Journal Articles

Permanent URI for this collectionhttps://mro.massey.ac.nz/handle/10179/7915

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    Investigating Indicators to Assess and Support Alcohol Taxation Policy: Results From the International Alcohol Control (IAC) Study
    (Kerman University of Medical Sciences, 2025-03-01) Casswell S; Parker K; Randerson S; Huckle T; Athauda L; Banavaram A; Callinan S; Campbell O; Chaiyasong S; Dearak S; Romero-Garcia L; Gururaj G; Kalapat R; Karki K; Karlsson T; Kong M; Liu S; Maldonado N; González-Mejía JF; Naimi T; Nthomang K; Oladunni O; Owino K; Herrera-Palacio J; Phatchana P; Pradhan P; Rossow I; Shorter G; Sibounheuang V; Štelemėkas M; Son DT; Vallance K; van Dalen W; Wettlaufer A; Zamora A
    Alcohol taxation is a key policy to reduce consumption and alcohol harm but evidence on tax design and indicators to assess taxation policy are lacking. Tax design and two indicators: tax as a share of lowest retail price and affordability, were investigated in eight high-income and nine middle-income jurisdictions. Collaborators populated the International Alcohol Control (IAC) study online Alcohol Policy Tool, providing measures of tax design, tax rates; and typical lowest prices available for retail take-away alcohol. These data were used to calculate tax/share of retail price. Affordability of alcohol was assessed against gross national income (GNI) per capita. High-income jurisdictions had higher tax/share and higher affordability on average compared with middle-income jurisdictions. Over the sample as a whole there was no association between these two indicators of tax policy. The tax designs used also varied with high-income jurisdictions more likely to use specific excise tax reflecting potency and middle-income jurisdictions more likely to utilise ad valorem and specific volume based taxes and to use more than one method across a beverage. Increased alcohol taxation to reduce alcohol consumption and harm is established as a high impact policy and is believed to work by affecting affordability. However, less is known about the best taxation methods to reduce affordability or the best measures to monitor and compare alcohol taxation between countries and over time. In this sample of high-and middle-income jurisdictions tax/price share was not found to predict affordability, suggesting the need to further research indicators of alcohol affordability.
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    Comparing alcohol policy environments in high-income jurisdictions with the International Alcohol Control Policy Index.
    (John Wiley and Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs, 2025-02-23) Casswell S; Randerson S; Parker K; Huckle T; Callinan S; Campbell O; Karlsson T; Rossow I; Shorter G; Štelemėkas M; Vallance K; van Dalen W; Wettlaufer A
    INTRODUCTION: Considerable evidence exists on the most effective policy to reduce alcohol harm; however, a tool and index to allow comparisons of policy status of the most effective policies between similar jurisdictions and change over time within a jurisdiction has not been widely used. The International Alcohol Control (IAC) Policy Index is designed to address this gap and monitor the alcohol policy environment with regard to four effective policy domains (tax/pricing, availability, marketing and drink driving). METHODS: This study compares IAC Policy Index scores across 11 high-income jurisdictions: Aotearoa (Māori language name for New Zealand); Australia; Finland; Norway; the Netherlands; (Republic of Ireland; Lithuania; Ontario; Alberta; Quebec; British Columbia). Collaborators in the 11 high-income jurisdictions populated the online Alcohol Policy Tool with available indicators. The team in Aotearoa New Zealand sought to validate information and worked with collaborators to clarify any uncertainties in the data. RESULTS: Lithuania, Norway, Finland and Ireland scored above average on the IAC Policy Index. The jurisdictions varied in terms of the strength of policy in different domains, with drink driving legislation showing the greatest consistency and marketing the strongest relationship between stringency of policy and impact on the ground. DISCUSSION AND CONCLUSIONS: Results in high-income jurisdictions suggested the IAC Policy Index provides a useful overview of core alcohol policy status, allows for comparisons between jurisdictions and has the potential to be useful in alcohol policy debate.
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    Systemic inequities in alcohol licensing: Case studies in eight Aotearoa New Zealand communities.
