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Lesch M, McCambridge J. Continuities and change in alcohol policy at the global level: a documentary analysis of the 2010 Global Strategy for Reducing the Harmful Use of Alcohol and the Global Alcohol Action Plan 2022-2030. Global Health 2024; 20:47. [PMID: 38877515 PMCID: PMC11179290 DOI: 10.1186/s12992-024-01034-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/23/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND There are only two major statements which define alcohol policy development at the global level. There has not been any comparative analysis of the details of these key texts, published in 2010 and 2022 respectively, including how far they constitute similar or evolving approaches to alcohol harm. METHODS Preparatory data collection involved examination of documents associated with the final policy statements. A thematic analysis across the two policy documents was performed to generate understanding of continuity and change based on comparative study. Study findings are interpreted in the contexts of the evolving conceptual and empirical literatures. RESULTS Both documents exhibit shared guiding principles and identify similar governance challenges, albeit with varying priority levels. There is more emphasis on the high-impact interventions on price, availability and marketing in 2022, and more stringent targets have been set for 2030 in declaring alcohol as a public health priority therein, reflecting the action-oriented nature of the Plan. The identified roles of policy actors have largely remained unchanged, albeit with greater specificity in the more recent statement, appropriately so because it is concerned with implementation. The major exception, and the key difference in the documents, regards the alcohol industry, which is perceived primarily as a threat to public health in 2022 due to commercial activities harmful to health and because policy interference has slowed progress. CONCLUSIONS The adoption of the Global Alcohol Action Plan 2022-30 potentially marks a pivotal moment in global alcohol policy development, though it is unclear how fully it may be implemented. Perhaps, the key advances lie in advancing the ambitions of alcohol policy and clearly identifying that the alcohol industry should not be seen as any kind of partner in public health policymaking, which will permit progress to the extent that this influences what actually happens in alcohol policy at the national level.
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Affiliation(s)
- Matthew Lesch
- Department of Politics and International Relations, Derwent College, University of York, D/N/126, Heslington, York, YO10 5DD, UK.
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Doyle A, Foley R, Houghton F. A spatial examination of alcohol availability and the level of disadvantage of schools in Ireland. BMC Public Health 2024; 24:795. [PMID: 38481175 PMCID: PMC10938707 DOI: 10.1186/s12889-024-18261-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND The availability of alcohol is a major factor in underage drinking and according to the alcohol harm paradox, those living in more deprived communities are more susceptible to the negative consequences of alcohol use, despite drinking the same or less than those from more affluent areas. Alcohol availability within the vicinity of the home or school normalises alcohol for schoolchildren. For the first time in the Republic of Ireland, this study examines the number of premises licensed to sell alcohol within 300 m of all schools in Ireland and differences in this number between disadvantaged and non-disadvantaged schools. METHODS Using publicly available data from the Department of Education and Revenue, the addresses of all schools (n = 3,958) and all premises with at least one liquor licence (n = 14,840) were geocoded and analysed using the Geographic Information System software, Quantum GIS (QGIS). Schools were identified by their disadvantaged classification using the HP Pobal Deprivation Index and the number of liquor licences within 300 m of each school type was examined. To test for significant differences between schools' level of disadvantage, a combination of Mann-Whitney U tests, Kruskal-Wallis tests and Dunn-Bonferroni tests were used. RESULTS There was a mean of two licenced premises within 300 m of all schools in Ireland, but when disadvantaged schools were compared to non-disadvantaged schools, there was a significantly higher number of licenced premises around disadvantaged schools (p < .001). Primary schools are further classified according to their level of disadvantage and the results indicated that those schools classified as the most disadvantaged had a significantly greater number of liquor licences within 300 meters (p < .001). There was no significant difference in density of licenced premises when comparing disadvantaged secondary schools with non-disadvantaged secondary schools (p = .705). CONCLUSION Ireland is considering increasing alcohol availability through the Sale of Alcohol Bill, 2022. However, this analysis indicates already problematic numbers of licenced premises within close proximity of schools in Ireland. It is essential that the harms associated with alcohol availability are considered, especially for those living and attending school in disadvantaged communities, where higher numbers of licenced premises were identified.
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Affiliation(s)
- Anne Doyle
- Health Research Board, Grattan House 67-72 Lower Mount Street, Dublin, Ireland.
| | - Ronan Foley
- Maynooth University, Maynooth, Co. Kildare, Ireland
| | - Frank Houghton
- Technological University of the Shannon, Limerick, Ireland
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Schess J, Bennett-Li L, Velleman R, Bhatia U, Catalano A, Jambhale A, Nadkarni A. Alcohol policies in India: A scoping review. PLoS One 2023; 18:e0294392. [PMID: 37976246 PMCID: PMC10655994 DOI: 10.1371/journal.pone.0294392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/25/2023] [Indexed: 11/19/2023] Open
Abstract
Globally, alcohol consumption causes significant societal harm and is a leading risk factor for death and disability in adults. In India, 3.7% of all deaths and 3.1% disability adjusted life years (DALYs) can be attributed to alcohol. In the context of rapid economic development and emphasized by the COVID-19 pandemic, India's lack of a consolidated and comprehensive alcohol policy has posed significant challenges to addressing this harm. In this context, the aim of our review was to undertake a comprehensive mapping of the State and national policy environment surrounding alcohol and its use in India, based on an analysis of policy documents. We did this though a scoping review of academic and grey literature, which helped to iteratively identify the websites of 15 international organizations, 21 Indian non-governmental organizations, and eight Indian Federal governmental organizations as well as State/Union Territory government sites, to search for relevant policy documents. We identified 19 Federal policy documents and 36 State level policy documents within which we have identified the specific policy measures which address the 10 categories of the World Health Organization's Global Action Plan to Reduce the Harmful Use of Alcohol. We found that there are major gaps in regulation of marketing and price controls, with much of this controlled by the States. In addition, regulation of availability of alcohol varies widely throughout the country, which is also a policy area controlled locally by States. Through the clear elucidation of the current policy environment surrounding alcohol in India, policy makers, researchers and advocates can create a clearer roadmap for future reform.
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Affiliation(s)
- Jaclyn Schess
- Addictions Research Group, Sangath, Porvorim, Goa, India
- Department of Health Policy and Management, University of California, Berkeley School of Public Health, Berkeley, California, United States of America
| | | | - Richard Velleman
- Addictions Research Group, Sangath, Porvorim, Goa, India
- Department of Psychology, University of Bath, Bath, England, United Kingdom
| | - Urvita Bhatia
- Addictions Research Group, Sangath, Porvorim, Goa, India
- Oxford Brookes University, Oxford, England, United Kingdom
| | | | | | - Abhijit Nadkarni
- Addictions Research Group, Sangath, Porvorim, Goa, India
- Centre for Global Mental Health, Department of Population Health, London School of Hygiene & Tropical Medicine, London, England, United Kingdom
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O'Brien P, Dwyer R, Gleeson D, Cook M, Room R. Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104115. [PMID: 37549594 DOI: 10.1016/j.drugpo.2023.104115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol. METHODS 48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments. RESULTS In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol. CONCLUSION The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.
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Affiliation(s)
- Paula O'Brien
- Melbourne Law School, University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Robyn Dwyer
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - Megan Cook
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3083, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Bundoora, Victoria, 3083, Australia; Centre for Social Research on Alcohol & Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
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Heenan M, Shanthosh J, Cullerton K, Jan S. Influencing and implementing mandatory alcohol pregnancy warning labels in Australia and New Zealand. Health Promot Int 2023; 38:daac022. [PMID: 35462394 PMCID: PMC10308210 DOI: 10.1093/heapro/daac022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Alcohol labelling laws and policy are contentious and highly politicized. Very few countries have been able to implement health warnings on alcohol labels due to complex legal and governance systems and coordinated industry lobbying. In 2020, Australia and New Zealand implemented a mandatory and evidence-based legal standard for pregnancy warning labels on alcohol products. This article discusses some of the challenges faced in achieving policy change and how these barriers were overcome by public health advocacy groups to build the evidence, counter industry conflicts of interest, consumer test health messages, mobilize community support and gather political support. Reflecting on the decades of ineffective regulation and politicization of this health issue, lessons for other countries include the importance of creating and maintaining relationships with decision makers and regularly updating them with evidence and recommendations, highlighting industry failures and tactics, building broad-based coalitions and sharing lived-experiences.
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Affiliation(s)
- Maddie Heenan
- The George Institute for Global Health, University of New South Wales, Level 5/1 King Street, Newtown, NSW 2042, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia
- Australian Human Rights Institute, The Law Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Janani Shanthosh
- The George Institute for Global Health, University of New South Wales, Level 5/1 King Street, Newtown, NSW 2042, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia
- Australian Human Rights Institute, The Law Building, University of New South Wales, Sydney, NSW 2052, Australia
| | - Katherine Cullerton
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia
- School of Public Health, University of Queensland, 266 Herston Road, Herston, QLD 4006, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Level 5/1 King Street, Newtown, NSW 2042, Australia
- The Australian Prevention Partnership Centre, Level 3, 30C Wentworth Street, Glebe, NSW 2037, Australia
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JERNIGAN DAVIDH. Alcohol and Public Health: Failure and Opportunity. Milbank Q 2023; 101:552-578. [PMID: 37096612 PMCID: PMC10126957 DOI: 10.1111/1468-0009.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/01/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points Public health science regarding alcohol consumption and problems, alcohol's role in equity and social justice, and identification of effective policy interventions has grown steadily stronger in the past 30 years. Progress on effective alcohol policies has stalled or gone backward in the United States and much of the world. Because alcohol influences at least 14 of the 17 sustainable development goals, as well as more than 200 disease and injury conditions, reducing alcohol problems should offer a platform for collaboration across public health silos but will require that public health itself respect and follow its own science.
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Radoš Krnel S, Levičnik G, van Dalen W, Ferrarese G, Tricas-Sauras S. Effectiveness of Regulatory Policies on Online/Digital/Internet-Mediated Alcohol Marketing: a Systematic Review. J Epidemiol Glob Health 2023; 13:115-128. [PMID: 36732366 PMCID: PMC10006384 DOI: 10.1007/s44197-023-00088-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/17/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The rapid growth of social networking sites and video sharing platforms has created an opportunity for the alcohol industry to employ advanced advertising and marketing approaches to target their audiences, increasingly blurring the lines between commercial marketing and user-generated content, which poses a challenge for effective regulation. METHODS We conducted a systematic search through three peer-reviewed journal databases (WoS, PubMed, Scopus). Studies were included if published in English, after 2004, and assessed statutory regulation or voluntary industry codes, enacted by an EU or nation's governmental agency or private entity, and with the intent to restrict digital alcohol advertising. In addition, we conducted a manual search of gray literature. RESULTS A total of 4690 records were identified. After duplicate removal and full-text assessment, 14 articles were examined. Our findings indicate that children and adolescents may often be exposed to alcohol advertisements on social media and websites due to industry's self-regulatory age-affirmation systems being largely ineffective at preventing under-aged access. Cases of self-regulatory violations by the alcohol industry, and increasingly innovative 'gray-area' advertising approaches have also been noted. Additionally, research illustrates a lack of developed statutory restrictions of digital alcohol advertising and instead continued reliance on voluntary industry self-regulation. CONCLUSIONS There is a substantial need for further research to examine the effectiveness of digital alcohol advertising restrictions in social media, websites and image/video sharing platforms. Moreover, there is a necessity for countries to develop comprehensive statutory frameworks, which would effectively restrict and monitor rapidly advancing digital alcohol advertising practices on new digital media.
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Affiliation(s)
- Sandra Radoš Krnel
- Analysis and Development Centre, National Institute of Public Health, Trubarjeva Cesta 2, 1000, Ljubljana, Slovenia.
| | - Gorazd Levičnik
- Analysis and Development Centre, National Institute of Public Health, Trubarjeva Cesta 2, 1000, Ljubljana, Slovenia
| | - Wim van Dalen
- EUCAM - European Centre for Monitoring Alcohol Marketing, Utrecht, The Netherlands
| | - Giulia Ferrarese
- EUCAM - European Centre for Monitoring Alcohol Marketing, Utrecht, The Netherlands
| | - Sandra Tricas-Sauras
- Ecole de Santé Publique, Centre de Recherche Approches Sociales de la Santé, Brussels, Belgium
- Eurocare: The Alcohol Policy Alliance, Brussels, Belgium
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Popova S, Charness ME, Burd L, Crawford A, Hoyme HE, Mukherjee RAS, Riley EP, Elliott EJ. Fetal alcohol spectrum disorders. Nat Rev Dis Primers 2023; 9:11. [PMID: 36823161 DOI: 10.1038/s41572-023-00420-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 02/25/2023]
Abstract
Alcohol readily crosses the placenta and may disrupt fetal development. Harm from prenatal alcohol exposure (PAE) is determined by the dose, pattern, timing and duration of exposure, fetal and maternal genetics, maternal nutrition, concurrent substance use, and epigenetic responses. A safe dose of alcohol use during pregnancy has not been established. PAE can cause fetal alcohol spectrum disorders (FASD), which are characterized by neurodevelopmental impairment with or without facial dysmorphology, congenital anomalies and poor growth. FASD are a leading preventable cause of birth defects and developmental disability. The prevalence of FASD in 76 countries is >1% and is high in individuals living in out-of-home care or engaged in justice and mental health systems. The social and economic effects of FASD are profound, but the diagnosis is often missed or delayed and receives little public recognition. Future research should be informed by people living with FASD and be guided by cultural context, seek consensus on diagnostic criteria and evidence-based treatments, and describe the pathophysiology and lifelong effects of FASD. Imperatives include reducing stigma, equitable access to services, improved quality of life for people with FASD and FASD prevention in future generations.
