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

Comparing alcohol policy environments in high-income jurisdictions with the International Alcohol Control Policy Index

INTRODUCTION

Considerable evidence exists on the most effective policy to reduce alcohol harm; however, a tool and index to allow comparisons of policy status of the most effective policies between similar jurisdictions and change over time within a jurisdiction has not been widely used. The International Alcohol Control (IAC) Policy Index is designed to address this gap and monitor the alcohol policy environment with regard to four effective policy domains (tax/pricing, availability, marketing and drink driving).

METHODS

This study compares IAC Policy Index scores across 11 high-income jurisdictions: Aotearoa (Māori language name for New Zealand); Australia; Finland; Norway; the Netherlands; (Republic of Ireland; Lithuania; Ontario; Alberta; Quebec; British Columbia). Collaborators in the 11 high-income jurisdictions populated the online Alcohol Policy Tool with available indicators. The team in Aotearoa New Zealand sought to validate information and worked with collaborators to clarify any uncertainties in the data.

RESULTS

Lithuania, Norway, Finland and Ireland scored above average on the IAC Policy Index. The jurisdictions varied in terms of the strength of policy in different domains, with drink driving legislation showing the greatest consistency and marketing the strongest relationship between stringency of policy and impact on the ground.

DISCUSSION AND CONCLUSIONS

Results in high-income jurisdictions suggested the IAC Policy Index provides a useful overview of core alcohol policy status, allows for comparisons between jurisdictions and has the potential to be useful in alcohol policy debate.

Using the International Alcohol Control (IAC) policy index to assess effects of legislative change in Aotearoa New Zealand

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.

"They start on the zero-alcohol and they wanna try the real thing": Parents' views on zero-alcohol beverages and their use by adolescents

OBJECTIVE

Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents' earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents' views on zero-alcohol beverages and their provision to adolescents.

METHODS

We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data.

RESULTS

Parents considered zero-alcohol beverages to be 'adult beverages' that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in 'appropriate' contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported.

CONCLUSIONS

Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents.

IMPLICATIONS FOR PUBLIC HEALTH

As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses.

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.