    (John Wiley and Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs, 2025-01-21) Randerson S; Casswell S; Borell B; Rychert M; Gordon L; Lin E-Y; Huckle T; Graydon-Guy T
    Introduction Many countries, including Aotearoa New Zealand, have socioeconomic and ethnic inequities in alcohol outlet density, yet the potential contribution of alcohol licensing systems is almost unexplored. After licensing reforms in Aotearoa in 2012, community groups and Māori (the Indigenous people) continued to struggle to influence decisions, prompting calls for reform and authority for Māori reflecting Te Tiriti o Waitangi obligations. This study explored factors in the failure of public objections in under-resourced neighbourhoods. Methods In a descriptive, multimethod qualitative study, we analysed eight decisions to grant off-licence approvals in socioeconomically deprived areas. Each licence was opposed. Hearing participants and local residents were interviewed. Data were thematically analysed to identify factors affecting objector influence, alignment with Indigenous rights and residents' awareness of alcohol issues and licensing processes. Results Residents identified relevant local harms but were largely unaware of opportunities to object. Objectors faced structural barriers to accessing and influencing hearings that were exacerbated by resource challenges, including travel costs, lost income, competing social issues and limited legal representation. Evidence of area deprivation supported objectors' arguments regarding risk, but a lack of official data on harms undermined them. Māori input was excluded by legal barriers and failures to recognise relevant rights and elements of culture. Discussion and Conclusions Structural barriers, including racism, restricted the influence of under-resourced communities and Māori in licensing decisions and weakened risk assessment, which may hinder community efforts to reduce their disproportionate exposure to alcohol outlets. Licensing systems should be reviewed from equity and Indigenous perspectives.
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    Assessing alcohol industry penetration and government safeguards: the International Alcohol Control Study
    (BMJ Publishing Group, 2024-11-24) Leung JYY; Casswell S; Randerson S; Athauda L; Banavaram A; Callinan S; Campbell O; Chaiyasong S; Dearak S; Dumbili EW; Romero-García L; Gururaj G; Kalapat R; Karki K; Karlsson T; Kong M; Liu S; Maldonado Vargas ND; Gonzalez-Mejía JF; Naimi T; Nthomang K; Oladunni O; Owino K; Herrera Palacio JC; Phatchana P; Pradhan PMS; Rossow I; Shorter G; Sibounheuang V; Štelemėkas M; Son DT; Vallance K; van Dalen W; Wettlaufer A; Zamora A; Jankhotkaew J; Veitch E
    BACKGROUND: The alcohol industry uses many of the tobacco industry's strategies to influence policy-making, yet unlike the Framework Convention on Tobacco Control, there is no intergovernmental guidance on protecting policies from alcohol industry influence. Systematic assessment of alcohol industry penetration and government safeguards is also lacking. Here, we aimed to identify the nature and extent of industry penetration in a cross-section of jurisdictions. Using these data, we suggested ways to protect alcohol policies and policy-makers from undue industry influence. METHODS: As part of the International Alcohol Control Study, researchers from 24 jurisdictions documented whether 22 indicators of alcohol industry penetration and government safeguards were present or absent in their location. Several sources of publicly available information were used, such as government or alcohol industry reports, websites, media releases, news articles and research articles. We summarised the responses quantitatively by indicator and jurisdiction. We also extracted examples provided of industry penetration and government safeguards. RESULTS: There were high levels of alcohol industry penetration overall. Notably, all jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported government officials or politicians having held industry roles. There were multiple examples of government partnerships or agreements with the alcohol industry as corporate social responsibility activities, and government incentives for the industry in the early COVID-19 pandemic. In contrast, government safeguards against alcohol industry influence were limited, with only the Philippines reporting a policy to restrict government interactions with the alcohol industry. It was challenging to obtain publicly available information on multiple indicators of alcohol industry penetration. CONCLUSION: Governments need to put in place stronger measures to protect policies from alcohol industry influence, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Data collection can be improved by measuring these government safeguards in future studies.
