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Increasing compliance with alcohol service laws in a developing country: intervention trial in the Kingdom of Bhutan
Author(s) -
Dorji Gampo,
DeJong William,
Bor Jacob,
DeSilva Mary Bachman,
Sabin Lora,
Feeley Frank Rich,
Udon Pema,
Wangchuk Nima,
Wangdi Ugyen,
Choden Tshering,
Gurung Mongal Singh,
Chogyel Tandin,
Wangchuk Dorji,
Kypri Kypros
Publication year - 2016
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.13202
Subject(s) - medicine , confidence interval , intervention (counseling) , difference in differences , logistic regression , compliance (psychology) , demography , environmental health , psychology , social psychology , psychiatry , sociology , economics , econometrics
Aim Bhutan is a low‐middle income country that, like many others, experiences significant alcohol‐related harm and low compliance with laws restricting availability and promotion. This study assessed changes in compliance of alcohol outlets with sales restrictions following a multi‐sector programme aimed at improving this. Design Pre–post design with covert observation of service practices. Setting Thimphu , Bhutan , June – November 2013. Alcohol is not permitted for sale except from 1 to 10 p.m. Wednesday – Monday . Serving minors (< 18 years old) or intoxicated patrons is illegal. Participants Seventy‐one outlets selected randomly from all 209 on‐premises outlets in downtown Thimphu . Intervention Multi‐sector programme involving visits to outlets, education of owners and staff, a toolkit and implementation checks. Measurements Ten mystery‐shopper visits were made to each outlet both before and after the intervention. We assessed compliance in five purchasing scenarios: (1) before 1 p.m., (2) after 10 p.m., (3) on Tuesdays and (4) shoppers who appeared to be underage or (5) intoxicated. Changes in compliance rates were assessed using multi‐variable logistic regression models. Findings Overall compliance increased from 20 to 34% [difference: 14%; 95% confidence interval (CI) = 7–22%]. Improvement was found in refusals of service before 1 p.m.: 10–34% (difference adj = 24%; 95% CI = 12–37%) and on Tuesdays: 43–58% (difference adj = 14%; 95% CI = 1–28%). Differences in refusal to serve alcohol: after 10 p.m. (difference adj = 15%; 95% CI = –8 to 37%); to underage patrons (difference adj = –5%; 95% CI = 14 to 4%); and to intoxicated patrons (difference adj = 7%; 95% CI = –7–20%) were not statistically significant. Younger servers, stand‐alone bars and outlets permitting indoor smoking were each less likely to comply with the alcohol service laws. Conclusion A multi‐sector programme to improve compliance with legal restrictions on serving alcohol in Bhutan appeared to have a modest effect but even after the programme, in two‐thirds of the occasions tested, the laws were broken.