 Karlsruhe, Germany
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Nyagwachi AO, Chelwa G, van Walbeek C. The effect of tobacco- and alcohol-control policies on household spending patterns in Kenya: An approach using matched difference in differences. Soc Sci Med 2020; 256:113029. [PMID: 32464415 DOI: 10.1016/j.socscimed.2020.113029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/22/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
Abstract
This paper examines the effect of tobacco and alcohol control policies on tobacco and alcohol consumption patterns and the evolution of crowding-out effects on other household expenditure in Kenya. The current literature on crowding-out does not provide a defensible instrumental variable for a system of demand equations. This paper uses Matched Difference in Differences (MDID) as an alternative strategy and data from two nationally representative surveys in Kenya conducted ten years apart (2005/6 and 2015/16). We find that tobacco-control policies contributed to a decrease in the proportion of tobacco-consuming households between 2005 and 2015. Alcohol-control policies were only effective in reducing the proportion of alcohol-consuming households in the bottom quartile of the expenditure distribution. Overall, tobacco-consuming households spent less on education, communication, and some food items. Alcohol-consuming households also spent less on some food items, but expenditure on transportation was the only non-food item crowded out. Tobacco and alcohol control policies, when they result in reduced consumption of these products, can increase household expenditure on human capital development in the long run.
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Affiliation(s)
- Abel Otwori Nyagwachi
- Research Unit on the Economics of Excisable Products, School of Economics, University of Cape Town, Cape Town, South Africa; Parliamentary Budget Office, Nairobi, Kenya.
| | - Grieve Chelwa
- Graduate School of Business, University of Cape Town, Cape Town, South Africa
| | - Corné van Walbeek
- Research Unit on the Economics of Excisable Products, School of Economics, University of Cape Town, Cape Town, South Africa
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Menya D, Kigen N, Oduor M, Maina SK, Some F, Chumba D, Ayuo P, Osano O, Middleton DR, Schüz J, McCormack VA. Traditional and commercial alcohols and esophageal cancer risk in Kenya. Int J Cancer 2019; 144:459-469. [PMID: 30117158 PMCID: PMC6294681 DOI: 10.1002/ijc.31804] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 11/06/2022]
Abstract
Squamous cell esophageal cancer is common throughout East Africa, but its etiology is poorly understood. We investigated the contribution of alcohol consumption to esophageal cancer in Kenya, based on a hospital-based case-control study conducted from 08/2013 to 03/2018 in Eldoret, western Kenya. Cases had an endoscopy-confirmed esophageal tumor whose histology did not rule out squamous cell carcinoma. Age and gender frequency-matched controls were recruited from hospital visitors/patients without digestive diseases. Logistic regression was used to calculate odds ratios (ORs) and their 95% confidence intervals (CI) adjusting for tobacco (type, intensity) and 6 other potential confounders. A total of 422 cases (65% male, mean at diagnosis 60 (SD 14) years) and 414 controls were included. ORs for ever-drinking were stronger in ever-tobacco users (9.0, 95% CI: 3.4, 23.8, with few tobacco users who were never drinkers) than in never-tobacco users (2.6, 95% CI: 1.6, 4.1). Risk increased linearly with number of drinks: OR for >6 compared to >0 to ≤2 drinks/day were 5.2 (2.4, 11.4) in ever-tobacco users and 2.1 (0.7, 4.4) in never-tobacco users. Although most ethanol came from low ethanol alcohols (busaa or beer), for the same ethanol intake, if a greater proportion came from the moonshine chang'aa, it was associated with a specific additional risk. The population attributable fraction for >2 drinks per day was 48% overall and highest in male tobacco users. Alcohol consumption, particularly of busaa and chang'aa, contributes to half of the esophageal cancer burden in western Kenya.
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Affiliation(s)
- Diana Menya
- School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Nicholas Kigen
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Margaret Oduor
- University Health Services, University of Eldoret, Eldoret, Kenya
| | | | - Fatma Some
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - David Chumba
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Paul Ayuo
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Odipo Osano
- School of Environment Studies, University of Eldoret, Kenya
| | - Daniel Rs Middleton
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Joachim Schüz
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
| | - Valerie A McCormack
- Section of Environment and Radiation, International Agency for Research on Cancer, Lyon, France
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Mkuu RS, Barry AE, Swahn MH, Nafukho F. Unrecorded alcohol in East Africa: A case study of Kenya. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 63:12-17. [PMID: 30453128 DOI: 10.1016/j.drugpo.2018.07.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/13/2018] [Accepted: 07/28/2018] [Indexed: 01/12/2023]
Abstract
Alcohol misuse contributes substantially to the global morbidity and mortality burden. Unrecorded alcohol, alcohol that is purchased by means which precludes regulation, represents a substantial proportion of the alcohol consumed in East Africa. In Kenya, homebrew also known as traditional brew, has been linked to several fatalities and hospitalizations. Previously banned, the Kenyan government recently legalized homebrew in an effort to regulate and reduce its harm. Despite legalization, however, homebrew continues to be endemic. In this paper, we examine the scope and harm associated with unrecorded alcohol in Kenya, and discuss current policies and interventions aimed at reducing production and consumption of unrecorded alcohol in the Kenyan context that reflect its culture, politics, environment and resources.
