Implementation Of Alcohol Policy Research Articles

Global alcohol policy implementation in Thailand: A narrative review

Alcohol consumption is growing in emerging economies. Thailand is an upper-middle-income emerging economy in Southeast Asia where the alcohol market has been under an oligopoly, which political groups are attempting to amend. The Thai Ministry of Public Health works in close partnership with the non-profit sector in alcohol control, and has recently adapted the World Health Organization’s (WHO) SAFER initiatives as part of the national alcohol agenda. In light of these ongoing changes, we conducted a narrative review with the following objectives: (1) to describe the development of alcohol control policy strategies in Thailand; and (2) to describe the current situation on alcohol policy implementation. We performed a search of the published and grey literature in both Thai and English languages using keywords related to topics of interest, and reviewed data on SAFER's effectiveness using a group of indicators (policy-attributable health outcomes). We found that Thailand has laws and regulations covering various domains of SAFER. However, gaps do exist with regard to regulation of alcohol outlet density, relatively low alcohol sales permit fees, control of online and surrogate marketing of alcoholic products, and enforcement of drinking-and-driving deterrence measures, among others. A review of the indicators showed that annual per capita alcohol consumption (APC) and prevalence of drinkers have remained constant since 2008, whereas the prevalence of binge-drinking has been on a decline since 2014. However, deaths attributable to alcohol have increased in both men and women. The findings of this narrative review may have implications for policymakers and stakeholders in behavioral health.

Perspectives of community leaders/members on factors hindering alcohol regulation in Nigeria

Background Previous studies have examined factors impairing alcohol policy implementation in Nigeria, but none adopted a community-based approach. Given that alcohol consumption has sociocultural, economic, religious, and legal connotations, it is pertinent that a community-based study interrogates how these, and other similar factors hinder its regulation. Methods We conducted semi-structured interviews with 30 community leaders/members in Anambra State, exploring their perspectives on factors hindering the regulation of alcohol (mis)use in their communities. Data were analyzed thematically. Results Findings show complex factors affecting alcohol regulation in Anambra communities. Participants argued that alcohol consumption is symbolic and essential to their lives; therefore, regulating it is difficult. Participants further indicated that sociocultural events in many communities promote the availability of free drinks. Thus, regulating the quantities that individuals consume on such occasions is impossible. They stated that rapid urbanization and the influx of migrants, unemployment and personal business interests are among the factors affecting regulating alcohol (mis)use among adults/minors. Participants revealed they could not establish laws banning alcohol (mis)use since the government has not implemented such policies/regulations. Conclusion Findings indicate that to implement effective alcohol regulation, community leaders/members should be involved in its development because of the sociocultural roles of alcohol.

Quantitative tools and measurements for assessing the implementation of regulatory policies in reducing alcohol consumption and alcohol-related harms: A scoping review.

Implementation of alcohol control policy is a global priority as alcohol contributes to negative individual health and societal impacts. However, there are no available reviews that comprehensively provide tools and measurements for assessing the implementation of alcohol control policy. This study reviews tools and measurements for assessing alcohol policy implementation. Policies considered include alcohol pricing and taxation, alcohol marketing control, physical availability control and drink-driving policy. We conducted a scoping review from Scopus, Web of Science and the World Health Organization's website. We included studies on policy implementation for the four most effective prevention policies published worldwide between 2000 and 2021. The search yielded 11,654 articles and these were narrowed down to 39 included studies. Of these 39 studies, almost half assessed the implementation of a drink-driving policy (n=19), followed multipolicy (n=12) and physical availability control (n=8). There was no single study assessing policy implementation of pricing and taxation or alcohol marketing control. The majority of the studies were conducted in high-income countries (n=31). Globally, there is no standardised tool or guidelines for measuring the policy implementation of these four policies. The tools for measuring policy implementation mostly focused on a single policy, and few covered multiple policies. We recommend developing standardised tools and measurements to monitor policy implementation across multiple policies at country levels. This review highlighted a lack of comprehensive and standardised tools to assess policy implementation and the limited number of studies on alcohol policy implementation in low- and middle-income countries.

Government Options to Reduce the Impact of Alcohol on Human Health: Obstacles to Effective Policy Implementation.

