Alcohol Use and Policy Responses in Modern China: New Developments in a Changing Society
Excessive alcohol consumption is a worldwide social problem that has greatly contributed to the global burden of disease, disability and death. Overall volume of alcohol consumption and prevalence of alcohol-related problems in China have remained relatively low in comparison to many western countries until recent years. Since the liberal economic reforms of the early 1980s, China has witnessed an alarmingly increasing rate of alcohol consumption, and as a result, increasing incidence of alcohol-related injuries and morbidity. However, comprehensive alcohol policy and public health infrastructure to address the problems associated with these changes have not yet been established. Using data from the China Health and Nutrition Survey, this dissertation - comprised of three papers - utilizes quantitative methods to examine alcohol consumption behaviors in China, in order to identify alcohol policies and interventions that are both applicable to and appropriate for the Chinese context and to recommend next steps for alcohol control policy and intervention areas in China. The first paper explores the socio-demographic and other factors that are associated with alcohol consumption behaviors in order to identify populations that are at risk for problem alcohol use and that may be targeted for prevention/public health education programs. The second paper establishes evidence regarding alcohol consumption behaviors and its association with community-level alcohol access characteristics, such as proximity of alcohol outlets and price of different types of alcohol. The third examines the association between alcohol consumption and healthcare utilization, in order to identify health policy needs for persons at risk for the development of costly chronic diseases. The three principal conclusions from the three papers are: (1) there is strong evidence of a closing gender gap in problematic alcohol consumption behaviors between men and women - although men are still more likely to consume more alcohol and be frequent and heavy drinkers than women, alcohol consumption levels and rates of heavy drinking among women are significantly increasing; (2) absence of alcohol vendor availability is associated with decreased alcohol consumption, and cost of beer and aged liquor is inversely associated amount of alcohol consumed and heavy drinking; and (3) problematic drinkers in China appear to under-utilize preventive healthcare services and possibly formal medical care in general.