The alcohol marketing policy environment and adolescent drinking in Sri Lanka: A qualitative exploration of stakeholder perspectives

• Published date: 01 September 2022
• Author: Lathika Athauda,Roshini Peiris‐John,Judith McCool,Rajitha Wickremasinghe,Shanthi Ameratunga
• Date: 01 September 2022
• DOI: http://doi.org/10.1002/wmh3.471

World Med. & Health Policy. 2022;14:544–559.wileyonlinelibrary.com/journal/wmh3544

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© 2021 Policy Studies Organization

Received: 8 December 2020

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Revised: 15 June 2021

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Accepted: 4 July 2021

DOI: 10.1002/wmh3.471

ORIGINAL ARTICLE

The alcohol marketing policy environment and

adolescent drinking in Sri Lanka: A qualitative

exploration of stakeholder perspectives

Lathika Athauda

1,2

|Roshini Peiris‐John

1

|Judith McCool

1

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Rajitha Wickremasinghe

2

|Shanthi Ameratunga

1

1

School of Population Health, University of

Auckland, Auckland, New Zealand

2

Department of Public Health, Faculty of

Medicine, University of Kelaniya, Colombo,

Sri Lanka

Correspondence

Lathika Athauda, Department of Public

Health, Faculty of Medicine, University of

Kelaniya, PO Box 06, Thalagolla Rd, Ragama

11010, Sri Lanka.

Email: lathika@kln.ac.lk and

lath383@aucklanduni.ac.nz

Abstract

Adolescents continue to be exposed to alcohol market-

ing, despite the existence of alcohol control policies in

Sri Lanka. National‐level policies restrict all forms of al-

cohol advertising, promotions, and sponsorship and sale

to minors. The act calls for the need to protect children

and adolescents from exposure to the harm of alcohol.

This article investigates stakeholders' perceptions of the

alcohol marketing policy environment in Sri Lanka, with

a specific focus on policies designed to prevent or curtail

adolescent drinking. Between May and July 2019, in‐

depth interviews were conducted with policy stake-

holders in Colombo, Sri Lanka. Thematic analysis was

conducted on the audio‐recorded interviews that were

transcribed and translated and imported to NVivo12.

Fifteen policy stakeholders from government and non-

government organizations participated in this study. The

overarching theme identified a lukewarm alcohol mar-

keting policy environment. This situation was facilitated

by the alcohol industry acting as the vector, an amber

light approach towards public health programs, and

other factors contributing to the perceived ineffective-

ness of the alcohol marketing policy environment. A

unified public health approach supported by policy and

political commitment may pave the way for better alcohol

control in Sri Lanka.

KEYWORDS

adolescent, alcohol, policy environment, qualitative, Sri Lanka

Key points

•The Sri Lankan alcohol policy environment appears

weak due to both internal and external challenges.

•Industry influence, policy fragmentation, lack of clear

focus and other contextual factors weaken the alcohol

policy environment.

•A unified public health approach and policy and poli-

tical commitment is important for better alcohol control

in Sri Lanka.

INTRODUCTION

Adolescents (10‐to 19‐year olds) in Sri Lanka account for approximately 16.2% of the

population (Government of Sri Lanka, 2015). It is estimated that of all 15‐to 19‐year olds in

Sri Lanka, 18% consumed alcohol (World Health Organization, 2018). Despite this pre-

valence being comparatively lower than in high‐income countries, there is evidence to

suggest that alcohol is marketed towards young people through legally banned advertising

and promotions (Athauda et al., 2021).

Restrictive alcohol policies such as limitations in marketing or restricting purchase by age

are key to reducing adolescent drinking (Bendtsen et al., 2014), particularly in Low and

Middle‐Income Countries (LMIC) (Moodie et al., 2013). Limiting alcohol availability, pricing,

marketing, and promotions, as well as distribution, have been established as policies that

are effective in alcohol control (Babor et al., 2010; Noel, 2019). Widespread alcohol mar-

keting has been observed to target adolescents and young people on a global scale (Scott

et al., 2017). This early influence is associated with the initiation and maintenance of

drinking across the lifespan resulting in social, economic, health and justice issues at the

national and global level (Esser & Jernigan, 2018).

Regulating the marketing of alcohol requires the policy environment to negotiate the

relationship between policy actors (people in government who make or shape policy), in-

stitutions (the government, commercial industries, lobby groups) ideas, and contexts

(Cairney, 2016). In short, the policy environment needs to focus on all these components to

effectively control and regulate alcohol. A weak policy environment can result in a poorly

regulated alcohol industry. Alcohol, as a risk factor for preventable disease and as an

addictive substance, poses considerable public health concern when marketed to adoles-

cents (Clark et al., 2020). Indeed, recent studies affirm the need for greater restriction of

alcohol marketing strategies to protect adolescents (Jernigan et al., 2017; Noel et al., 2017).

Public health programs designed to reduce risk factors for non‐communicable diseases

(NCD) need to prioritize public health over commercial interests (Swinburn et al., 2019).

In the case of alcohol, this poses a considerable challenge as the industry is highly adept at

influencing policy (McCambridge et al., 2018).

An assessment of support for various alcohol policies among consumers aged 16–65

years (Casswell, 2012a,2012b) found that the highest support came from consumers in

LMICs such as Peru and Mongolia, whereas support was lowest in high‐income countries

such as New Zealand (Parry et al., 2018). The Alcohol Environment Protocol that assessed

policy implementation on aspects such as availability and marketing established that in

LMICs (e.g., Thailand), alcohol policies were less effective due to lack of implementation

and enforcement compared to higher‐income countries (e.g., UK, New Zealand)

(Casswell, 2018). Cultural and contextual determinants shape alcohol policies. Hence the

value of generating an understanding of local systems is key to developing and im-

plementing effective alcohol policies (Babor & Winstanley, 2008).

Evaluation of local alcohol interventions and policies in Scandinavia, North America, and

Australasia found community‐based outcomes which require more effort to implement and

sustain result in better policy outcomes such as pricing control, restricting underage

ALCOHOL POLICY ENVIRONMENT IN SRI LANKA

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