Pham Viet Cuong

Measuring compliance with Viet Nam's mandatory motorcycle helmet legislation

The objective of this roadside observational study was to monitor helmet wearing among motorcycle riders and passengers in three provinces (Yen Bai, Da Nang and Binh Duong) in the Socialist Republic of Viet Nam, before and after a mandatory helmet law took effect on 15 December 2007. A total of 665,428 motorcycle riders and passengers were observed between November 2007 and February 2011 at 45 randomly selected sites covering the entire road network. Across all locations and time periods, correct helmet wearing averaged 40.1% before the law and 92.5% after; however, there were significant differences between time points and locations. The Viet Nam Governments decision to require all motorcycle riders and passengers to wear helmets has been thoroughly implemented nation wide and the results show that high wearing has been sustained. Further study is required on how high helmet wearing has and will translate into a reduction in motorcycle head injuries; however, Viet Nams motorcycle helmet legislation should be seen as an important policy example for other low- and middle-income countries with a high utilization of motorcycles for personal transport.

Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries

Injuries result in nearly 6 million deaths and incur 52 million disability-adjusted life-years annually, making up 15% of the global disease burden. More than 90% of this burden occurs in low- and middle-income countries. Given this burden, it is not unexpected that injuries are the leading cause of death among travelers to low- and middle-income countries, namely, from road traffic crashes and drowning. Therefore, pretravel advice regarding foreseeable dangers and how to avoid them may significantly mitigate injury risk, such as wearing seatbelts, helmets, and personal flotation devices when appropriate; responsibly consuming alcohol; and closely supervising children.

Cross‐country comparison of proportion of alcohol consumed in harmful drinking occasions using the International Alcohol Control Study

Abstract Introduction and Aims This study examines the proportion of alcohol markets consumed in harmful drinking occasions in a range of high‐, middle‐income countries and assesses the implications of these findings for conflict of interest between alcohol producers and public health and the appropriate role of the alcohol industry in alcohol policy space. Design and Methods Cross‐sectional surveys were conducted in 10 countries as part of the International Alcohol Control study. Alcohol consumption was measured using location‐ and beverage‐specific measures. A level of consumption defined as harmful use of alcohol was chosen and the proportion of the total market consumed in these drinking occasions was calculated for both commercial and informal alcohol. Results In all countries, sizeable proportions of the alcohol market were consumed during harmful drinking occasions. In general, a higher proportion of alcohol was consumed in harmful drinking occasions by respondents in the middle‐income countries than respondents in the high‐income countries. The proportion of informal alcohol consumed in harmful drinking occasions was lower than commercial alcohol. Discussion and Conclusions Informal alcohol is less likely to be consumed in harmful drinking occasions compared with commercial alcohol. The proportion of commercial alcohol consumed in harmful drinking occasions in a range of alcohol markets shows the reliance of the transnational alcohol corporations on harmful alcohol use. This reliance underpins industry lobbying against effective policy and support for ineffective approaches. The conflict of interest between the alcohol industry and public health requires their exclusion from the alcohol policy space.

Drinking patterns vary by gender, age and country-level income: Cross-country analysis of the International Alcohol Control Study: Drinking patterns by gender, age and country-level income

Abstract Introduction and Aims Gender and age patterns of drinking are important in guiding country responses to harmful use of alcohol. This study undertook cross‐country analysis of drinking across gender, age groups in some high‐and middle‐income countries. Design and Methods Surveys of drinkers were conducted in Australia, England, Scotland, New Zealand, St Kitts and Nevis (high‐income), Thailand, South Africa, Mongolia and Vietnam (middle‐income) as part of the International Alcohol Control Study. Drinking pattern measures were high‐frequency, heavier‐typical quantity and higher‐risk drinking. Differences in the drinking patterns across age and gender groups were calculated. Logistic regression models were applied including a measure of country‐level income. Results Percentages of high‐frequency, heavier‐typical quantity and higher‐risk drinking were greater among men than in women in all countries. Older age was associated with drinking more frequently but smaller typical quantities especially in high‐income countries. Middle‐income countries overall showed less frequent but heavier typical quantities; however, the lower frequencies meant the percentages of higher risk drinkers were lower overall compared with high‐income countries (with the exception of South Africa). Discussion and Conclusions High‐frequency drinking was greater in high‐income countries, particularly in older age groups. Middle‐income countries overall showed less frequent drinking but heavier typical quantities. As alcohol use becomes more normalised as a result of the expansion of commercial alcohol it is likely frequency of drinking will increase with a likelihood of greater numbers drinking at higher risk levels.