Evidence for effective government policies to reduce exposure to alcohol’s carcinogenic and hepatoxic effects has strengthened in recent decades. Policies with the strongest evidence involve reducing the affordability, availability and cultural acceptability of alcohol. However, policies that reduce population consumption compete with powerful commercial vested interests. This paper draws on the Canadian Alcohol Policy Evaluation (CAPE), a formal assessment of effective government action on alcohol across Canadian jurisdictions. It also draws on alcohol policy case studies elsewhere involving attempts to introduce minimum unit pricing and cancer warning labels on alcohol containers. Canadian governments collectively received a failing grade (F) for alcohol policy implementation during the most recent CAPE assessment in 2017. However, had the best practices observed in any one jurisdiction been implemented consistently, Canada would have received an A grade. Resistance to effective alcohol policies is due to (1) lack of public awareness of both need and effectiveness, (2) a lack of government regulatory mechanisms to implement effective policies, (3) alcohol industry lobbying, and (4) a failure from the public health community to promote specific and feasible actions as opposed to general principles, e.g., ‘increased prices’ or ‘reduced affordability’. There is enormous untapped potential in most countries for the implementation of proven strategies to reduce alcohol-related harm. While alcohol policies have weakened in many countries during the COVID-19 pandemic, societies may now also be more accepting of public health-inspired policies with proven effectiveness and potential economic benefits.

The Canadian Alcohol Policy Evaluation project: Findings from a review of provincial and territorial alcohol policies.

Effective alcohol control measures can prevent and reduce alcohol-related harms at the population level. This study aims to evaluate implementation of alcohol policies across 11 evidence-based domains in Canada's 13 jurisdictions. The Canadian Alcohol Policy Evaluation project assessed all provinces and territories on 11 evidence-based domains weighted for scope and effectiveness. A scoring rubric was developed with policy and practice indicators and peer-reviewed by international experts. The 2017 data were collected from publicly-available regulatory documents, validated by government officials, and independently scored by team members. The average score for alcohol policy implementation across Canadian provinces and territories was 43.8%; Ontario had the highest (63.9%) and Northwest Territories the lowest (38.4%) jurisdictional scores. Only six of 11 policy domains had average scores above 50% with Monitoring and Reporting scoring the highest (62.8%) and Health and Safety Messaging the lowest (25.7%). A 2017 provincial/territorial current best practice score of 86.6% was calculated taking account of the highest scores for any individual policy indicators implemented in at least one jurisdiction across the country. Most of the evidence-based alcohol policies assessed by the Canadian Alcohol Policy Evaluation project were not implemented across Canadian provinces and territories as of 2017, and many provinces showed declining scores since 2012. However, the majority of policies assessed have been implemented in at least one jurisdiction. Improved alcohol policies to reduce related harm are therefore achievable and could be implemented consistently across Canada.

Local Alcohol Policy Implementation in Scotland: Understanding the Role of Accountability within Licensing.

Scotland has been ambitious in its policy and legislative efforts to tackle alcohol-related harm, efforts which include the innovative feature of a ‘public health objective’ within local alcohol licensing. However, the persistence of alcohol-related harms and inequalities requires further examination of both the overarching Scottish alcohol strategy and its specific implementation. A qualitative case study was undertaken to explore how alcohol policy is implemented locally in Scotland, with data generated from (i) documentary analysis of 12 relevant policies, legislation, and guidance documents; and (ii) a thematic analysis of semi-structured interviews with 54 alcohol policy implementers in three Scottish localities and nine national-level stakeholders. The data suggest there is a tension between the intentions of licensing legislation and the way it is enacted in practice, and that accountability emerges as an important factor for understanding why this occurs. In particular, there are a lack of accountability mechanisms acting upon Scottish Licensing Boards to ensure they contribute to the public health goals of the Scottish alcohol strategy. From a public health perspective, this has perpetuated a system in which Licensing Boards continue to act with autonomy from the rest of the alcohol policy implementation system, creating a challenge to the achievement of public health goals. Alcohol policy in Scotland is likely to fall short of intended goals as long as the tension between licensing legislation and enacted licensing practices remains.