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    Normative value of 'best buys' and the case of bans on alcohol marketing.
    (BMJ Publishing Group, 2024-08-05) Casswell S; Babor TF; Carah N; Jernigan DH; Petticrew M; Godlee F
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    Benchmarking alcohol policy based on stringency and impact: The International Alcohol Control (IAC) policy index.
    (PLOS, 2022-04-22) Casswell S; Huckle T; Parker K; Romeo J; Graydon-Guy T; Leung J; Byron K; Callinan S; Chaiyasong S; Gordon R; MacKintosh AM; Meier P; Paraje G; Parry CD; Pham C; Petersen Williams P; Randerson S; Schelleman-Offermans K; Sengee G; Torun P; van Dalen W; Harker N; Peer N
    This study developed a measurement tool to assess stringency and 'on-the-ground' impact of four key alcohol policy domains to create an alcohol policy index suitable for benchmarking alcohol policy and assessing change over time in middle- and high-income countries. It involved a collaboration between researchers in 12 diverse countries: New Zealand; Australia; England; Scotland; Netherlands; Vietnam; Thailand; South Africa; Turkey; Chile; Saint Kitts and Nevis and Mongolia. Data on the four most effective alcohol policy domains (availability, pricing policy, alcohol marketing, drink driving) were used to create an alcohol policy index based on their association with alcohol per capita consumption (APC) of commercial (recorded) alcohol. An innovation was the inclusion of measures of impact along with the stringency of the legislation or regulation. The resulting International Alcohol Control (IAC) Policy Index showed a very high negative correlation (-0.91) with recorded APC. Greater affordability of alcohol, an impact measure taking into account prices paid and countries' Gross Domestic Product, was predictive of higher APC (-0.80). Countries in which more modes of alcohol marketing are legally allowed and used had higher APC. Legislation on outlet density and drink driving predicted APC whereas trading hours did not. While stringency and impact measures varied between domains in terms of relationship with APC, overall, there was a strong correlation between impact and stringency (0.77). The IAC Policy Index, which includes measures of policy stringency and 'on-the-ground' impacts in relation to four key policy areas, was found to be strongly associated with commercial alcohol consumed in a number of diverse country settings. It showed a larger relationship than previous indices that include more policy dimensions. The index provides a relatively simple tool for benchmarking and communication with policy makers to encourage a strong focus on uptake of these four most effective alcohol policies.
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    A composite index of provincial alcohol control policy implementation capacity in Thailand.
    (Elsevier B.V., 2024-06-26) Jankhotkaew J; Casswell S; Huckle T; Chaiyasong S; Kalapat R; Waleewong O; Parker K
    BACKGROUND: There is a well-published literature on the effectiveness and stringency of alcohol control policies, but not many studies focus on policy implementation, where policies transform into impact. The objective of this study is to create a composite index that measures the capacity for implementing effective alcohol control policies across all provinces in Thailand. METHODS: Based on the international literature, we developed a list of key indicators for tracking the implementation of alcohol policies at the subnational level. To ensure these indicators were relevant to the Thai context, we obtained feedback from Thai experts. We collected primary data according to the developed indicators using questionnaires filled in by key informants at the implementing agencies and gathered secondary data at the provincial level. On this basis, we developed indices that reflect the status of alcohol control policy implementation. We then investigated the association between the indices and the prevalence and pattern of alcohol consumption and alcohol-related harms while adjusting for potential confounders using multiple linear regression and negative binomial regression, respectively. RESULTS: Scores on the Provincial Alcohol Policy Implementation Capacity (PAPIC) Index ranged between 39 and 79. We found that each 1-point increase in PAPIC score was associated with a 1.98 % reduction in the quantity of alcohol consumed in grams per day (coefficient: -0.02; 95 %CI: -0.03, -0.00; p-value<0.05; e-0.02= 0.9802). We also found that for each 1-point increase in PAPIC score, the proportion of regular drinkers reduced by 0.30 per cent (coefficient: -0.30; 95 %CI: -0.55, -0.05; p-value<0.05). However, we did not find any association between the indices and alcohol-related harms. CONCLUSION: The level of implementation of alcohol control policy at the sub-national level is associated with alcohol consumption levels. The findings suggest the value of allocating resources to the implementation of alcohol control policy.
