Alcohol Control Measures Research Articles

Democracy in a bottle: Attitudes towards alcohol regulation in the post-communist Baltic Sea Region

In a democracy policy measures aimed at reducing alcohol-related harms are dependent on acquiring some level of public support. This study presents findings from a survey in the Baltic countries and Poland regarding public opinion on alcohol control and the perception of alcohol-related problems. Overall, support for alcohol control measures was high, although varying between countries, sub-groups and policy items. As has been found in previous studies, gender, age, and drinking pattern were particularly important predictors of restrictive attitudes. In an analysis of inter-country variation Latvia stood out as most pro-regulation. Such variation may indicate underlying socio-cultural patterns affecting the propensity to favour collective regulations, or simply reflect variations in the prevalence of alcohol-related problems.

The economics of alcohol abuse and alcohol-control policies.

Economic research has contributed to the evaluation of alcohol policy through empirical analysis of the effects of alcohol-control measures on alcohol consumption and its consequences. It has also provided an accounting framework for defining and comparing costs and benefits of alcohol consumption and related policy interventions, including excise taxes. The most important finding from the economics literature is that consumers tend to drink less ethanol, and have fewer alcohol-related problems, when alcoholic beverage prices are increased or alcohol availability is restricted. That set of findings is relevant for policy purposes because alcohol abuse imposes large "external" costs on others. Important challenges remain, including developing a better understanding of the effects of drinking on labor-market productivity.

A scale of formal alcohol control policy in 15 European countries

Thomas Karlsson & Esa Österberg: A scale of formal alcohol control policy in 15 European countries As part of the alcohol control policy analysis of the ECAS project, this article reviews and discusses previous attempts to measure the strictness of alcohol control policies and to conduct a similar analysis in the ECAS countries. Based on the knowledge gathered from previous studies, we have created a scale of our own to measure the strictness of alcohol control policies and have applied it to the countries included in the ECAS project. The scales reviewed in this article and the scale we have constructed only measure the strictness of formal alcohol control. Drawing on the results of the ECAS scale, it seems that formal alcohol control in the EU member states has become stricter during the second half of the twentieth century. In the 1950s only three of the 15 countries were classified as having “high alcohol control”. In the year 2000 the number of high alcohol control countries had increased to six. The number of countries with low alcohol control had decreased from nine to zero between 1950 and 2000. Comparing the scores in the different countries or the average scores in all the ECAS countries over time is, however, problematic because the changes in these numbers reflect two different trends. On the one hand, there has been a decrease in the control of production and sales of alcoholic beverages or the regulation on alcohol availability. On the other hand, alcohol control measures targeted at demand or alcohol-related problems have become more prevalent. This means that alcohol control policies have become more similar in the ECAS countries in the second half of the twentieth century. Because of the limitations of the scale, however, we have to make certain reservations about the results and be very careful not to draw too far-reaching conclusions based solely on the results and rankings on the ECAS scale or any other scale for that matter. The scale and the results should therefore be considered as yet another attempt to quantify and rank alcohol control policies according to their strictness and not as an attempt to provide a perfect solution to a mission impossible.

Impacts of international trade, services and investment treaties on alcohol regulation.

There is an underlying incompatibility between government efforts to minimize the harm associated with alcohol, particularly by regulating its supply, and international commercial treaties that promote the freer flow of goods, services and investment. These treaties have already forced changes to many government measures affecting alcohol availability and control, primarily by constraining the activities of government alcohol monopolies and by altering taxation regimes. The North American Free Trade Agreement and the World Trade Organization agreements open new avenues for challenges against alcohol control measures. Some of these agreements extend beyond trade, border measures and differential taxation and allow challenges that intrude into areas of non-discriminatory domestic regulation affecting market access, intellectual property, investment and services. Effective protection from these agreements for vital public health measures has rarely been obtained, although it is increasingly essential. The WTO "services" agreement, basically unknown to the public, is currently being re-negotiated and poses the gravest new challenge to policies designed to influence patterns of alcohol use and minimize alcohol-related harm. In future, these international agreements will probably affect adversely those alcohol approaches considered to be the most effective or promising. These include: maintaining effective state monopolies, restricting the number and locations of retail outlets, taxing and regulating beverages according to alcohol strength, restricting commercial advertising, and maintaining and enhancing public alcohol education and treatment programs. These effects can, in turn, be expected to increase the availability and access to alcohol, to lower alcohol taxes, and to increase advertising and promotion, resulting in increased alcohol consumption and associated health problems. Until more balanced international rules are developed, the challenge facing alcohol policy researchers is to defend national and local alcohol measures from further erosion. This will require greater coordination with researchers in other affected sectors, intervention with government representatives in health and related areas and the promotion of alternative approaches to current international commercial agreements.

Survival from head and neck cancer in Mumbai (Bombay), India.