Examining alcohol management practices in community sports clubs: a systems approach

PurposeThe purpose of this study is to investigate the influence of macro-level regulatory systems on alcohol management for community sport organisations (CSOs). It examines how alcohol regulations translate into meso-level management actions and interactions that impact alcohol consumption in community sport clubs.Design/methodology/approachManagement of alcohol was explored through the holistic lens of macro, meso, and micro-levels of influence. Sixteen semi-structured interviews were conducted with Australian club administrators from community sports clubs.FindingsThematic analysis revealed macro-level influences on alcohol management in CSOs, with government regulations and the state sport associations being the most influential. Challenges arise in alcohol policy implementation when sport administrators do not prioritise alcohol consumption as a problem to be addressed, or where a conflict of interest arises between alcohol revenue generation and clubs positioning as health promoting environments.Practical implicationsTargeting club administrators’ attitudes towards alcohol as a benign influence and revising alcohol management practices are recommended as priority strategies to enhance the implementation and promotion of responsible alcohol management in sport clubs. Affiliate state sport associations were also identified as influential settings to provide administrative or strategic direction to CSOs, which would reduce the resources required by volunteers and standardise alcohol management practices across sports clubs.Originality/valueThe prevailing alcohol research focuses on the consumption behaviour of individual members and sports players. The study findings are novel and important as they explore the macro-level influences that administrators experience when enacting and policing alcohol management strategies in sports clubs. To-date, administrators of CSOs have not been included in many studies about alcohol consumption regulation; therefore, the findings provide an original perspective on alcohol regulation and demonstrate how CSOs operationalise alcohol management in club settings. The original insights from this study informed the conceptualisation of a multilevel sport system framework, which can be applied to guide future governance of alcohol consumption in sport settings.

Animal house: University risk environments and the regulation of students’ alcohol use

BackgroundThis article extends the risk environment framework to understand the factors that universities identify as influencing university students’ risky drinking behaviours and universities attempts at managing risky alcohol use on their campuses. MethodsThis article examines data collected as part of qualitative fieldwork on university corporate security services, and others involved in university alcohol policy implementation (e.g., residence services), conducted at five Canadian universities. Interviews (n=56), fieldnotes from 246h of observations of university corporate security personnel, and university policy documents (i.e., codes of student behaviour, residence policies) were analysed to understand the influence of risk environments on high-risk alcohol use. ResultsWe identify three risk environments on university campuses in relation to the use and regulation of alcohol: the physical, social, and policy environments. Residence buildings and abutting spaces (physical risk environment) and the university “party” culture (social risk environment) are principal contributors to risk within their risk environments. University policies and practices (policy risk environment) attempt to modify these environments in order to manage risky alcohol use. ConclusionWe suggest current approaches to regulating student alcohol use may not be the best approach to preventing harms (e.g., health problems, legal troubles) to students. Given university policies and practices have the potential to shape and influence risky alcohol use and associated harms we argue it is necessary for university administrators to adopt the best practices of “harm reduction” and seek new ways to address on-campus alcohol use.

An Implementation Model to Increase the Effectiveness of Alcohol Control Policies

Public policies that reduce the availability of alcohol in communities can reduce consumption and related harms. In this article, we propose a practical model to guide alcohol policy implementation. The conceptual model is informed by a case study of three U.S. cities that adopted restrictions on high-alcohol malt liquor sales. The three cities included Seattle, Washington; Santa Ana, California; and Washington, D.C. Participants (n = 39) represented neighborhood groups, city officials, local police, Alcohol Beverage Control (board members and enforcement personnel), alcohol retailers, alcohol industry representatives, and advocacy and service organizations. We conducted key informant interviews with participants in each city. We coded and analyzed the data by using a grounded theory approach. Findings were used to identify and illustrate model components. Implementation components include building public awareness and educating stakeholders, monitoring and enforcing compliance, evaluating process and outcomes, and institutionalizing the policy. The experiences of study cities illustrate the importance of these activities in maintaining policy effectiveness; for example, a lack of enforcement resources appeared to contribute to the erosion of compliance over time. The model addresses an important gap in alcohol policy research. It is intended to spur further research on the subject, provide a guide for policy practitioners, and ultimately improve the long-term effectiveness of alcohol control policies.