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Affiliation(s)
- Svetlana Popova
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
| | - Michael E Charness
- VA Boston Healthcare System, West Roxbury, MA, USA.,Department of Neurology, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Larry Burd
- North Dakota Fetal Alcohol Syndrome Center, Department of Pediatrics, University of North Dakota School of Medicine and Health Sciences, Pediatric Therapy Services, Altru Health System, Grand Forks, ND, USA
| | - Andi Crawford
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - H Eugene Hoyme
- Sanford Children's Genomic Medicine Consortium, Sanford Health, and University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA
| | - Raja A S Mukherjee
- National UK FASD Clinic, Surrey and Borders Partnership NHS Foundation Trust, Redhill, Surrey, UK
| | - Edward P Riley
- Center for Behavioral Teratology, San Diego State University, San Diego, CA, USA
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,New South Wales FASD Assessment Service, CICADA Centre for Care and Intervention for Children and Adolescents affected by Drugs and Alcohol, Sydney Children's Hospitals Network, Westmead, Sydney, New South Wales, Australia
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Schneider CH, Parambath S, Young JJ, Jain S, Slater H, Sharma S, Kopansky-Giles D, March L, Briggs AM. From Local Action to Global Policy: A Comparative Policy Content Analysis of National Policies to Address Musculoskeletal Health to Inform Global Policy Development. Int J Health Policy Manag 2023; 12:7031. [PMID: 37579444 PMCID: PMC10125103 DOI: 10.34172/ijhpm.2022.7031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 11/26/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Global policy to guide action on musculoskeletal (MSK) health is in a nascent phase. Lagging behind other non-communicable diseases (NCDs) there is currently little global policy to assist governments to develop national approaches to MSK health. Considering the importance of comparison and learning for global policy development, we aimed to perform a comparative analysis of national MSK policies to identify areas of innovation and draw common themes and principles that could guide MSK health policy. METHODS Multi-modal search strategy incorporating a systematic online search targeted at the 30 most populated nations; a call to networked experts; a specified question in a related eDelphi questionnaire; and snowballing methods. Extracted data were organised using an a priori framework adapted from the World Health Organization (WHO) Building Blocks and further inductive coding. Subsequently, texts were open coded and thematically analysed to derive specific sub-themes and principles underlying texts within each theme, serving as abstracted, transferable concepts for future global policy. RESULTS The search yielded 165 documents with 41 retained after removal of duplicates and exclusions. Only three documents were comprehensive national strategies addressing MSK health. The most common conditions addressed in the documents were pain (non-cancer), low back pain, occupational health, inflammatory conditions, and osteoarthritis. Across eight categories, we derived 47 sub-themes with transferable principles that could guide global policy for: service delivery; workforce; medicines and technologies; financing; data and information systems; leadership and governance; citizens, consumers and communities; and research and innovation. CONCLUSION There are few examples of national strategic policy to address MSK health; however, many countries are moving towards this by documenting the burden of disease and developing policies for MSK services. This review found a breadth of principles that can add to this existing work and may be adopted to develop comprehensive system-wide MSK health approaches at national and global levels.
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Affiliation(s)
- Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Sarika Parambath
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - James J. Young
- Center for Muscle and Joint Health, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Swatee Jain
- Sydney Musculoskeletal, Bone & Joint Health Alliance, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Helen Slater
- Curtin School of Allied Health, and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Saurab Sharma
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW, Australia
| | - Deborah Kopansky-Giles
- Department of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Lyn March
- Florance and Cope Professorial Department of Rheumatology, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, NSW, Australia
| | - Andrew M. Briggs
- Curtin School of Allied Health, and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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Swahn MH, Robow Z, Balenger A, Staton CA, Kasirye R, Francis JM, Komba S, Siema P. Preventing Alcohol-Related Harm in East Africa: Stakeholder Perceptions of Readiness across Five Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14979. [PMID: 36429695 PMCID: PMC9690202 DOI: 10.3390/ijerph192214979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE While alcohol-related harm is a recognized public health priority, the capacity to address and mitigate its harm is lacking, primarily in low-income countries. Recent developments including new tools that can assess readiness for preventing alcohol-related harm, specifically in low-resource settings, can be used to determine strengths and opportunities for supporting, planning, and resource allocation. In this study, we determined the perceptions of readiness and capacity for the prevention of alcohol-related harm across East Africa among stakeholders engaged in such work. METHODS We conducted a cross-sectional survey in 2020, distributed by the East Africa Alcohol Policy Alliance to their member alliances and stakeholders across five countries in East Africa (i.e., Burundi, Kenya, Rwanda, Tanzania, and Uganda). The survey included modified measures from the Readiness Assessment for the Prevention of Child Maltreatment (RAP-CM) short form, organizational size and funding, research capacity and priorities, and perceptions related to alcohol prevention and harm both locally and in the region. Analyses were computed based on 142 persons/organizations completing the survey. RESULTS In terms of general readiness, the overall adjusted aggregate score for East Africa was 39.70% (ranging from 30.5% in Burundi to 47.0% in Kenya). Of the 10 domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol prevention (8.43), institutional links and resources (6.15) and legislation, mandates and policies (5.46) received the highest scores. In contrast, measures pertaining to resources (i.e., material, human, technical, and informal) received the lowest score. CONCLUSIONS Our results demonstrate substantial variability in the readiness to address alcohol-related harm across East Africa. The highest capacity was noted for knowledge towards alcohol prevention, institutional links, and legislative mandates and policies. However, important gaps were noted in terms of attitudes towards alcohol prevention, the will to address the problem, as well as material, human, and informal resources, which need to be urgently addressed to strengthen capacity for addressing and mitigating the significant toll of alcohol-related harm in the region.
