International Health Policy Program -Thailand Present by : Wittaya Wisutruangdaj Sopit Nasueb Alcohol control policies and alcohol consumption by youth: A multi-national study

International Health Policy Program -Thailand 2 INTRODUCTION Many countries to implement policies restricting alcohol availability in order to reduce consumption and related harm among young people. Example - Setting a minimum legal purchase or drinking age. - Restricting the types of alcoholic beverages sold in stores. - Restricting the density of stores selling alcoholic beverages in a given area. - Restricting the hours of business when alcohol can be sold. - Mandatory training of alcoholic beverage servers and increasing the price of alcohol.

International Health Policy Program -Thailand 3 Alcohol policies may affect consumption by youth directly and indirectly through their effects on consumption and drinking norms in the general population. Most previous research on the effects of alcohol policies on drinking behavior is based on analysis of data within single countries. So discourse about alcohol policies and consumption is often framed in international terms, and for most countries alcohol policy is set at a national level. They adopt an ecological design examining statistical associations between alcohol policy ratings and drinking behavior in 30 Organization for Economic Cooperation and Development (OECD) countries.

International Health Policy Program -Thailand 4 In part Cross-national studies of alcohol policy and alcohol consumption are rare, because of the difficulty of quantifying such policies across different countries. Recently, however, the Alcohol Policy Index (API) was developed to rate the relative comprehensiveness and strength of alcohol control policies and has been applied to 30 countries. The API comprises 5 domains(16 policy topics). – Corresponding to alcohol availability – Drinking context – Price – Advertising – Motor vehicles

International Health Policy Program -Thailand 5 Weights of API scoring were assigned to each domain based on the potential effectiveness of the regulatory 16 policy. API score ranging from 0 to 100 with a higher score indicating The validity of the API was supported through (1) A sensitivity analysis in which several methodological assumptions were varied (2) Correlation and regression analysis showing an inverse association between API score and 2003 per capita alcohol consumption in litres of ethanol [r = -0.57, P = 0.001, b = -0.10, 95% confidence interval] The API does not capture the level of policy enforcement, which may vary considerably across policy topics, domains and geographic areas within each country. Additionally, the API does not reflect research on the effectiveness of regulatory policies since 2003, and thus may weight some of the policy topics incorrectly.

International Health Policy Program -Thailand 6 None the less, the API provides an opportunity to examine possible relationships between alcohol control policies and national estimates of adolescent alcohol consumption. Such prevalence estimates are provided by the 2003 European School Survey Project on Alcohol and Other Drugs (ESPAD) and by national surveys of youth in other countries. Such as the Monitoring the Future Survey in the United States.However, the national youth surveys such as ESPAD and Monitoring the Future are typically anonymous and respondents are encouraged to provide truthful responses to survey questions, such bias is likely to be minimal.

International Health Policy Program -Thailand 7 Based on previous research and on considerations derived from deterrence and availability theories. They hypothesize their countries with more comprehensive and stringent alcohol control policies. The analyses examined simple bivariate correlations. Regression analyses controlling for per capita consumption were then conducted for those outcomes found to be related significantly to the API scores. Per capita consumption was included in these analyses because of its potential role as a confounder or mediator of observed associations between alcohol control policies and youth alcohol consumption.

International Health Policy Program -Thailand 8 METHOD Data sources Alcohol control policies API scores and scores for the 5 policy domains but Brand were not able to find any data for some countries. Because extensive efforts were made by Brand to find data for each policy domain from a variety of potential sources, zero values were used where policy data were missing.

International Health Policy Program -Thailand 9 Per capita consumption Per capita consumption was included in the regression analyses as a proxy for cultural or socioeconomic factors thatmay influence both alcohol control policies and alcohol use by youth.

International Health Policy Program -Thailand 10 Adolescent alcohol use Prevalence data for any past 30 day alcohol use, measures of more frequent past 30 day use (3 to 5 times, 6 or more times), heavy or ‘binge’ drinking (5 or more drinks) and age of having first standard drink of beer, wine and spiritswere obtained from the 2003 ESPAD report. The 2003 ESPAD report includes separate prevalence rates for drinking beer, wine and spirits by age 13. They used the highest of the three prevalence rates for each country. For simplicity, they refer to this variable as “having first drink by age 13”. The 2003 ESPAD report also summarizes past 30 day alcohol use data from national secondary school surveys conducted in Spain in 2002 and the United States in 2003 (Monitoring the Future). For national secondary school surveys in Australia in 2002 and New Zealand in 2001 and a national household survey conducted in Canada in Prevalence data for adolescents in the same age range as the ESPAD were obtained from these reports.

International Health Policy Program -Thailand 11 Table 1 provides selected characteristics of ESPAD and other national youth surveys, the majority of which were self-administered surveys in school settings in March – May, Exceptions include: The Canadian household survey conducted from December 2003 to April 2004 using computer-assisted telephone interviews. The New Zealand secondary school survey conducted in 2001 with laptop computers and the nationalschool surveys in Australia and Spain that were conducted in Response rates were greater than 80% for the majority of school-based surveys, but lower response rates were reported for the Australian.

International Health Policy Program -Thailand 12 Canadian and New Zealand surveys. Post-hoc sample weights were developed for some of the surveys to adjust for under or over representation of demographic subgroups. Sample sizes varied across the 26 countries Further details about survey methods, data analysis procedures and validity and reliability of survey results can be found in the referenced reports.

International Health Policy Program -Thailand 13 Table 1 13

International Health Policy Program -Thailand 14 Data analysis Overall API scores and past 30 day alcohol use prevalence data were available for 26 countries.The number of countries with data for at least one specific policy domain and alcohol use prevalence data ranged from 21 to 26. Statistical power tables for Pearson product moment correlations indicate that a minimum samplesize of 19 is needed to detect a large effect size (r > 0.60) with power > 0.80 at the 0.05 significance level Pearson product–moment correlations between alcohol policy ratings and alcohol prevalence measures were examined first. Regression analyses controlling for per capita consumption were then conducted for those outcomes found to be related significantly to the API scores.

International Health Policy Program -Thailand 15 Next Sopit Nasueb PRESENT

International Health Policy Program -Thailand 16 RESULTS 16

International Health Policy Program -Thailand 17 Regression analyses 17

International Health Policy Program -Thailand 18 Regression analyses

International Health Policy Program -Thailand 19 DISCUSSION Alcohol availability and advertising control reduce the prevalence and frequency of alcohol consumption by youth. More comprehensive alcohol policies are associated with lower prevalence rates of alcohol use among youth

International Health Policy Program -Thailand DISCUSSION The API is limited in a number of ways. Alcohol marketing to youth is of particular concern to public health officials, health practitioners and parents, and has received a great deal of research attention. Motor vehicle policy ratings were not associated with prevalence estimates for youth alcohol consumption, they may be related to youth drinking and driving. 20

International Health Policy Program -Thailand 21 Thank you