Abstract
BackgroundAlcohol use is a major public health problem in Bhutan. Compliance with regulations at the point of sale is an important strategy in alcohol control. Retail outlets were briefed on sale regulations and provided notification of rules, which they were directed to display on the premises. The extent to which licensed alcohol outlets responded to possible alcohol purchases was assessed through the use of young proxy-purchasers, adults feigning alcohol intoxication and sober adults. A total of 854 visits (pre versus post visits) were made across four district towns. Two towns (Damphu town in Tsirang district and Pema Gatshel town in Pema Gatshel district) received pre- and post-intervention purchase surveys, while the other two neighbouring towns (Khuruthang town in Punakha and Bajo town in Wangdue) were administered only baseline surveys.MethodWe used a pre- and post-test community intervention design covering all alcohol retailers both on premise (bar, hotel, restaurant, karaoke bars) and off premise (grocery shops). Compliance with alcohol regulations at the point of sale was assessed through the use of young proxy-purchasers, adults feigning alcohol intoxication and sober adults.ResultsRetailers rarely checked the age and/or identification (ID) of the proxy-purchasers before the intervention. There was a 22.7% (8.6, 37) percent increase in compliance with laws after the intervention. While some strategies are suggested, the strongest and most effective measure to prevent under-age drinking and service to intoxicated individuals is more rigorous enforcement of existing liquor laws.ConclusionAlcohol control requires ongoing government enforcements, supplemented by public awareness and knowledge.
Highlights
Alcohol use is a major public health problem in Bhutan
This study aimed to [1] assess current levels of compliance with alcohol sale regulations in four townships in Bhutan, [2] evaluate the effect of alcohol legal information education and enforcement intervention, and [3] assess factors associated with compliance with legal alcohol sales amongst licensed retailers
Failed purchase attempts prior to intervention were poorest in Pema Gatshel town, where all purchasing attempts were successful, and compliance was highest in Damphu town at 19.6%
Summary
Alcohol use is a major public health problem in Bhutan. Retail outlets were briefed on sale regulations and provided notification of rules, which they were directed to display on the premises. A total of 854 visits (pre versus post visits) were made across four district towns. Alcohol use is a major public health problem globally. In Bhutan, alcohol-related liver disease is the number one cause of mortality, accounting for 11% of the total deaths that occurred in health facilities in 2019 [1]. Mortality is even higher after accounting for alcohol-related. One-third (33.1%) of adult Bhutanese are current drinkers (last 30 days) [2], which is higher than figures in neighbouring countries (Nepal 18%, Myanmar 20% and Sri Lanka 18% and India 11%).
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