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Affiliation(s)
- Monica H. Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA 30144, USA
| | - Zakaria Robow
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Adelaide Balenger
- School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke Global Health Institute, Duke University, Durham, NC 27710, USA
| | - Rogers Kasirye
- Uganda Youth Development Link, Kampala P.O. Box 12659, Uganda
| | - Joel M. Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Sophia Komba
- East Africa Alcohol Policy Alliance, Dar es Salam, Tanzania
| | - Patterson Siema
- African Population and Health Research Center, Nairobi 00100, Kenya
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Leung JYY, Casswell S. Management of Conflicts of Interest in WHO's Consultative Processes on Global Alcohol Policy. Int J Health Policy Manag 2022; 11:2219-2227. [PMID: 34814668 PMCID: PMC9808266 DOI: 10.34172/ijhpm.2021.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/02/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) has engaged in consultations with the alcohol industry in global alcohol policy development, including currently a draft action plan to strengthen implementation of the Global strategy to reduce the harmful use of alcohol. WHO's Framework for Engagement with Non-State Actors (FENSA) is an organization-wide policy that aims to manage potential conflicts of interest in WHO's interactions with private sector entities, non-governmental institutions, philanthropic foundations and academic institutions. METHODS We analysed the alignment of WHO's consultative processes with non-state actors on "the way forward" for alcohol policy and a global alcohol action plan with FENSA. We referred to publicly accessible WHO documents, including the Alcohol, Drugs and Addictive Behaviours Unit website, records of relevant meetings, and other documents relevant to FENSA. We documented submissions to two web-based consultations held in 2019 and 2020 by type of organization and links to the alcohol industry. RESULTS WHO's processes to conduct due diligence, risk assessment and risk management as required by FENSA appeared to be inadequate. Limited information was published on non-state actors, primarily the alcohol industry, that participated in the consultations, including their potential conflicts of interest. No minutes were published for WHO's virtual meeting with the alcohol industry, suggesting a lack of transparency. Organizations with known links to the tobacco industry participated in both web-based consultations, despite FENSA's principle of non-engagement with tobacco industry actors. CONCLUSION WHO's consultative processes have not been adequate to address conflicts of interest in relation to the alcohol industry, violating the principles of FENSA. Member states must ensure that WHO has the resources to implement and is held accountable for appropriate and consistent safeguards against industry interference in the development of global alcohol policy.
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Affiliation(s)
- June YY Leung
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
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Sanchez ZM, Carvalho A, Sacramento C, D’Alva F, Rita I, Pinheiro S, Soares de Barros EM, Gil VS, Costa Alegre MC, Ancia A, Monteiro MG, Opoko CA, Tello JE. Development of alcohol control law, Sao Tome and Principe. Bull World Health Organ 2022; 100:628-635. [PMID: 36188018 PMCID: PMC9511675 DOI: 10.2471/blt.22.288590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/19/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022] Open
Abstract
The World Health Organization (WHO) African Region is struggling with increasing harm associated with alcohol consumption. Legislators of Sao Tome and Principe, concerned about this harm and the high prevalence of alcohol use disorders, designed a comprehensive alcohol control bill to tackle this situation. Input into the design of the bill was obtained through interviews involving many stakeholders. The process had five phases: (i) scoping the problem to understand the social burden of the harm caused by alcohol consumption; (ii) updating the evidence on alcohol policies and identifying areas for legislative interventions; (iii) drafting the bill; (iv) aligning the legislative framework of the bill; and (v) initiating the parliamentary procedure. The new bill scored 92/100 using a standardized alcohol control policy scale. The bill covers all domains of WHO’s 2010 global strategy to reduce the harmful use of alcohol, and includes the three most cost-effective interventions for reducing alcohol consumption: increased excise taxes on alcohol; bans or comprehensive restrictions on exposure to alcohol advertising; and restrictions on the availability of retailed alcohol through reduced hours of sale. The National Assembly plenary session upheld the bill, which is now under evaluation of the specialized First Commission on Political, Legal, Constitutional and Ethical Affairs. Approval of the bill requires the final voting once it is back with the National Assembly and its promulgation by the President. Drafting an alcohol control bill which is country-led, inclusive, evidence-based and free of interference by the alcohol industry helps prioritize public health objectives over other interests.
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Affiliation(s)
- Zila M Sanchez
- Department of Preventive Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Arlindo Carvalho
- Sao Tome National Assembly of Deputies, Sao Tome, Sao Tome and Principe
| | | | - Filomena D’Alva
- Sao Tome National Assembly of Deputies, Sao Tome, Sao Tome and Principe
| | - Iazalde Rita
- Sao Tome National Assembly of Deputies, Sao Tome, Sao Tome and Principe
| | | | | | | | | | - Anne Ancia
- World Health Organization Country Office, Sao Tome, Sao Tome and Principe
| | - Maristela G Monteiro
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, United States of America
| | - Chidinma A Opoko
- Cluster of Universal Health Coverage and Healthier Population, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Juan E Tello
- Department of Health Promotion, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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13
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Swahn MH, Culbreth R, Fodeman A, Cottrell-Daniels C, Tumwesigye NM, Jernigan DH, Kasirye R, Obot I. Heavy drinking and problem drinking among youth in Uganda: A structural equation model of alcohol marketing, advertisement perceptions and social norms. Drug Alcohol Rev 2022; 41:1444-1456. [PMID: 35761763 PMCID: PMC9546093 DOI: 10.1111/dar.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/05/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022]
Abstract
Introduction To determine the role of alcohol marketing, perceptions of marketing and social norms on heavy alcohol use and problem drinking among vulnerable youth in Uganda. Methods The Kampala Youth Survey is a cross‐sectional study conducted in 2014 with service‐seeking youth (ages 12–18 years) living in the slums of Kampala (n = 1134) who were participating in Uganda Youth Development Link drop‐in centres. Survey measures assessed perceptions of alcohol advertisements, social norms regarding alcohol use, heavy alcohol use and problem drinking. Factor analyses and structural equation models were computed to determine the predictors (e.g. social norms and alcohol marketing exposure) for drinking amounts, heavy drinking and problem drinking. Results Alcohol marketing allure, perceptions of adults' alcohol attitudes and respondent's male gender were significantly predictive of heavy drinking. Similarly, in addition to drinking amount and heaviness, only alcohol marketing exposure and friends' alcohol attitudes, as well as respondent's own attitudes about alcohol, significantly predicted variation in problem drinking. Discussion and Conclusions Alcohol marketing exposure and allure are significant predictors of heavy drinking and problem drinking among youth in Uganda. Prevention programs that reduce exposure to and allure of alcohol marketing may prove promising for reducing alcohol use and related problems among these vulnerable youth in a low‐resource setting.