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    Using the International Alcohol Control (IAC) policy index to assess effects of legislative change in Aotearoa New Zealand.
    (BioMed Central Ltd, 2024-06-11) Casswell S; Randerson S; Parker K; Huckle T
    BACKGROUND: The IAC Policy Index was developed to allow comparison in alcohol policy between countries and within countries over time including in low resource settings. It measures four effective alcohol policies and takes into account stringency of regulation and the actual impact on the alcohol environment, such as trading hours and prices paid. This framework was used to assess policy in Aotearoa New Zealand in a time period covering two relevant legislative changes. This is the first study to use an alcohol policy index to assess and describe legislative change within country. METHODS: Data to calculate the IAC Policy Index was collected for 2013 and 2022. Stringency of policy was assessed from legislative statutes and impacts of policy on the alcohol environment from administrative data and specifically designed data collection. RESULTS: The overall IAC Policy Index score improved over the time period. The scores for the separate policy areas reflected the legislative changes as hypothesised, but also independent changes in impact, given ecological changes including reduced enforcement of drink driving countermeasures and increased exposure to marketing in digital channels. The IAC Policy index reflects the changes in policy status observed in Aotearoa, NZ. DISCUSSION: The IAC Policy Index provided a useful framework to assess and describe change in alcohol legislation contextualised by other influences on policy impact over time within a country. The results indicated the value of assessing stringency and impact separately as these moved independently. CONCLUSIONS: The IAC Alcohol Policy Index, measuring both stringency and actual impact on the alcohol environment with a focus on only the most effective alcohol policies provides meaningful insights into within-country policy strength over time. The IAC Policy Index used over time can communicate to policy makers successes and gaps in alcohol policy.
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    Beverage-specific consumption trends: A cross-country, cross-sectional comparison.
    (Elsevier B.V., 2023-05-12) Torney A; Room R; Huckle T; Casswell S; Callinan S
    INTRODUCTION: The price of alcoholic beverages can vary for a range of reasons, including tax. Risky drinkers purchase more low-cost alcoholic drinks than moderate drinkers, contributing to beverage-specific risks for that category. The study aimed to examine the proportion of total alcohol consumption comprised by each beverage type and their correlates. Australian and New Zealand populations were compared, where drinking cultures are similar, but taxation of alcohol differs. METHOD: Data was taken from the International Alcohol Control study in Australia (N=1580) and New Zealand (N =1979), a cross national survey that asks questions on beverage specific alcohol consumption at a range of different locations. Tax rates were obtained from previous analyses run on the dataset. RESULTS: Ready to Drink (pre-mixed) beverages are more popular in New Zealand and the proportion of these drinks consumed out of total alcohol consumption by risky drinkers was correspondingly higher there. Conversely, the proportion of wine consumed by risky drinkers was higher in Australia. The consumption of spirits and beer by risky drinkers was similar in both countries. DISCUSSION: Differences found for the proportion of beverages consumed by risky drinkers between the countries are fairly well aligned with differences in the taxation of each drink type. Future adaptations in taxation systems should consider the impact of taxes on preferential beverage choice and associated harms.
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    Foetal alcohol spectrum disorder in Aotearoa, New Zealand: Estimates of prevalence and indications of inequity.
    (John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs, 2023-02-21) Romeo JS; Huckle T; Casswell S; Connor J; Rehm J; McGinn V
    INTRODUCTION: Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity. METHODS: FASD prevalence was estimated from self-reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta-analysis of case-ascertainment or clinic-based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation. RESULTS: We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval [CI] 1.0%; 2.7%) in the 2012/2013 year. For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Māori, from 1.7% to 6.3%. DISCUSSION AND CONCLUSIONS: This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Māori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol-free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure.