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

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

The International Alcohol Control Study: Methodology and implementation.

INTRODUCTION AND AIMS: The International Alcohol Control (IAC) Study is a multi-country collaborative project to assess patterns of alcohol consumption and the impact of alcohol control policy. The aim of this paper is to report the methods and implementation of the IAC. DESIGN AND METHODS: The IAC has been implemented among drinkers 16-65 years in high- and middle-income countries: Australia, England, Scotland, New Zealand, St Kitts and Nevis, Thailand, South Africa, Peru, Mongolia and Vietnam (the latter four samples were sub-national). Two research instruments were used: the IAC survey of drinkers and the Alcohol Environmental Protocol (a protocol for policy analysis). The survey was administered via computer-assisted interview and the Alcohol Environmental Protocol data were collected via document review, administrative or commercial data and key informant interviews. RESULTS: The IAC instruments were readily adapted for cross-country use. The IAC methodology has provided cross-country survey data on key measures of alcohol consumption (quantity, frequency and volume), aspects of policy relevant behaviour and policy implementation: availability, price, purchasing, marketing and drink driving. The median response rate for all countries was 60% (range 16% to 99%). Where data on alcohol available for consumption were available the validity of survey consumption measures were assessed by calculating survey coverage found to be 86% or above. Differential response bias was handled, to the extent it could be, using post-stratification weights. DISCUSSION AND CONCLUSIONS: The IAC study will allow for cross-country analysis of drinking patterns, the relationship between alcohol use and policy relevant behaviour in different countries

Socio-economic disadvantage is associated with heavier drinking in high but not middle-income countries participating in the International Alcohol Control (IAC) Study

INTRODUCTION AND AIMS: To investigate if socio-economic disadvantage, at the individual- and country-level, is associated with heavier drinking in some middle- and high-income countries. DESIGN AND METHODS: Surveys of drinkers were undertaken in some high- and middle-income countries. Participating countries were Australia, England, New Zealand, Scotland (high-income) and Peru, Thailand and Vietnam (middle-income). Disadvantage at the country-level was defined as per World Bank (categorised as middle-or high-income); individual-level measures were (i) years of education and (ii) whether and individual was under or over the poverty line in each country. Measures of heavier drinking were (i) proportion of drinkers that consumed 8+ drinks and (ii) three drinking risk groups (lower, increasing and higher). Multi-level logistic regression models were used. RESULTS: Individual-level measures of disadvantage, lower education and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle-income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high-income countries. Interactions between country-level income and individual-level disadvantage were undertaken: disadvantaged drinkers in the middle-income countries were less likely to be heavier drinkers relative to those with less disadvantage in the high-income countries. DISCUSSION AND CONCLUSIONS: Associations between socio-economic disadvantage and heavier drinking vary depending on country-level income. These findings highlight the value of exploring cross-country differences in heavier drinking and disadvantage and the importance of including country-level measurements to better elucidate relationships

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

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

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

No abstract available

Paper 7 _ Drug and Alcohol Review

Associations between socio-economic disadvantage and heavier drinking vary depending on country-level income. These findings highlight the value of exploring cross-country differences in heavier drinking, and the importance of including country-level measurements to better elucidate relationships. Individual-level measures of disadvantage, lower education, and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle-income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high-income countries

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

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