Increasing compliance with alcohol service laws in a developing country: intervention trial in the Kingdom of Bhutan. (28th December 2015)

• Record Type: Journal Article
• Authors: 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
• Is Part Of: Addiction. Volume 111:Number 3(2016)
• Page Start: 467
• Page End: 474
• Publication Date: 2015-12-28
• Subjects: Alcohol -- community intervention -- covert observation -- education -- mystery shopper -- policy -- service; Alcoholism -- Periodicals; Drug addiction -- Periodicals; 616.86
• DOI: 10.1111/add.13202
• Languages: English
• ISSNs: 0965-2140

Abstract

Abstract: 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% (differenceadj = 24%; 95% CI = 12–37%) and on Tuesdays: 43–58% (differenceadj = 14%; 95% CI = 1–28%). Differences in refusal to serve alcohol: after 10 p.m. (differenceadj = 15%; 95% CI = –8 to 37%); to underage patrons (differenceadj = –5%; 95% CI = 14 to 4%); and to intoxicated patrons (differenceadj = 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.