Abstract
Nowadays, adolescents are a group that is targeted by the alcohol industry; and there is an increase of online marketing efforts. However, the main supply of alcohol is via physical availability (e.g., convenience stores, retail shops, pubs, bars). This can be monitored by the “density of alcohol sales licenses” per population. The World Health Organization (WHO) recommends a core set of alcohol best buy intervention strategies. One of them is the “restricted access to retailed alcohol”. This study explored the relationship between the density of alcohol outlets, alcohol sale licences, and alcohol drinking behaviors in Thai teenagers during the last 10 years (2007-2017). We drew data from two data sets. Firstly, alcohol drinking behavior was extracted from the 2007, 2011, 2014, and 2017 waves of the, nationally representative, Tobacco and Alcohol Consumption Survey in Thailand. Alcohol drinking behavior was categorised as: current drinker, regular drinker (≥1 time/week), and binge drinker (≥ 4-5 standard drinks in each time). Secondly, the density of alcohol sales licenses per 1,000 population in each province was calculated by the number of alcohol sales licenses from the Royal Thai Ministry of Finance, divided by the mid-year population number from the Royal Ministry of Interior. In this study, the density of alcohol sales licenses suggested alcohol outlet density. The relationships between the alcohol sales license figures and drinking behavior were analyzed by a heatmap and spatiotemporal mixed model. Our data had two levels. The upper level (i.e., provincial level) featured the density of alcohol sales licenses (spatial effect), years of survey (temporal effect) and the Social Deprivation Index (SDI). The lower level (i.e. individual level) had the demographic data of participants. We found that the density of alcohol sales licenses increased the odds for the current drinker category to be present (odds ratio [OR] = 1.08, 95% confidence interval [CI], 1.04-1.45), especially in male (OR = 1.09, 95%CI, 1.04-1.14). Furthermore, it also increased the odds for the presence of the binge drinker category but only in regards to females (OR = 1.23, 95%CI, 1.05-1.44). The number of alcohol sales licenses from 2007 to 2018 was, on average, nine licenses per 1,000 residents. In 2007 and 2008, the density of alcohol sales licenses was lower than the other years. Meanwhile, in 2015, the density of alcohol sales licenses was higher than the others. It could be concluded that the number of alcohol sales licenses showed quite steady density adjustments and no declines. Based on our results, increasing alcohol sales licenses is associated with a higher proportion of alcohol drinking from Thai teenagers. Thus, it is suggested that government organizations develop and apply strategies towards reducing the number of licenses for the sale of alcohol. Potential examples are: stricter control on the license applications and renewals process, increasing licensing fees, and using the density of alcohol sales licenses as a metric assisting the development of targets in the national alcohol control strategy.