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Affiliation(s)
- Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, USA.,School of Public Health, Georgia State University, Atlanta, USA
| | - Rachel Culbreth
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, USA
| | - Ari Fodeman
- College of Arts and Sciences, Georgia State University, Atlanta, USA
| | | | | | | | | | - Isidore Obot
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
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14
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Swahn MH, Palmier JB, May A, Dai D, Braunstein S, Kasirye R. Features of alcohol advertisements across five urban slums in Kampala, Uganda: pilot testing a container-based approach. BMC Public Health 2022; 22:915. [PMID: 35534847 PMCID: PMC9082884 DOI: 10.1186/s12889-022-13350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the high prevalence of alcohol use and marketing in many settings across sub-Saharan Africa, few studies have systematically sought to assess alcohol marketing exposure, particularly in vulnerable areas such as urban slums where alcohol is often highly prevalent but where educational programs and alcohol prevention messages are scarce. OBJECTIVE To pilot test the development and implementation of environmental scans of alcohol advertisements in five urban slums across different areas of Kampala, Uganda: Bwaise, Kamwokya, Makindye, Nakulabye, and Nateete. METHODS Each of the five scans was conducted in geographical circles, within a 500-m radius of a Uganda Youth Development Link (UYDEL) drop-in Center using a container-based approach. Using a Garmin GPS with photo capabilities and a tablet for data entry, teams of at least two trained researchers walked the main roads within the target area and gathered information about each alcohol advertisement including its location, type, size, and placement and other characteristics. Data with the GPS coordinates, photos and descriptive details of the adverts were merged for analyses. RESULTS A total of 235 alcohol adverts were found across all five data collection sites reflecting 32 different brands. The majority of the adverts (85.8%) were smaller and medium sizes placed by restaurants and bars, stores and kiosks, and liquor stores. The most frequently noted types of alcohol in the adverts were spirits (50.6%) and beer (30.6%). RECOMMENDATIONS The pilot test of the methodology we developed indicated that implementation was feasible, although challenges were noted. Since monitoring alcohol marketing is key for addressing underage alcohol use and harm, the advantages and disadvantages of the approach we developed are discussed. Future research needs to strengthen and simplify strategies for monitoring alcohol marketing in low-resource settings such as urban slums which have unique features that need to be considered. Meanwhile, the findings may yield valuable information for stakeholders and to guide intervention developments and alcohol marketing policy to protect youth.
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Affiliation(s)
- Monica H Swahn
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA. .,Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, 30144, USA.
| | - Jane B Palmier
- Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, 30144, USA
| | - Alicia May
- School of Public Health, University of Georgia, Athens, GA, USA
| | - Dajun Dai
- Department of Geosciences, Georgia State University, P.O. Box 4105, Atlanta, GA, 30302, USA
| | - Sarah Braunstein
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Rogers Kasirye
- Uganda Youth Developmental Link, P.O. Box 12659, Kampala, Uganda
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15
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Swahn MH, Robow Z, Umenze F, Balenger A, Dumbili EW, Obot I. A readiness assessment for the prevention of alcohol-related harm in West Africa: A new methodological approach to inform practice and policy. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103650. [PMID: 35339092 DOI: 10.1016/j.drugpo.2022.103650] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/05/2022] [Accepted: 03/06/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Alcohol-related harm is a growing concern globally and particularly in West Africa. However, tools for assessing the readiness for prevention of alcohol-related harm in low-resource settings have been lacking. We modified the WHO tool, the Readiness Assessment for the Prevention of Child Maltreatment Short Form (RAP-CM), to assess readiness for the prevention of alcohol-related harm across West Africa. METHODS We conducted a cross-sectional survey in the fall of 2020, distributed by the West Africa Alcohol Policy Alliance to their member alliances and stakeholders, predominantly community-based organizations (CBOs) and non-governmental organizations (NGOs), across 7 countries in West Africa (N = 140). The survey included modified measures from the RAP-CM short form. RESULTS In terms of general readiness, the overall adjusted aggregate score for West Africa was 45.0% (ranging from 42.9% in Liberia to 52.7% in Senegal). Of the ten domains assessed (on a 0-10 scale), across all countries, knowledge of alcohol-related harm prevention (8.3) and legislation, mandates, and policies (6.7) received the highest readiness scores. The lowest readiness scores were observed for human and technical resources (2.5), attitudes toward preventing alcohol-related harm (2.7), and the will to address the problem (2.9). CONCLUSIONS Our results demonstrate substantial variability across domains in the readiness to address alcohol-related harm with clear strengths and limitations for future priority setting and capacity building. The barriers to progress include attitudes toward alcohol-related harm prevention, lack of willingness to address the problem, and limited human and technical resources available. These barriers need to be mitigated to address the high burden of alcohol-related harm in the region and to inform both practice and policy.
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Affiliation(s)
- Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, USA.
| | - Zakaria Robow
- School of Public Health, Georgia State University, USA
| | - Franklin Umenze
- Preston Hospital Lekki, West African Alcohol Policy Alliance, Lagos, Nigeria
| | | | - Emeka W Dumbili
- Institute for Therapy and Health Research, Kiel, Germany, Department of Sociology and Anthropology, Nnamdi Azikiwe University, Anambra State, Nigeria
| | - Isidore Obot
- Centre for Research and Information on Substance Abuse (CRISA), Uyo, Nigeria
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Qu X, Liu M, Ke C, Liang J, Du Y, Yao L, Li J, Mu G, Liu S, Wang C. Burden of alcohol use disorders in China and the regions with different income levels over the world. J Glob Health 2022; 11:08011. [PMID: 35003718 PMCID: PMC8710067 DOI: 10.7189/jogh.11.08011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Alcohol use disorders (AUD) has long been one of the most disability mental disorders and a major cause of health loss. Methods Based on open access data from the 2019 Global Burden of Disease (GBD 2019) study, we extracted data of years lived with disability (YLD), years of life lost (YLL) and disability-adjusted life years (DALY) to describe the changes of AUD burden over the period of 1990-2019 stratified by sex in globe, high-income countries (HICs), upper-middle income countries (UMCs), lower-middle income countries (LMCs), low-income countries (LICs) and China. We used Joinpoint regression model to fit the changing trend of years. And pairwise comparison was applied to test the coincidence parallelism and judge whether the difference of the trend among different regions is statistically significant. Results LMCs experienced the largest changes in the YLD rate of AUD from 1990 to 2019 (average annual percent change (AAPC) = -0.7, 95% confidence interval (CI) = -0.8, -0.7, P < 0.05), with China experienced a higher increase in 1990 to 1993 (annual percent change (APC) = 3.8, 95% CI = 3.2, 4.4, P < 0.05) than other regions, and the rate of decline in China from 1996 to 2002 (APC = -3.4, 95% CI = -3.6, -3.1, P < 0.05) was higher than that in other regions. UMCs experienced the largest changes in the YLL rate of AUD from 1990 to 2019 (AAPC = -1.1, 95% CI = -1.6, -0.6, P < 0.05), with a larger decline in 2004 to 2012 (APC = -6.2, 95% CI = -6.7, -5.7, P < 0.05) than other regions, and China experienced a larger increase in the rate of YLL from 1999 to 2004 (APC = 9.2, 95% CI = 8.5, 9.9, P < 0.05) than other regions. LMCs experienced the largest changes in the DALY rate of AUD from 1990 to 2019 (AAPC = -0.9, 95% CI = -1.0, -0.8, P < 0.05), with a larger decline in 2006 to 2010 (APC = -3.3, 95% CI = -3.6, -2.9, P < 0.05) than other regions, and UMCs showed a larger increase in the rate of DALY from 1990 to 1994 (APC = 4.5, 95% CI = 3.8, 5.1, P < 0.05) than other regions. Conclusions Given the large variations in AUD burden of disease by income level, future strategies to prevent and reduce the burden should be developed and implemented based on country-specific development status.