The Role of Health Economics in Alcohol Policy

In a 2010 editorial, Doran and Jainullabudeen[1] outlined the potential role health economics can play in the development and implementation of alcohol policy. In particular, efficiency can be attained when the negative externalities due to alcohol consumption can be reduced and where the socially optimum level of alcohol is consumed. A socially optimum level can be thought of as one where the marginal cost of reducing associated harm is equal to the marginal benefit from reduced harm.[2] This optimum level requires an assessment of both supply-side factors (availability, marketing and price of alcohol) and demand-side factors (taste, willingness, preferences and income) and the interactions of these factors in minimizing alcohol misuse.[3] With the aim of enhancing the evidence base related to the role of health economics in alcohol policy, Applied Health Economics and Health Policy invited submission of original work to be published in this special issue. After a rigorous peer-review process, three original research articles are presented that focus on the impact and role of pricing strategies. Byrnes et al.[4] consider the efficiency of a volumetric alcohol tax in Australia; Ataguba[5] examines alcohol policy and taxation in South Africa and Ludbrook et al.[6] present research aimed at addressing alcohol misuse using a minimum pricing approach in the UK. Each article offers a unique contribution to the literature and enhances our limited understanding of the potential role health economics can play in the development of efficient and equitable alcohol policy. Byrnes et al.[4] quantify the economic impact of four different alcohol taxation systems, relative to the current Australian system: two different types of volumetric taxation (deadweight loss neutral and tax revenue neutral); the recent strategy trialled in Australia of increasing the tax only on ready-to-drink alcoholic beverages; and a tiered tax system, which may be more politically acceptable. A partial equilibrium approach was used to measure taxation revenue and deadweight loss in alcohol markets. The results of the analysis suggest that a volumetric tax on alcohol, relative to the current system, can reduce pure alcohol consumption for the same amount of tax revenue collected and increase consumer welfare, or, for the same level of loss to consumer welfare, taxation revenue can be increased. A tiered taxation system, as considered by the National Preventative Taskforce,[7] appears to achieve some benefit relative to current practice, but is not as efficient as an unmixed volumetric tax. Specifically, compared with the deadweight loss neutral scenario, a tiered taxation system is associated with an increased deadweight loss of taxation, less taxation revenue collected by government and a smaller reduction in pure alcohol consumption. However, the ability of taxation policy to reduce pure alcohol consumption for the least amount of deadweight loss may only be one consideration of alcohol taxation policy. As Ataguba[5] notes, the application of alcohol taxation policy on efficiency grounds is difficult to impose in reality and the goal of alcohol taxation as it relates to equity is also an important consideration, especially in a highly unequal society like South Africa. Ataguba[5] empirically examines the distribution of economic burden (i.e. the tax incidence) that taxes on alcoholic beverages place on households in South Africa. Using data from the 2005/06 South African Income and Expenditure Survey, Ataguba suggests that the taxation of alcohol in South Africa is regressive, with the most regressive tax on local beer and the least regressive on spirits. In the context of these findings, Ataguba[5] contends that within South Africa, alcohol tax policy built on the principle of 'the drinker should pay' has produced a regressive distribution of tax that has had little impact on per capita consumption over the years. Ataguba[5] comments that it is important to gain a better understanding of the current pattern of drinking and explore why the poor drink and thereby bear a greater burden of alcohol taxes. …

The implementation process of alcohol policies in eight Swedish football clubs

PurposeAlcohol stands in an ambiguous relationship to sports, and there is a common belief that participation in sports prevents alcohol consumption. Although this is not always the case, sports clubs can be important settings for health promoting alcohol policy interventions .The purpose of this paper is to explore the process of implementing alcohol policies in eight football clubs in Sweden and, in particular, how the implementation process is conveyed in the clubs’ alcohol policy projects, the similarities and differences between this case study and Durlak and DuPre's implementation model and the recommendations for successful alcohol policy implementation in relation to the result.Design/methodology/approachIn total, 15 semi‐structured interviews on the subject of sports’ club alcohol policies were conducted with project leaders and board members from eight sports clubs. The interviews were analysed using Durlak and DuPre's model of factors affecting implementation processes.FindingsThe results show that almost all the factors in Durlak and DuPre's model were comprehensively manifested in the football clubs’ alcohol policy projects, although with slightly different significance and emphases.Practical implicationsThe results are discussed in relation to recommendations for successful alcohol policy implementation in sports clubs. Recommendations are presented in six areas: an explicit message; fit; internal policy dissemination; alcohol policy as a part of overall policy; support; and actors.Originality/valueMany sports clubs do an excellent job of implementing alcohol policies successfully and it is imperative to incorporate their “good” practices into research and provide assistance to those whose policies and practice are less developed.