Introduction and AimsGender 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 MethodsSurveys 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.ResultsPercentages 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 ConclusionsHigh‐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.

In a policy arena in which the interest groups and stakeholders have different perceptions of appropriate policy responses to alcohol-related harm, a robust methodology to assess the impact of policy will contribute to the debate.

Introduction and AimsThe 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 MethodsThe 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.ResultsThe 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 ConclusionsThe IAC study will allow for cross‐country analysis of drinking patterns, the relationship between alcohol use and policy relevant behaviour in different countries.

The alcohol industry have attempted to position themselves as collaborators in alcohol policy making as a way of influencing policies away from a focus on the drivers of the harmful use of alcohol (marketing, over availability and affordability). Their framings of alcohol consumption and harms allow them to argue for ineffective measures, largely targeting heavier consumers, and against population wide measures as the latter will affect moderate drinkers. The goal of their public relations organisations is to 'promote responsible drinking'. However, analysis of data collected in the International Alcohol Control study and used to estimate how much heavier drinking occasions contribute to the alcohol market in five different countries shows the alcohol industry's reliance on the harmful use of alcohol. In higher income countries heavier drinking occasions make up approximately 50% of sales and in middle income countries it is closer to two-thirds. It is this reliance on the harmful use of alcohol which underpins the conflicting interests between the transnational alcohol corporations and public health and which militates against their involvement in the alcohol policy arena. [Caswell S, Callinan S, Chaiyasong S, Cuong PV, Kazantseva E, Bayandorj T, Huckle T, Parker K, Railton R, Wall M. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev 2016;35:661-664].

Introduction and AimTo report data on the implementation of alcohol policies regarding availability and marketing, and drink driving, along with ratings of enforcement from two small high‐income to three high‐middle income countries, and one low‐middle income country.MethodThis study uses the Alcohol Environment Protocol, an International Alcohol Control study research tool, which documents the alcohol policy environment by standardised collection of data from administrative sources, observational studies and interviews with key informants to allow for cross‐country comparison and change over time.ResultsAll countries showed adoption to varying extents of key effective policy approaches outlined in the World Health Organization Global Strategy to Reduce the Harmful Use of Alcohol (2010). High‐income countries were more likely to allocate resources to enforcement. However, where enforcement and implementation were high, policy on availability was fairly liberal. Key Informants judged alcohol to be very available in both high‐ and middle‐income countries, reflecting liberal policy in the former and less implementation and enforcement and informal (unlicensed) sale of alcohol in the latter. Marketing was largely unrestricted in all countries and while drink‐driving legislation was in place, it was less well enforced in middle‐income countries.ConclusionIn countries with fewer resources, alcohol policies are less effective because of lack of implementation and enforcement and, in the case of marketing, lack of regulation. This has implications for the increase in consumption taking place as a result of the expanding distribution and marketing of commercial alcohol and consequent increases in alcohol‐related harm.

Introduction and AimsTo 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 MethodsSurveys 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.ResultsIndividual‐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 ConclusionsAssociations 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.

Objectives Identify costs, outcomes and stakeholders' perspectives associated with incorporation of community pharmacy services into the Thai National Health Insurance System and their values to all stakeholders. Methods Using a combination of search terms, a comprehensive literature search was performed using the Thai Journal Citation Index Centre, Health System Research Institute database, PubMed and references from recent reviews. Identified studies were published between January 2000 and December 2014. The review included publications in English and Thai on primary research undertaken in community pharmacies associated with the National Health Insurance System. Two independent authors performed study selection, data extraction and quality assessment. Key findings The literature search yielded 251 titles, with 18 satisfying the inclusion criteria. Clinical outcomes of community pharmacy services included control and reduction in blood pressure and blood sugar, improved adherence to medications, an increase in acceptance of interventions, and an increase in healthy behaviours. Thirty-three percentage of those at risk of diabetes and hypertension achieved normal blood sugar and blood pressure levels after being followed for 2-6 months by a community pharmacist. The cost of collaborative screening by community pharmacies and primary care units was US$ 4.5. Diabetes management costs were US$ 5.1-30.7. Community pharmacists reported high satisfaction rates. Stakeholders' perspectives revealed support for the community pharmacists' roles and the inclusion of community pharmacies as partners with the National Health Insurance System. Conclusions Community pharmacy services improved outcomes for diabetic and hypertensive patients. This review supports the feasibility of incorporating community pharmacies into the Thai National Health System.

ObjectivesThis study examined the association between alcohol consumption trajectory and deaths due to cancer, cardiovascular diseases (CVDs) and all-cause mortality in Thailand.DesignData were obtained from a Thai prospective cohort study with more than 30 years of follow-up (n=1961).SettingAll participants resided in Bangkok and its vicinity.ParticipantsEmployees from the Electricity Generating Authority of Thailand aged between 35 and 54 years old were randomly selected.Main outcome measuresExposure was alcohol consumption trajectory over the study period from 1985 to 2012. The main outcomes were all-cause mortality, and deaths due to cancer and CVDs recorded in national vital registries between 2002 and 2015. Cox’s proportional hazard regression was used to determine the associations between alcohol consumption trajectory and each outcome adjusting for sample characteristics, health behaviours and health conditions.ResultsFrom a total of 59 312 person years, 276 deaths were observed. Compared with drinkers who drank occasionally or most occasional over their lifetime, consistent regular or mostly consistent-regular drinkers had higher rates of all-cause mortality (HR: 1.53; 95% CI 1.09 to 2.16) and cancer mortality (HR: 2.05; 95% CI 1.13 to 3.74). The study did not find a significant association between trajectory of alcohol consumption and deaths due to CVDs.ConclusionsRegular drinking of alcohol increased risk for all-cause and cancer mortality. Effective interventions should be implemented to reduce number of regular drinkers in order to saves life of individuals.