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Affiliation(s)
- Xiang Qu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Mi Liu
- Hospital infection management office, The Second People's Hospital of Lianyungang Lianyungang, China
| | - Changrong Ke
- School of Public Health, Weifang Medical University, Weifang, China
| | - Juanjuan Liang
- School of Public Health, Weifang Medical University, Weifang, China
| | - Yuanze Du
- School of Public Health, Weifang Medical University, Weifang, China
| | - Liqun Yao
- School of Public Health, Weifang Medical University, Weifang, China
| | - Juanjuan Li
- School of Public Health, Weifang Medical University, Weifang, China
| | - Guixian Mu
- School of Public Health, Weifang Medical University, Weifang, China
| | - Shiwei Liu
- Tobacco Control office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunping Wang
- School of Public Health, Weifang Medical University, Weifang, China
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17
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Trangenstein PJ, Peddireddy SR, Cook WK, Rossheim ME, Monteiro MG, Jernigan DH. Alcohol Policy Scores and Alcohol-Attributable Homicide Rates in 150 Countries. Am J Prev Med 2021; 61:311-319. [PMID: 34229927 PMCID: PMC8769715 DOI: 10.1016/j.amepre.2021.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/23/2021] [Accepted: 03/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION More comprehensive state-level alcohol policy environments are associated with lower alcohol-attributable homicide rates in the U.S., but few studies have explored this internationally. This study tests whether 3 national-level alcohol policy scores are associated with alcohol-attributable homicide rates. METHODS Data were from the 2016 WHO Global Survey on Alcohol and Health and the 2017 Global Burden of Disease Study (N=150 countries). In 2020, the authors calculated domain-specific alcohol policy scores for physical availability, marketing, and pricing policies. Higher scores represented more comprehensive/restrictive alcohol policy environments. Negative binomial regressions with Benjamini-Simes-Hochberg multiple testing correction measured the associations between policies and alcohol-attributable homicide rates. Authors stratified countries by World Bank income group to determine whether the associations differed among low- and middle-income countries. RESULTS A 10% increase in the alcohol policy score for pricing was associated with an 18% lower alcohol-attributable homicide rate among all the countries (incidence rate ratio=0.82, adjusted p-value or q<0.001) and with a 14% (incidence rate ratio=0.86, q=0.01) decrease among 107 low- and middle-income countries. More controls on days and times of retail sales (incidence rate ratio=0.96, q=0.01) and affordability of alcohol (incidence rate ratio=0.95, q=0.04) as well as adjusting excise taxes for inflation (incidence rate ratio=0.96, q<0.01) were associated with a 4%-5% lower alcohol-attributable homicide rate in the full sample. CONCLUSIONS Countries with policies that reduce alcohol's affordability or days/hours of sales tend to have fewer alcohol-attributable homicides, regardless of their income level. Alcohol-attributable homicide rates are highest in low- and middle-income countries; policies that raise alcohol-relative prices may hold promise for curbing these harms.
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Affiliation(s)
- Pamela J Trangenstein
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Snigdha R Peddireddy
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Won K Cook
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Matthew E Rossheim
- Department of Global and Community Health, George Mason University, Fairfax, Virginia
| | - Maristela G Monteiro
- Alcohol and Substance Abuse, Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, District of Columbia
| | - David H Jernigan
- Department of Health, Law, Policy & Management, School of Public Health, Boston University, Boston, Massachusetts
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18
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de Oliveira CWL, Mendes CV, Kiepper A, Monteiro MG, Wagner GA, Sanchez ZM. Analysis of gaps in alcohol policies in Brazil using the Pan American Health Organization's Alcohol Policy Scoring. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103322. [PMID: 34271251 DOI: 10.1016/j.drugpo.2021.103322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/14/2021] [Accepted: 05/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND National alcohol policies need to be systematized and evaluated to identify the gaps that should be filled by future laws. This study aims to search for and classify Brazilian public alcohol policies at the federal and state levels, based on the ten Alcohol Policy Scoring (APS) domains used by the Pan American Health Organization (PAHO), to identify any gaps METHODS: Documental research was carried out in two phases: document identification and content analysis. The search included laws, decrees, and ordinances for alcohol referred to in this text as regulatory documents (RD), enacted until December 31, 2019, in Brazil and its 26 states and the Federal District. The APS was used to classify and score the RD, which consists of ten policy domains (including pricing, availability, marketing, and health services), weighted according to the level of scientific evidence of each strategy RESULTS: We identified and categorized 435 valid RD (21 national laws and 414 state laws). Overall, Brazilian alcohol policies account for 51.6% (255/494) of the APS score. In the pricing policy domain, the second most robust indicator of the APS, the policy gap reached 87% in 25 states, demonstrating a weakness. Only the federal laws against drink-driving include all the recommended dimensions. There are important legislative contradictions in the definition of an alcoholic beverage and in the content of the policies to control marketing CONCLUSION: At the national level, the federal government adopted alcohol policies in several of the PAHO policy domains but enacted RD with little practical effect. At the subnational level, despite the autonomy to complement federal laws, the states have not yet addressed the most important gaps.
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Affiliation(s)
- Camila W Lopes de Oliveira
- Departamento de Psiquiatria e Psicologia Médica. Universidade Federal de São Paulo, São Paulo, Brazil. Rua Borges Lagoa, 570 - 1º Andar - São Paulo, SP, Brazil
| | - Camila Vieira Mendes
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | | | - Maristela G Monteiro
- Noncommunicable Diseases and Mental Health Department, Pan American Health Organization (PAHO), 525 Twenty-third Street, N.W., Washington, DC 20037, United States
| | - Gabriela Arantes Wagner
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil
| | - Zila M Sanchez
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, Brazil. Rua Botucatu, 740, 4° andar, São Paulo, SP, Brazil.