Support for alcohol policies among drinkers in Mongolia, New Zealand, Peru, South Africa, St Kitts and Nevis, Thailand and Vietnam: Data from the International Alcohol Control Study: IAC study: Cross-national alcohol policy support

Abstract Introduction and Aims A 2010 World Health Assembly resolution called on member states to intensify efforts to address alcohol‐related harm. Progress has been slow. This study aims to determine the magnitude of public support for 12 alcohol policies and whether it differs by country, demographic factors and drinking risk (volume consumed). Design and Methods Data are drawn from seven countries participating in the International Alcohol Control Study which used country‐specific sampling methods designed to obtain random, representative samples. The weighted total sample comprised 11 494 drinkers aged 16–65 years. Results Drinking risk was substantial (24% ‘increased’ risk and 16% ‘high’ risk) and was particularly high in South Africa. Support varied by alcohol policy, ranging from 12% to 96%, but was above 50% for 79% of the possible country/policy combinations. Across countries, policy support was generally higher for policies addressing drink driving and increasing the alcohol purchase age. There was less support for policies increasing the price of alcohol, especially when funds were not earmarked. Policy support differed by country, and was generally higher in the five middle‐income countries than in New Zealand. It also differed by age, gender, education, quantity/frequency of drinking, risk category and country income level. Discussion and Conclusions We found a trend in policy support, generally being highest in the low–middle‐income countries, followed by high–middle‐income countries and then high‐income countries. Support from drinkers for a range of alcohol policies is extensive across all countries and could be used as a catalyst for further policy action.

Socio-economic disadvantage is associated with heavier drinking in high but not middle-income countries participating in the International Alcohol Control Study: Disadvantage and heavy drinking cross-country

Abstract Introduction and Aims To investigate if socio‐economic disadvantage, at the individual‐ and country‐level, is associated with heavier drinking in some middle‐ and high‐income countries. Design and Methods Surveys of drinkers were undertaken in some high‐ and middle‐income countries. Participating countries were Australia, England, New Zealand, Scotland (high‐income) and Peru, Thailand and Vietnam (middle‐income). Disadvantage at the country‐level was defined as per World Bank (categorised as middle‐or high‐income); individual‐level measures were (i) years of education and (ii) whether and individual was under or over the poverty line in each country. Measures of heavier drinking were (i) proportion of drinkers that consumed 8+ drinks and (ii) three drinking risk groups (lower, increasing and higher). Multi‐level logistic regression models were used. Results Individual‐level measures of disadvantage, lower education and living in poverty, were associated with heavier drinking, consuming 8+ drinks on a typical occasion or drinking at the higher risk level, when all countries were considered together. Drinkers in the middle‐income countries had a higher probability of consuming 8+ drinks on a typical occasion relative to drinkers in the high‐income countries. Interactions between country‐level income and individual‐level disadvantage were undertaken: disadvantaged drinkers in the middle‐income countries were less likely to be heavier drinkers relative to those with less disadvantage in the high‐income countries. Discussion and Conclusions Associations between socio‐economic disadvantage and heavier drinking vary depending on country‐level income. These findings highlight the value of exploring cross‐country differences in heavier drinking and disadvantage and the importance of including country‐level measurements to better elucidate relationships.

Alcohol taxes’ contribution to prices in high and middle-income countries: Data from the International Alcohol Control Study: Alcohol prices and international tax policies

Abstract Introduction Taxation is increasingly being used as an effective means of influencing behaviour in relation to harmful products. In this paper we use data from six participating countries of the International Alcohol Control Study to examine and evaluate their comparative prices and tax regimes. Methods We calculate taxes and prices for three high‐income and three middle‐income countries. The data are drawn from the International Alcohol Control survey and from the Alcohol Environment Protocol. Tax systems are described and then the rates of tax on key products presented. Comparisons are made using the Purchasing Power Parity rates. The price and purchase data from each countrys International Alcohol Control survey is then used to calculate the mean percentage of retail price paid in tax weighted by actual consumption. Results Both ad valorem and specific per unit of alcohol taxation systems are represented among the six countries. The prices differ widely between countries even though presented in terms of Purchasing Power Parity. The percentage of tax in the final price also varies widely but is much lower than the 75% set by the World Health Organization as a goal for tobacco tax. Conclusion There is considerable variation in tax systems and prices across countries. There is scope to increase taxation and this analysis provides comparable data, including the percentage of tax in final price, from some middle and high‐income countries for consideration in policy discussion.