Head and neck cancers, among the 10 most frequent cancers in the world, are common in regions with a high prevalence of tobacco and alcohol habits. They account for one-fourth of male and one-tenth of female cancers in India. The authors report and discuss the survival from these cancers in Mumbai (Bombay), India. Follow-up information on 6311 head and neck cancer patients registered in the Bombay Population-Based Cancer Registry for the period 1987-1991 was obtained by a variety of methods, including matching with death certificates from the Bombay vital statistics registration system, postal/telephone enquiries, home visits, and scrutiny of medical records. The survival for each case was determined as the duration between the date of incidence and the date of death or date of loss to follow-up or the closing date of the study (December 31, 1996). Cumulative observed and relative survival were calculated by the Hakulinen method. For comparison of results with other populations, age-standardized relative survival (ASRS) was calculated by directly standardizing age specific relative survival to the specific age distributions of the estimated global incidence of major cancers in 1985. The log rank test was used in univariate analysis to identify the potentially important prognostic variables. The variables showing statistical significance in univariate analysis were introduced stepwise into a Cox regression model to identify the independent predictors of survival. The 5-year relative survival rates were 74.5% for the lip, 42.7% for the anterior tongue, 25.5% for the posterior tongue, 45.1% for the mouth, 29.7% for the oropharynx, 38.7% for the nasopharynx, 29.1% for the hypopharynx, and 41.2% for the larynx. Age, marital status, religion, and site and clinical extent of disease emerged as independent predictors of survival. Age specific 5-year relative survival declined with advancing age. Single patients had a 20% excess risk of death compared with married patients. Those with cancers of the lip, mouth, nasopharynx, and larynx had a better prognosis than those with cancer at other sites. Those with regional spread of disease experienced a threefold increased risk of death, and those with distant metastasis experienced a sixfold excess risk. Less than one-fourth of cancers were localized in the organ of origin at diagnosis; 5-year survival for localized cancers ranged from 52.9% to 80.2% depending on the subsite. There were significant variations in survival from cancer at individual sites within the head and neck region. Comparison with other populations revealed variations that seemed to be related to differences in detection and treatment. Tobacco and alcohol control measures and early detection linked with treatment are important measures to reduce mortality from head and neck cancer.

SOCIAL CLIMATE ON ALCOHOL IN ROTTERDAM, THE NETHERLANDS: PUBLIC OPINION ON DRINKING BEHAVIOUR AND ALCOHOL CONTROL MEASURES

Research was undertaken regarding the Dutch climate on alcohol in 1994 and results were compared with earlier findings. It was found that the social climate on alcohol in The Netherlands can be characterized by 'moderation'. Over the years, drinking without problems has become more acceptable (and is even encouraged at times) whereas excessive drinking and consequent problems still meet strong disapproval. Opinions concerning alcohol control measures mirror this attitude. Measures such as the restriction of drinking in public places and raising the age limits are endorsed by the public. However, more people are now against restrictions on the general availability of alcohol. Although drink-driving has decreased over the years, its prevalence is still high, especially among those who are most at risk.

Public drinking, problems and prevention measures in twelve countries: results of the WHO project on public drinking

Until recently, drinking in public venues has been a relatively neglected area of alcohol research despite the epidemiological significance of problems arising from drinking in licensed establishments and other public venues. In the WHO Project on Public Drinking, expert informants in 12 countries provided detailed information on alcohol consumption, drinking in public settings, the nature and magnitude of problems associated with public drinking, the regulation of public drinking, enforcement and prevention. The most commonly indicated problems associated with drinking in public venues were underage drinking, impaired driving, and alcohol-related violence. Many of the informants in the survey expressed concern that the enforcement of alcohol licensing laws receives very low priority on the political agenda. In general, few countries have developed prevention programs aimed specifically at preventing problems arising from drinking in public venues. Nonetheless the informants identified a wide variety of measures that can be taken to reduce these problems in public drinking environments. These include general alcohol preventive education, alcohol control measures (including restrictions on hours and days of operation), improved enforcement of licensing laws, impaired driving countermeasures, server training and the use of civil law to promote responsible beverage service, and the promotion of low-alcohol-content beverages.

