Marissa B. Esser

Alcohol Control Policies in 46 African Countries: Opportunities for Improvement

AIMS There is little information on the extent to which African countries are addressing alcohol consumption and alcohol-related harm, which suggests that evaluations of national alcohol policies are needed in this region. The aim of this article is to examine the strength of a mix of national alcohol control policies in African countries, as well as the relationship between alcohol policy restrictiveness scores and adult alcohol per capita consumption (APC) among drinkers at the national level. METHODS We examined national alcohol policies of 46 African countries, as of 2012, in four regulatory categories (price, availability, marketing and drink-driving), and analyzed the restrictiveness of national alcohol policies using an adapted Alcohol Policy Index (API). To assess the validity of the policy restrictiveness scores, we conducted correlational analyses between policy restrictiveness scores and APC among drinkers in 40 countries. RESULTS Countries attained a mean score of 44.1 of 100 points possible, ranging from 9.1 (Sao Tomé and Principe) to 75.0 (Algeria), with low scores indicating low policy restrictiveness. Policy restrictiveness scores were negatively correlated with and APC among drinkers (rs = -0.353, P = 0.005). CONCLUSIONS There is great variation in the strength of alcohol control policies in countries throughout the African region. Tools for comparing the restrictiveness of alcohol policies across countries are available and are an important instrument to monitor alcohol policy developments. The negative correlation between policy restrictiveness and alcohol consumption among drinkers suggests the need for stronger alcohol policies as well as increased training and capacity building at the country level.

Alcohol and public health in Africa: can we prevent alcohol-related harm from increasing?

AIMS According to the World Health Organization (WHO), the total amount of alcohol consumed in the African region is expected to increase due to the growth of new alcohol consumers, especially young people and women. With the changing alcohol environment, increases in the alcohol-attributable burden of disease are inevitable. To our knowledge, there has not been a comprehensive analysis of the factors that could be driving those increases. The objective of this study was to examine the evidence from peer reviewed literature regarding the factors that could be instrumental in this process, in order to inform strategic policy-related decisions. METHOD A narrative review was conducted using a thematic analysis approach. We searched papers published between January 2000 and July 2014 in PubMed, the WHOs Global Health Library and African Journals Online. RESULTS Our analysis identified seven factors (demographics, rapid urbanization, economic development, increased availability, corporate targeting, weak policy infrastructure and trade agreements) which are potentially tied to changes in alcohol consumption in Africa. Driven largely by globalization, a potential convergence of these various factors is likely to be associated with continued growth in alcohol consumption and alcohol-related morbidity and mortality. CONCLUSIONS To address the emerging risk factors associated with increased alcohol consumption, African governments need to take a more active role in protecting the publics health. In particular, important strategic shifts are needed to increase implementation of intersectoral strategies, community involvement in the policy dialogue, health services re-orientation and better regulation of the alcohol beverage industry.

Evaluation of the Evidence Base for the Alcohol Industry’s Actions to Reduce Drink Driving Globally

OBJECTIVES To evaluate the evidence base for the content of initiatives that the alcohol industry implemented to reduce drink driving from 1982 to May 2015. METHODS We systematically analyzed the content of 266 global initiatives that the alcohol industry has categorized as actions to reduce drink driving. RESULTS Social aspects public relations organizations (i.e., organizations funded by the alcohol industry to handle issues that may be damaging to the business) sponsored the greatest proportion of the actions. Only 0.8% (n = 2) of the sampled industry actions were consistent with public health evidence of effectiveness for reducing drink driving. CONCLUSIONS The vast majority of the alcohol industrys actions to reduce drink driving does not reflect public health evidenced-based recommendations, even though effective drink-driving countermeasures exist, such as a maximum blood alcohol concentration limit of 0.05 grams per deciliter for drivers and widespread use of sobriety checkpoints.

Multinational Alcohol Market Development and Public Health: Diageo in India

Alcohol is a risk factor for communicable and noncommunicable diseases, and alcohol consumption is rising steadily in India. The growth of multinational alcohol corporations, such as Diageo, contributes to Indias changing alcohol environment. We provide a brief history of Indias alcohol regulation for context and examine Diageos strategies for expansion in India in 2013 and 2014. Diageo is attracted to Indias younger generation, women, and emerging middle class for growth opportunities. Components of Diageos responsibility strategy conflict with evidence-based public health recommendations for reducing harmful alcohol consumption. Diageos strategies for achieving market dominance in India are at odds with public health evidence. We conclude with recommendations for protecting public health in emerging markets.

