Policy-Relevant Behaviors Predict Heavier Drinking in Both On and Off Premises and Mediate the Relationship Between Heavier Alcohol Consumption and Age, Gender, and Socioeconomic Status-Analysis from the International Alcohol Control Study

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.

Residents perceptions of the alcohol environment: A participatory photovoice project in two districts with different socio-economic status in a large city

The purpose of this study was to present the alcohol environment as perceived by its residents in two districts of Madrid using the Photovoice participatory methodology. Secondly, we compared the results according to the socio-economic status of the districts. The study was conducted in the city of Madrid, Spain, in two districts with different socio-economic status. A total of 26 people participated, who took and discussed photographs about their alcohol environment. They grouped them into 33 final categories, such as the socialising role of alcohol or the alcohol advertising. Co-authors further grouped participants final categories into seven general areas. The participants in the Photovoice project have helped to deepen the understanding of the alcohol urban environment. These results may help to design more effective policies to prevent hazardous alcohol consumption.

Drinking patterns, alcohol-related harm and views on policies: results from a pilot of the International Alcohol Control Study in Canada

INTRODUCTION

We conducted a pilot assessment of the feasibility of implementing the International Alcohol Control (IAC) Study in Ontario, Canada, to allow for future comparisons on the impacts of alcohol control policies with a number of countries.

METHODS

The IAC Study questionnaire was adapted for use in the province of Ontario, and a split-sample approach was used to collect data. Data were collected by computer-assisted telephone interviewing of 500 participants, with half the sample each answering a subset of the adapted IAC Study survey.

RESULTS

Just over half of the sample (53.6%) reported high frequency drinking (once a week or more frequently), while 6.5% reported heavy typical occasion drinking (8 drinks or more per session). Self-reported rates of alcohol-related harms from one's own and others' drinking were relatively low. Attitudes towards alcohol control varied. A substantial majority supported more police spot checks to detect drinking and driving, while restrictions on the number of alcohol outlets and increases in the price of alcohol were generally opposed.

CONCLUSION

This pilot study demonstrated that the IAC Study survey can be implemented in Canada with some modifications. Future research should assess how to improve participation rates and the feasibility of implementing the longitudinal aspect of the IAC Study. This survey provides additional insight into alcohol-related behaviours and attitudes towards alcohol control policies, which can be used to develop appropriate public health responses in the Canadian context.

Knowledge of low-risk drinking and its relationship with a reduction in alcohol consumption: Results from six waves of an Australian national survey

This study examined changes in public knowledge of low-risk drinking, explored factors associated with knowledge level and its relationship with a reduction in alcohol consumption. Data (n = 153,820) of six waves of the National Drug Strategy Household Survey, conducted during the period 2001-2016, were analysed. Australian Guidelines to Reduce Health Risks from Drinking Alcohol was applied to compute participants' knowledge of low-risk drinking. This guideline was introduced in 2001 and later revised in 2009. Multivariable log-binomial regression model was used to analyse the pooled dataset. Subgroup analysis examined the relationship between knowledge score and a reduction in alcohol consumption across drinker categories. Public knowledge was better for long-term than short-term low-risk drinking, and women had better knowledge than men. Since 2010 there has been a small increase in knowledge of low-risk drinking. Although level of knowledge improved over time, it appears to align more towards the 2001-guideline, particularly for the recommended limits for men. Those who were relatively old; were women; received at least year-10 or more education; were not residing in the most disadvantaged areas; identified themselves as either light-, social-, heavy- or binge-drinkers; were currently/previously married; or perceived their health 'excellent' were significantly more likely than others to have an accurate knowledge of low-risk drinking. There was a positive association between knowledge score and the reduction in alcohol consumption among the self-reported social drinkers, heavy drinkers and binge drinkers. Tailored interventions are recommended for those who lack adequate knowledge and drink at a risky level.

Policy-relevant behaviours predict heavier drinking and mediate the relationship with age, gender and education status: Analysis from the International Alcohol Control Study

Introduction and Aims

To investigate behaviours related to four alcohol policy variables (policy‐relevant behaviours) and demographic variables in relation to typical quantities of alcohol consumed on‐premise in six International Alcohol Control study countries.

Design and Methods

General population surveys with drinkers using a comparable survey instrument and data analysed using path analysis in an overall model and for each country. Measures: typical quantities per occasion consumed on‐premise; gender, age; years of education, prices paid, time of purchase, time to access alcohol and liking for alcohol advertisements.

Results

In the overall model younger people, males and those with fewer years of education consumed larger typical quantities. Overall lower prices paid, later time of purchase and liking for alcohol ads predicted consuming larger typical quantities; this was found in the high‐income countries, less consistently in the high‐middle‐income countries and not in the low middle‐income country. Three policy‐relevant behaviours (prices paid, time of purchase, liking for alcohol ads) mediated the relationships between age, gender, education and consumption in high‐income countries.

Discussion and Conclusions

International Alcohol Control survey data showed a relationship between policy‐relevant behaviours and typical quantities consumed and support the likely effect of policy change (trading hours, price and restrictions on marketing) on heavier drinking. The path analysis also revealed policy‐relevant behaviours were significant mediating variables between the effect of age, gender and educational status on consumption. However, this relationship is clearest in high‐income countries. Further research is required to understand better how circumstances in low‐middle‐income countries impact effects of policies.

The Alcohol Environment Protocol: A new tool for alcohol policy

Introduction and Aim

To report data on the implementation of alcohol policies regarding availability and marketing, and drink driving, along with ratings of enforcement from two small high‐income to three high‐middle income countries, and one low‐middle income country.

Method

This study uses the Alcohol Environment Protocol, an International Alcohol Control study research tool, which documents the alcohol policy environment by standardised collection of data from administrative sources, observational studies and interviews with key informants to allow for cross‐country comparison and change over time.

Results

All countries showed adoption to varying extents of key effective policy approaches outlined in the World Health Organization Global Strategy to Reduce the Harmful Use of Alcohol (2010). High‐income countries were more likely to allocate resources to enforcement. However, where enforcement and implementation were high, policy on availability was fairly liberal. Key Informants judged alcohol to be very available in both high‐ and middle‐income countries, reflecting liberal policy in the former and less implementation and enforcement and informal (unlicensed) sale of alcohol in the latter. Marketing was largely unrestricted in all countries and while drink‐driving legislation was in place, it was less well enforced in middle‐income countries.

Conclusion

In countries with fewer resources, alcohol policies are less effective because of lack of implementation and enforcement and, in the case of marketing, lack of regulation. This has implications for the increase in consumption taking place as a result of the expanding distribution and marketing of commercial alcohol and consequent increases in alcohol‐related harm.