Promoting responsible alcohol service practices among licensed establishments in Thimphu, Bhutan: a pilot intervention (Thimphu-RASP)
Background: A study to assess compliance with existing alcohol service policies and to promote responsible alcohol sales practices among on-premise licensed outlets was conducted in downtown Thimphu, Bhutan from June through November 2013. A total of 202 bars, restaurants, and hotels/lodges received an education program and a follow up enforcement visit in order to improve compliance with and strengthen enforcement of alcohol policies prohibiting (1) underage sales (to potential customers younger than 18); (2) daily sales before 1 PM and after 10 PM; (3) sales on Tuesday when premises cannot sell alcohol; and (4) sales to alcohol-impaired customers. Method: The effect of the intervention was inferred from pretest to posttest changes in refusals ofalcohol purchase attempts at 71 establishments conducted at pretest and post- intervention by three categories of mystery shoppers: 1) underage-appearing shoppers, 2) sober adults, and 3) pseudo-intoxicated adults. Ten purchase attempts were made in each establishment with 710 total purchase attempts in each survey. Results: The baseline sales refusals (excluding Tuesdays) during prohibited hours before 1 PM were 9.6%; the refusals were similar for all three categories of mystery shoppers. Refusals for after 10 PM were 10%. Refusals during legal trading hours (1 PM - 10 PM) for non-servable clients (intoxicated and underage) were 6.4%. The proportion of refusals on Tuesdays was 43%, higher than other prohibited hours. After the intervention, there was an overall increase of 13.5 percentage points or a 1.7-fold increase in refusals (RR=1.7, 95% CI: 1.4- 2.0, p < 0.001). The overall post-intervention increase was significant in sober adult (RR=1.7, 95% CI: 1.2-2.5, p = 0.007) and pseudo-intoxicated (RR=l.7, 95% CI: 1.2-2.4, p = 0.002) shoppers, but not for underage-appearing shoppers (RR=l.3, 95% CI: 0.9-1.8, p = 0.126). Conclusion: Retailers' compliance with alcohol policies is poor in Thimphu. A brief intervention involving an education and follow up enforcement visit led to improved practices but establishments' compliance with underage alcohol laws remains a significant challenge.
Thesis (Dr.P.H.)--Boston University