Policy‐relevant behaviours predict heavier drinking and mediate the relationship with age, gender and education status: Analysis from the International Alcohol Control study

Abstract Introduction and Aims To investigate behaviours related to four alcohol policy variables (policy‐relevant behaviours) and demographic variables in relation to typical quantities of alcohol consumed on‐premise in six International Alcohol Control study countries. Design and Methods General population surveys with drinkers using a comparable survey instrument and data analysed using path analysis in an overall model and for each country. Measures: typical quantities per occasion consumed on‐premise; gender, age; years of education, prices paid, time of purchase, time to access alcohol and liking for alcohol advertisements. Results In the overall model younger people, males and those with fewer years of education consumed larger typical quantities. Overall lower prices paid, later time of purchase and liking for alcohol ads predicted consuming larger typical quantities; this was found in the high‐income countries, less consistently in the high‐middle‐income countries and not in the low middle‐income country. Three policy‐relevant behaviours (prices paid, time of purchase, liking for alcohol ads) mediated the relationships between age, gender, education and consumption in high‐income countries. Discussion and Conclusions International Alcohol Control survey data showed a relationship between policy‐relevant behaviours and typical quantities consumed and support the likely effect of policy change (trading hours, price and restrictions on marketing) on heavier drinking. The path analysis also revealed policy‐relevant behaviours were significant mediating variables between the effect of age, gender and educational status on consumption. However, this relationship is clearest in high‐income countries. Further research is required to understand better how circumstances in low‐middle‐income countries impact effects of policies.

The International Alcohol Control Study: Methodology and implementation: IAC study methodology and implementation

Abstract Introduction and Aims The International Alcohol Control (IAC) Study is a multi‐country collaborative project to assess patterns of alcohol consumption and the impact of alcohol control policy. The aim of this paper is to report the methods and implementation of the IAC. Design and Methods The IAC has been implemented among drinkers 16–65 years in high‐ and middle‐income countries: Australia, England, Scotland, New Zealand, St Kitts and Nevis, Thailand, South Africa, Peru, Mongolia and Vietnam (the latter four samples were sub‐national). Two research instruments were used: the IAC survey of drinkers and the Alcohol Environmental Protocol (a protocol for policy analysis). The survey was administered via computer‐assisted interview and the Alcohol Environmental Protocol data were collected via document review, administrative or commercial data and key informant interviews. Results The IAC instruments were readily adapted for cross‐country use. The IAC methodology has provided cross‐country survey data on key measures of alcohol consumption (quantity, frequency and volume), aspects of policy relevant behaviour and policy implementation: availability, price, purchasing, marketing and drink driving. The median response rate for all countries was 60% (range 16% to 99%). Where data on alcohol available for consumption were available the validity of survey consumption measures were assessed by calculating survey coverage found to be 86% or above. Differential response bias was handled, to the extent it could be, using post‐stratification weights. Discussion and Conclusions The IAC study will allow for cross‐country analysis of drinking patterns, the relationship between alcohol use and policy relevant behaviour in different countries.

The International Alcohol Control Study: Methodology and implementation (Forthcoming/Available Online)

Abstract Introduction and Aims The International Alcohol Control (IAC) Study is a multi‐country collaborative project to assess patterns of alcohol consumption and the impact of alcohol control policy. The aim of this paper is to report the methods and implementation of the IAC. Design and Methods The IAC has been implemented among drinkers 16–65 years in high‐ and middle‐income countries: Australia, England, Scotland, New Zealand, St Kitts and Nevis, Thailand, South Africa, Peru, Mongolia and Vietnam (the latter four samples were sub‐national). Two research instruments were used: the IAC survey of drinkers and the Alcohol Environmental Protocol (a protocol for policy analysis). The survey was administered via computer‐assisted interview and the Alcohol Environmental Protocol data were collected via document review, administrative or commercial data and key informant interviews. Results The IAC instruments were readily adapted for cross‐country use. The IAC methodology has provided cross‐country survey data on key measures of alcohol consumption (quantity, frequency and volume), aspects of policy relevant behaviour and policy implementation: availability, price, purchasing, marketing and drink driving. The median response rate for all countries was 60% (range 16% to 99%). Where data on alcohol available for consumption were available the validity of survey consumption measures were assessed by calculating survey coverage found to be 86% or above. Differential response bias was handled, to the extent it could be, using post‐stratification weights. Discussion and Conclusions The IAC study will allow for cross‐country analysis of drinking patterns, the relationship between alcohol use and policy relevant behaviour in different countries.