Impact of Maryland’s 2011 alcohol sales tax increase on alcoholic beverage sales

ABSTRACT Background: Increasing alcohol taxes has proven effective in reducing alcohol consumption, but the effects of alcohol sales taxes on sales of specific alcoholic beverages have received little research attention. Data on sales are generally less subject to reporting biases than self-reported patterns of alcohol consumption. Objectives: We aimed to assess the effects of Maryland’s July 1, 2011 three percentage point increase in the alcohol sales tax (6–9%) on beverage-specific and total alcohol sales. Methods: Using county-level data on Maryland’s monthly alcohol sales in gallons for 2010–2012, by beverage type, multilevel mixed effects multiple linear regression models estimated the effects of the tax increase on alcohol sales. We controlled for seasonality, county characteristics, and national unemployment rates in the main analyses. Results: In the 18 months after the tax increase, average per capita sales of spirits were 5.1% lower (p < 0.001), beer sales were 3.2% lower (p < 0.001), and wine sales were 2.5% lower (p < 0.01) relative to what would have been expected from sales trends in the 18 months prior to the tax increase. Overall, the alcohol sales tax increase was associated with a 3.8% decline in total alcohol sold relative to what would have been expected based on sales in the prior 18 months (p < 0.001). Conclusion: The findings suggest that increased alcohol sales taxes may be as effective as excise taxes in reducing alcohol consumption and related problems. Sales taxes also have the added advantages of rising with inflation and taxing the highest priced beverages most heavily.

Characteristics associated with alcohol consumption among emergency department patients presenting with road traffic injuries in Hyderabad, India

INTRODUCTION Each year in India, road traffic crashes lead to more than 200,000 deaths and the country has seen an unprecedented rate of roadway fatalities in recent years. At the same time, alcohol consumption per capita among Indians is rising. Despite these increasing trends of road traffic injuries (RTIs) and alcohol use, alcohol is not routinely assessed as a risk factor for RTIs. This study aims to examine the involvement of alcohol among emergency department patients presenting with RTIs in the Indian city of Hyderabad. PATIENTS AND METHODS As part of a prospective study, data were collected from 3366 patients (88.0% male) presenting with RTIs at an emergency department in Hyderabad, India, from September 2013 to February 2014. Logistic regression models were used to assess individual-level and road traffic crash characteristics associated with suspected or reported alcohol consumption six hours prior to the RTI. RESULTS Alcohol was suspected or reported among 17.9% of the patients with RTIs. Adjusting for confounders, males experienced 9.8 times greater odds of alcohol-related RTIs than females. Compared to 15-24 year-olds, the odds of alcohol consumption was 1.4 times greater among 25-34 year-olds and 1.7 times greater among 35-44 year-olds, adjusting for confounding factors. Patients who were passengers in vehicles other than motorized two-wheelers had 90% reduced odds of an alcohol-related RTI than motorized two-wheeler drivers. Drivers of non-two-wheelers, passengers on two-wheelers, and pedestrians did not have significantly different odds of an alcohol-related RTI compared to two-wheeler drivers. Nighttime crashes were associated with nearly a threefold increase in the odds of alcohol consumption. CONCLUSIONS Given that alcohol was suspected or reported in more than one in six injured ED patients with RTIs, it is clear that alcohol is a serious risk factor for RTIs; this evidence can guide prevention efforts. These findings suggest that evidence-based interventions to reduce drink-driving, such as random breath testing (where law enforcement officials stop drivers on the road to test them for alcohol use), could be more widespread in India. Future studies should assess the effectiveness of greater implementation and enforcement of policies to decrease alcohols availability to reduce RTIs.

Alcohol facts labels on Four Loko: Will the Federal Trade Commission’s order be effective in reducing hazardous drinking among underage youth?

Abstract Underage drinking accounts for 4400 alcohol-attributable deaths in the US each year. After several reports of the deaths of young people due to the consumption of the flavored-alcoholic beverage (FAB) Four Loko, the Federal Trade Commission (FTC) examined whether Phusion Projects violated federal law by using deceptive marketing. In 2013, the FTC responded by ordering alcohol facts labels on Four Loko disclosing the number of standard drinks contained in the product. This paper aims to discuss whether the FTC’s order for alcohol facts labels on Four Loko cans will effectively reduce the hazardous consumption of FABs among youth. The authors discuss the existing research that relates to the FTC’s order, including studies on the effectiveness of serving size labeling for reducing youth drinking, research on the brand-specific consumption of FABs among underage youth, and the associations between youth drinking and exposure to alcohol marketing. After synthesizing the evidence, the authors conclude that simply requiring the disclosure of the number of standard drinks on supersized Four Loko cans is not likely to adequately address the hazardous consumption of this beverage among underage drinkers. Instead, if the FTC addresses the marketing of these products and its potential to encourage the excessive use of alcohol, as the Attorneys General did recently in a settlement with the same company, it is possible that there would be a greater impact on reducing youth alcohol consumption. Additional research is needed to determine the impact of alcohol facts labels in changing underage drinking behaviors.