Are alcohol policies associated with alcohol consumption in low- and middle-income countries?

Aims: To examine the associations between alcohol control policies in four regulatory domains with alcohol consumption in low- and middle-income countries (LAMICs), controlling for country-level living standards and drinking patterns.

Design: Cross-sectional analyses of individual-level alcohol consumption survey data and country-level alcohol policies using multi-level modeling.

Setting: Data from 15 LAMICs collected in the Gender, Alcohol, and Culture: an International Study (GENACIS) data set.

Participants: Individuals aged 18-65 years.

Measurements: Alcohol policy data compiled by the World Health Organization; individual-level current drinking status, usual quantity and frequency of drinking, binge drinking frequency and total drinking volume; gross domestic product based on purchasing power parity (GDP-PPP) per capita; detrimental drinking pattern scale; and age and gender as individual-level covariates.

Findings: Alcohol policies regulating the physical availability of alcohol, particularly those concerning business hours or involving a licensing system for off-premises alcohol retail sales, as well as minimum legal drinking age, were the most consistent predictors of alcohol consumption. Aggregate relative alcohol price levels were associated inversely with all drinking variables (P < 0.05) except drinking volume. Greater restrictions on alcohol advertising, particularly beer advertising, were associated inversely with alcohol consumption (P < 0.05). Policies that set legal blood alcohol concentration (BAC) limits for drivers and random breath testing to enforce BAC limits were not associated significantly with alcohol consumption.

Conclusions: Alcohol policies that regulate the physical availability of alcohol are associated with lower alcohol consumption in low- and middle-income countries.