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Affiliation(s)
- Rahma S Mkuu
- Texas A&M University, Transdisciplinary Center of Health Equity Research, Department of Health and Kinesiology, Division of Health Education, Blocker Building, Office 311G, College Station, TX 77843-4243, United States.
| | - Adam E Barry
- Texas A&M University, Division of Health Education, Department of Health & Kinesiology, Blocker Bldg., Office 314C, College Station, TX 77843-4243, United States.
| | - Monica H Swahn
- Georgia State University, Division of Epidemiology and Biostatistics, Urban Life Building, 140 Decatur Street, Suite 420, Atlanta, GA 30303, United States.
| | - Fredrick Nafukho
- Texas A&M University, Educational Administration and Human Resource Development, 804B Harrington Office Building, 422, College Station, TX 77843-4243, United States.
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Mkuu RS, Barry AE, Montiel Ishino FA, Amuta AO. Examining characteristics of recorded and unrecorded alcohol consumers in Kenya. BMC Public Health 2018; 18:1058. [PMID: 30139353 PMCID: PMC6108107 DOI: 10.1186/s12889-018-5960-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to media reports of several deaths, consumption of unrecorded alcohol (i.e., alcohol brewed at home) has emerged as a public health threat in developing countries like Kenya. Empirical data on this issue, however, is scarce. This investigation compared demographic characteristics of Kenyans who drank recorded (regulated) and unrecorded alcohol. METHODS We examined all respondents who consumed alcohol in the past month (N = 718) on the 2015 nationally representative Kenya STEPwise survey. Descriptive statistics and bivariate logistic regression examined proportion of respondents consuming unrecorded alcohol, and social demographic factors associated with unrecorded alcohol consumption, respectively. RESULTS The sample was primarily male (86%), married (64%), middle class or higher (64%), with an average age of 37 years. Participants reported an average of 2.5 drinking events and 4.3 binge-drinking occasions per month. Overall, 37% of our sample consumed unrecorded alcohol. Compared to those with incomplete primary education or lower, individuals who completed primary education or above were less likely to report consuming unrecorded alcohol (OR = 0.22, 95% CI: 0.12-0.43). Compared to poorest and poor respondents, those identifying as middle class or above were less likely to consume unrecorded alcohol (OR = 0.47, 95% CI: 0.29-.78). Current smokers (OR = 2.19, 95% CI: 1.34-3.60) and those with higher binge drinking occasions in the past month (OR = 1.03, 95% CI: 1.004-1.07) were significantly more likely to consume unrecorded alcohol. CONCLUSION Kenyan adults who consume unrecorded alcohol engage in more binge drinking occasions, smoke, and have lower levels of education and socioeconomic status. It is vital that health promotion interventions aimed at reducing unrecorded alcohol consumption be tailored and targeted to individuals with low socio-economic status in Kenya.
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Affiliation(s)
- Rahma S Mkuu
- Division of Health Education, Department of Health & Kinesiology, Texas A&M University, 4243 TAMU, Blocker Building, Office 311G, College Station, TX, 77843-4243, USA.
| | - Adam E Barry
- Division of Health Education, Department of Health & Kinesiology, Texas A&M University, 4243 TAMU, Blocker Building, Office 311G, College Station, TX, 77843-4243, USA
| | - Francisco A Montiel Ishino
- Division of Health Education, Department of Health & Kinesiology, Texas A&M University, 4243 TAMU, Blocker Building, Office 311G, College Station, TX, 77843-4243, USA
| | - Ann O Amuta
- Department of Health Studies, Texas Woman's University, 304 Administration Dr. CFO 1011, Denton, TX, 75204, USA
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Okaru AO, Abuga KO, Kibwage IO, Lachenmeier DW. High Ethanol Contents of Spirit Drinks in Kibera Slums, Kenya: Implications for Public Health. Foods 2017; 6:foods6100089. [PMID: 29039800 PMCID: PMC5664028 DOI: 10.3390/foods6100089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/30/2017] [Accepted: 10/11/2017] [Indexed: 11/23/2022] Open
Abstract
Cheap licit and artisanal illicit spirit drinks have been associated with numerous outbreaks of alcohol poisoning especially with methanol. This study aimed to evaluate the quality of cheap spirit drinks in Kibera slums in Nairobi County, Kenya. The samples consisted of cheap licit spirits (n = 11) and the artisanal spirit drink, ‘chang’aa’, (n = 28). The parameters of alcoholic strength and volatile composition were used as indicators of quality and were determined using gas chromatography with flame ionization detection (GC-FID) and gas chromatography-mass spectrometry (GC-MS) respectively. The ranges for alcoholic strength were 42.8–85.8% vol and 28.3–56.7% vol for chang’aa and licit spirit drinks respectively, while the pH ranges were 3.3–4.2 and 4.4–4.8 for chang’aa and licit spirit drinks respectively. The majority of volatiles were found in artisanal spirits and they included higher alcohols, ethyl esters and carbonyl compounds. The alcoholic strength of all the artisanal spirits (100%) and 91% of the licit spirits was above the 40% vol of standard spirits such as vodka. The high ethanol content of the alcohol products was the only element of public health significance in this study.
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Affiliation(s)
- Alex O Okaru
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya.
| | - Kennedy O Abuga
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya.
| | - Isaac O Kibwage
- Department of Pharmaceutical Chemistry, University of Nairobi, Nairobi P.O. Box 19676-00202, Kenya.
| | - Dirk W Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Straße 3, 76187 Karlsruhe, Germany.
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