Civic participation by 18- to 20-year-olds as a predictor of support for alcohol control policies: the Communities Mobilizing for Change on Alcohol project

Evidence is accumulating that federal, state, and local alcohol control policies effectively reduce alcohol consumption and subsequent alcohol-related problems among young adults (Toomey et al., 1993; Wagenaar & Farrell, 1989; Ritson, 1994; Anderson & Lehto, 1994). Increasing the legal age for consumption of alcoholic beverages from 18 years to 21 years has been associated with reduced traffic fatality rates (O'Malley & Wagenaar, 1991) and with a reduction in other problems associated with youthful alcohol use such as suicide and unintentional injury (Jones et al., 1992). Increased taxation of alcohol has been associated with decreased auto fatality rates (Cook, 1981) and with reduced alcohol-related harm (Kendell et al., 1983). Additionally, it has been estimated that car crash fatalities among 18- to 20-year-olds could be markedly reduced if beer taxation were indexed for inflation (Saffer & Grossman, 1987). Public policy development and implementation, however, require public understanding, concern and support (Leedham, 1987; Room et al., 1995; Bang & Bang, 1991; Gordis, 1991). Policies that are widely supported are more likely to be successfully implemented and enforced. Efforts to enact alcohol control policy have been hampered by the alcohol industry (Ross, 1992) and by public perception that the majority of drinkers create few problems for society (Gordis, 1991). Despite these social barriers, increasing public support for alcohol control policy is possible (Room et al., 1995). Wagenaar (1993) documents how dissemination of high-quality research results beyond the scientific community by researchers and members of community organizations influenced public opinion and contributed to many states' decision to raise the minimum legal drinking age during the 1980s. Despite generally low levels of initial support for alcohol control policies in New Zealand, a community action project combined with media attention built increased public support for alcohol control policy (Casswell et al., 1989). Support for alcohol control policies among adults varies according to the specific policy (Wagenaar & Streff, 1990; Schmid et al., 1990). In general, prevention and control efforts that impose the fewest restrictions on the behavior of non-problem drinkers are the most widely supported (Hilton & Kaskutas, 1991). Although Schmid et al. reported generally high levels of support for all alcohol control policies among adults in Minnesota, policies promoting youth protection were the most strongly supported, followed by restrictions and prohibitions such as limiting advertising and then by increased alcohol taxes. Elimination of existing alcohol control measures was the least favored. Jones-Webb et al. (1993) reported ethnic differences in support for alcohol control polices in a large survey of adults in Marin County, California. Latinos were more likely than whites to support restricted sponsorship of sports events by the alcohol industry and server liability legislation. Demographic characteristics, alcohol consumption, and certain attitudes influence support for alcohol control policies. Women are more likely than men to support alcohol control policy (Ahlstrom & Osterberg, 1992); Schmid et al., 1990; Jeffery et al., 1990; Room et al., 1995; Casswell et al., 1989; Jones-Webb et al., 1993). Older age has been associated with higher levels of support for alcohol control policies (Schmid et al., 1990; Jeffery et al., 1990; Casswell et al., 1989), whereas younger age is associated with opposition to policies that restrict alcohol (Room et al., 1995). Light drinkers are more likely than heavier drinkers to support restrictive alcohol policy (Pendleton et al., 1990; Ahlstrom & Osterberg, 1991; Schmid et al.,1990; Room et al., 1995; Jones-Webb et al., 1993). Finally, those reporting higher levels of concern about drunk driving were more supportive of restrictive alcohol policies (Wagenaar & Streff, 1990). …

Effects of alcohol control measures on alcohol consumption.

This paper first very briefly discusses different kinds of alcohol control measures, and after that reviews the available studies of the effects of control measures on alcohol consumption. During recent years the field of evaluation of alcohol control measures has matured and drawn on new technologies. The new prevention evaluation literature has also taken several directions. Taken together, the results of various studies have very clearly shown that control measures can influence drinking patterns, and in turn the rate of drinking problems. However, effects of changes in alcohol prices and availability are also determined by the social, cultural, and economic circumstances characteristic to each country and period.

Drinking under special occasion permits: a neglected aspect of alcohol control measures?

Drinking that occurs under special permits in Canada, such as at weddings, private receptions and parties, is a neglected aspect of alcohol research. These permits are issued for many different occasions and are most common in the provinces with the highest per capita alcohol consumption. Special permit drinking is becoming a social and alcohol-control issue but information on the problems it creates is sparse. Specific problem areas such as excessive drinking and drinking by minors have not been studied, but because such drinking is rarely monitored they may be substantial. Further study of special permit drinking is recommended.

Public policy and alcohol related damage: Media campaigns or social controls

Abstract This paper discusses and criticizes the recurrent theme of “responsible drinking” that has been expressed in most educational programmes and media campaigns aimed at the prevention of alcohol abuse. Data on the impact of several such campaigns are reviewed and it is concluded that there is little evidence to date that the programmes have produced marked changes in attitudes. It is pointed out, however, that even if changes in attitudes could be demonstrated, this would not necessarily mean that the desired changes in behavior would have been achieved. Based on the distribution of consumption approach to understanding alcohol-related damage, it is suggested that the problem of changing behavior can best be addressed through social policy that manipulates market and other environmental variables that control availability and accessibility of alcoholic beverages. This approach to primary prevention then dictates that public educational campaigns might best be used to convince the general public of the need for specific alcohol control measures designed to prevent the rising incidence of alcohol-related damage.

Effects of liberalizing alcohol control measures

Effects of liberalizing alcohol control measures