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Leung JYY, Au Yeung SL, Lam TH, Casswell S. What lessons does the COVID-19 pandemic hold for global alcohol policy? BMJ Glob Health 2021; 6:e006875. [PMID: 34326071 PMCID: PMC8326027 DOI: 10.1136/bmjgh-2021-006875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/18/2023] Open
Affiliation(s)
- June Yue Yan Leung
- SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | - Shiu Lun Au Yeung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Sally Casswell
- SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
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20
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de Melo-Martin I, Crystal RG. Primum Non Nocere: Should Gene Therapy Be Used to Prevent Potentially Fatal Disease but Enable Potentially Destructive Behavior? Hum Gene Ther 2021; 32:529-534. [PMID: 33752441 DOI: 10.1089/hum.2021.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aldehyde dehydrogenase 2 (ALDH2) deficiency constitutes one of the most common hereditary enzyme deficiencies, affecting 35% to 40% of East Asians and 8% of the world population. It causes the well-known Asian Alcohol Flush Syndrome, characterized by facial flushing, palpitation, tachycardia, nausea, and other unpleasant feelings when alcohol is consumed. It is also associated with a marked increase in the risk of a variety of serious disorders, including esophageal cancer and osteoporosis. Our recent studies with murine models have demonstrated that a one-time administration of an adeno-associated virus (AAV) gene transfer vector expressing the human ALDH2 coding sequence (AAVrh.10hALDH2) will correct the deficiency state and prevent alcohol-induced abnormalities of the esophagus and bone. If successful in humans, such strategy would reduce the increased risk-associated disorders such as esophageal cancer and osteoporosis, but also prevent the Asian Alcohol Flush Syndrome. This treatment thus raises ethical concerns: although it would potentially prevent fatal disease, it could also allow affected individuals to drink alcohol without suffering the Asian Alcohol Flush Syndrome and, hence, potentially enable personal destructive behavior. Here we explore the ethical arguments against the development of a gene therapy for ALDH2 deficiency and we find them wanting. We contend that development of such treatments is ethically appropriate and should be part and parcel of the solutions offered against the condition.
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Affiliation(s)
| | - Ronald G Crystal
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York, USA
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21
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Morojele NK, Dumbili EW, Obot IS, Parry CDH. Alcohol consumption, harms and policy developments in sub-Saharan Africa: The case for stronger national and regional responses. Drug Alcohol Rev 2021; 40:402-419. [PMID: 33629786 DOI: 10.1111/dar.13247] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 01/06/2023]
Abstract
ISSUES Sub-Saharan Africa (SSA) has long been characterised as a region with weak alcohol policies, high proportions of abstainers and heavy episodic drinkers (among drinkers), and as a target for market expansion by global alcohol producers. However, inter-regional analyses of these issues are seldom conducted. APPROACH Focusing mainly on the period 2000-2016, we compare alcohol consumption and harms, alcohol policy developments and alcohol industry activities over time and across the four sub-regions of SSA. KEY FINDINGS Per-capita consumption of alcohol and alcohol-related disease burden have increased in Central Africa but stabilised or reduced in other regions, although they are still high. Most countries have implemented tax policies, but they have seldom adopted other World Health Organization 'best buys' for cost-effective alcohol control policies. Countries range from having minimal alcohol controls to having total bans (e.g. some Muslim-majority countries); and some, such as Botswana, have attempted stringent tax policies to address alcohol harm. Alcohol producers have continued their aggressive marketing and policy interference activities, some of which have been highlighted and, in a few instances, resisted by civil society and public health advocates, particularly in southern Africa. IMPLICATIONS Increased government support and commitment are needed to be able to adopt and implement effective alcohol policies and respond to pressures from alcohol companies to which SSA remains a target market. CONCLUSION SSA needs effective alcohol control measures in order to reverse the trajectory of worsening alcohol harms observed in some countries and reinforce improvements in alcohol harms observed in others.
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Affiliation(s)
- Neo K Morojele
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa.,Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Emeka W Dumbili
- Institute for Therapy and Health Research, Kiel, Germany.,Department of Sociology and Anthropology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Isidore S Obot
- Centre for Research and Information on Substance Abuse, Uyo, Nigeria
| | - Charles D H Parry
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa
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Pantani D, Sanchez ZM, Greene C, Pinsky I. The alcohol industry 'smart affordability' strategy is to reach the poor. Drug Alcohol Rev 2020; 40:509-510. [PMID: 33073391 DOI: 10.1111/dar.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Daniela Pantani
- Department of Preventive Medicine, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - Zila M Sanchez
- Department of Preventive Medicine, Paulista School of Medicine, Federal University of São Paulo, Sao Paulo, Brazil
| | - Claire Greene
- Program on Forced Migration and Health, Department of Population and Family Health, Columbia University, New York, USA
| | - Ilana Pinsky
- School of Public Health, City University of New York, New York, USA
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Park SH, Kim DJ. Global and regional impacts of alcohol use on public health: Emphasis on alcohol policies. Clin Mol Hepatol 2020; 26:652-661. [PMID: 33053937 PMCID: PMC7641561 DOI: 10.3350/cmh.2020.0160] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 12/14/2022] Open
Abstract
Alcohol is a well-known risk factor for premature morbidity and mortality. The per capita alcohol consumption of the world's population rose from 5.5 L in 2005 to 6.4 L in 2010 and was still at the level of 6.4 L in 2016. Alcohol-attributable deaths and disability-adjusted life years (DALYs) declined from 2000 to 2016 by 17.9% and 14.5%, respectively. However, these gains observed in the alcohol-attributable burden have proportionally not kept pace with the total health gains during the same period. In 2016, 3.0 million deaths worldwide and 132 million DALYs were attributable to alcohol, responsible for 5.3% of all deaths and 5.0% of all DALYs. These burdens are the highest in the regions of Eastern Europe and sub-Saharan Africa. The alcohol-attributable burden is particularly heavy among young adults, accounting for 7.2% of all premature mortalities. Among the disease categories to which alcohol is related, injuries, digestive diseases, and cardiovascular diseases are the leading causes of the alcohol-attributable burden. To reduce the harmful use of alcohol in a country, the 'whole of government' and 'whole of society' approaches are required with the implementation of evidence-based alcohol control policies, the pursuit of public health priorities, and the adoption of appropriate policies over a long period of time. In this review, we summarize previous efforts to investigate the alcohol-attributable disease burden and the best ways to protect against harmful use of alcohol and promote health.
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Affiliation(s)
- Seung Ha Park
- Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Joon Kim
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
- Institute for Liver and Digestive Diseases, Hallym University,
Chuncheon, Korea
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Täht T, Köhler K, Ohov E, Menne B, Zambon F, Nemer L. Estonia advances on SDG achievement by tackling high alcohol consumption through a multi-pronged approach. Eur J Public Health 2020; 30:i45-i47. [PMID: 32391896 PMCID: PMC7213472 DOI: 10.1093/eurpub/ckaa031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Estonia has implemented a comprehensive, multipronged approach to the reduction of alcohol consumption in the population, comprising a series of successful policy responses. The Estonian alcohol strategy (2014) builds on the Global strategy to reduce the harmful use of alcohol and the European action plan to reduce the harmful use of alcohol 2012-2010. It aims to decrease the overall yearly consumption of alcohol among the adult population to less than 8 litres of absolute alcohol per capita. Gathering support across society from a range of stakeholders, including policy-makers, researchers, parents and advocates, has been one of the key elements in the implementation of the policy. High-level political commitment and strategic timing of efforts have maintained the issue of alcohol control on the political agenda and in the public's mind.
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Affiliation(s)
- Triinu Täht
- Public Health Department, Ministry of Social Affairs, Tallinn, Estonia
| | - Kristina Köhler
- Public Health Department, Ministry of Social Affairs, Tallinn, Estonia
- Analysis and Statistics Department, Ministry of Social Affairs, Tallinn, Estonia
| | - Elen Ohov
- Public Health Department, Ministry of Social Affairs, Tallinn, Estonia
- EU Affairs and International Cooperation Department, Ministry of Social Affairs, Tallinn, Estonia
| | - Bettina Menne
- Sustainable Development and Health, Division of Policy and Governance for Health and Well-being, WHO Regional Office for Europe, Copenhagen, Denmark
| | - Francesco Zambon
- Investment for Health and Development in Healthy Settings, WHO European Office for Investment for Health and Development, Venice, Italy
| | - Leda Nemer
- Investment for Health and Development in Healthy Settings, WHO European Office for Investment for Health and Development, Venice, Italy
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McCambridge J, Coleman R, McEachern J. Public Health Surveillance Studies of Alcohol Industry Market and Political Strategies: A Systematic Review. J Stud Alcohol Drugs 2019; 80:149-157. [PMID: 31014459 PMCID: PMC6582508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 12/03/2018] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE This review examines public health surveillance (PHS) studies of alcohol industry actors that explore the implications of the integration of business and political strategies for public health. METHOD Eligible for inclusion were studies published in English language peer-reviewed journals since 1980 that sought to investigate both alcohol industry business and political strategies and their implications for public health. Studies were also required to present economic, political, and health data together. Seven databases were searched until May 2018. RESULTS Six studies were identified as eligible for inclusion in this review, undertaken in high-, middle-, and low-income countries and published between 2000 and 2015. Political strategies are driven largely by business interests, whether at the company, sectoral, or industry level, and corporate social responsibility activities may be integrated within overall strategies. There is a high degree of collaboration in political strategy development between companies, facilitated by growing concentration among global producers operating in increasingly oligopolistic markets. There are limited insights into the dynamics of market competition and limited methodological data available. CONCLUSIONS PHS studies play a valuable role in identifying aspects of alcohol industry strategies that warrant more detailed and carefully designed research, as well as in elucidating global health implications. Further research in PHS and other kinds of studies will assist efforts to reduce the global burden of disease caused by alcohol.
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Affiliation(s)
- Jim McCambridge
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Rachel Coleman
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
| | - Julie McEachern
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
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Lange C, Manz K, Rommel A, Schienkiewitz A, Mensink GBM. Alcohol consumption of adults in Germany: Harmful drinking quantities, consequences and measures. JOURNAL OF HEALTH MONITORING 2016; 1:2-20. [PMID: 36654844 PMCID: PMC9838581 DOI: 10.17886/rki-gbe-2016-029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Harmful alcohol consumption is one of the five essential risk factors for disease, impairments and premature death around the world. It is considered to be a contributory cause for more than 200 diseases and is co-responsible for causing many intentional and unintentional injuries. In order to reduce harmful alcohol consumption, the health target "Reduce alcohol consumption" has been currently elaborated in Germany and focuses on a policy mix of behavioural and situational preventive measures to include as far as possible all relevant players for the development of overarching objectives. The data from the recurrent health surveys by the Robert Koch Institute (RKI) allow an evaluation of trends of harmful alcohol consumption in the population aged 25 to 69 between 1990/1992, 1997/1999, and 2008/2011. Harmful alcohol consumption is defined as a daily consumption of pure alcohol of more than 10g for women and more than 20g for men. For the years 2008-2011 harmful alcohol consumption for the age group 18 to 79 years is calculated based on the "German Health Interview and Examination Survey for Adults" (DEGS1) and examined in connection with socio-demographic and health-related factors. The results of DEGS1 show that 13.1% of women and 18.5% of men consume alcohol in harmful quantities. For men harmful alcohol consumption rises with the age; for women the lowest prevalence is found in those aged 30-39 years and the highest in the age group 50-59 years. Women with a high socio-economic status drink a harmful quantity of alcohol to a higher extent than women from medium or low status groups. For men there are no corresponding differences. Mainly smoking is associated with harmful alcohol consumption. Between 1990 and 1992 as well as between 2008 and 2011 harmful alcohol consumption has strongly declined, for women from 50.9% to 13.6%, for men from 52.6% to 18.3% (age group 25 to 69 years). Even if harmful alcohol consumption in the population has strongly declined, the per capita consumption of pure alcohol is above the average of the EU Member States in Germany. For that reason, preventive measures for specific target groups are required.
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Affiliation(s)
- Cornelia Lange
- Corresponding author Dr. C. Lange, Robert Koch Institute, Department for Epidemiology and Health Monitoring, General-Pape-Str. 62–66, D-12101 Berlin, Germany, E-mail:
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Heung CM, Rempel B, Krank M. Strengthening the Canadian alcohol advertising regulatory system. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2012; 103:e263-6. [PMID: 23618638 PMCID: PMC6974103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 06/11/2012] [Accepted: 05/05/2012] [Indexed: 03/29/2024]
Abstract
Research evidence points to harmful effects from alcohol advertising among children and youth. In particular, exposure to alcohol advertising has been associated with adolescents drinking both earlier and heavier. Although current federal and provincial guidelines have addressed advertising practices to prevent underage drinking, practice has not been supported by existing policy. While protective measures such as social marketing campaigns have the potential for counteracting the effects from alcohol advertising, the effectiveness of such measures can be easily drowned out with increasing advertising activities from the alcohol industry, especially without effective regulation. Research reviewed by the European Focus on Alcohol Safe Environment (FASE) Project has identified a set of key elements that are necessary to make alcohol advertising policy measures effective at protecting children and youth from the harmful effects of alcohol marketing. Using these key elements as an evaluation framework, there are critical components in the Canadian alcohol advertising regulatory system that clearly require strengthening. To protect impressionable children and youth against the harmful effects of alcohol advertising, 13 recommendations to strengthen current alcohol advertising regulations in Canada are provided for Canadian policy-makers, advertising standard agencies, and public health groups.
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