Rupali J. Limaye MPH, PhD Candidate, Bangorn Srirojn MA, Co-investigator, Pam Lilleston MHS, PhD Student, Apinun Aramrattana MD, PhD, Principal Investigator, Nicholas Thomson PhD, Research Associate, David D. Celentano ScD, Professor and Chair, Susan G. Sherman PhD, MPH, Associate Professor. Correspondence to Ms Rupali J. Limaye, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA. Tel: +1 410 659 6300; Fax: +1 410 659 6266; E-mail: firstname.lastname@example.org
Asia Pacific Column
A qualitative exploration of the effects of increasing the minimum purchase age of alcohol in Thailand
Article first published online: 5 JUL 2012
© 2012 Australasian Professional Society on Alcohol and other Drugs
Drug and Alcohol Review
Volume 32, Issue 1, pages 100–105, January 2013
How to Cite
[A qualitative exploration of the effects of increasing the minimum purchase age of alcohol in Thailand. Drug Alcohol Rev 2012], , , , , , .
- Issue published online: 10 JAN 2013
- Article first published online: 5 JUL 2012
- Manuscript Accepted: 31 MAY 2012
- Manuscript Received: 22 DEC 2011
- alcohol law;
Introduction and Aims
Although prevalence of alcohol consumption has been relatively stable among Thai youth, concerns over alcohol-related harms affecting youth influenced the passage of new laws in early 2008, which made it illegal to sell alcohol to anyone under the age of 20. This qualitative study explored the effects of the law on the purchasing patterns of underage Thai bar patrons, in order to understand the strategies employed by underage youth to circumvent the law.
Design and Methods
A total of 41 in-depth interviews were conducted with 18- to 19-year-old bar patrons in Chiang Mai, Thailand.
Underage Thai bar patrons frequented shops where enforcement was not strict and purchased alcohol from familiar shopkeepers in their neighbourhoods. Participants suggested that purchasing alcohol was relatively easy as long as shopkeepers were driven by the need to make a profit.
Discussion and Conclusions
To address alcohol-related harms, the control law must be enforced in a meaningful way to deter youth from purchasing alcohol. Otherwise, the law will have minimal effectiveness in reducing the harms associated with alcohol.
From 2001 to 2007, Thailand experienced relatively stable prevalence rates of current or past year drinkers across age groups , with prevalence rates ranging from 21.6 to 22.22 among those aged 15–24. Alcohol is the most commonly used substance among youth  and youth consumption has been identified as a significant social and public health problem . However, despite relatively low prevalence rates of current drinkers among young Thais, alcohol-related harms among youth are considerable : alcohol consumption is an important risk factor for traffic accidents among youth , alcohol is associated with much of the mortality and morbidity among youth , and 40% of youth crimes are related to alcohol .
Throughout the world, governments have implemented a range of regulations in an effort to reduce the negative effects of alcohol consumption, particularly among youth . The Alcoholic Beverage Control Act B.E. 2551, passed in February 2008, raised the minimum legal drinking age from 18 to 20 years and made it illegal to sell alcohol to anyone under the age of 20 , with additional objectives being to control the availability and accessibility of alcohol through restrictions of times and places for selling and drinking alcohol and to reduce the attraction of alcohol use through the ban of alcoholic beverage advertisements, promotion and marketing strategies .
In a review examining the effects of drinking laws in the US from 1960 to 2000 , the authors concluded that increasing the legal age for purchase and consumption of alcohol has been one of the most successful efforts to reduce consumption among underage youth. Within the global context, a review examining the effects of alcohol control policies on youth in 26 countries found that policies affecting alcohol availability such as a minimum legal purchase age law were associated with lower prevalence and frequency of adolescent alcohol consumption and age of first alcohol use .
Our study sought to explore one aspect of the new act: the illegality of selling alcohol to anyone under the age of 20. To our knowledge, our study is the first to qualitatively explore the association between the Alcoholic Beverage Control Act and alcohol-related purchasing patterns among underage youth. The current study explored strategies and preferences that under-aged bar patrons employed to purchase alcohol illegally, and solicited opinions about the effects of the new law. We interviewed 41 underage bar patrons to understand the different ways underage youth were able to purchase alcohol after the new law was passed.
Research was conducted in Chiang Mai, Thailand from March to December 2009. The current analysis is based on 41 in-depth interviews that were conducted by 12 interviewers who received extensive training by the second author on ethnographic methods, in-depth and participant observation techniques, and ethical guidelines.
Venue identification, recruitment, sample, and informed consent
The sample was a purposeful sample of Thai youth, aged 18–19 years old (N = 41; n = 23 females; n = 18 males) and recruited from a range of drinking establishments including bars, dance clubs, karaoke bars, restaurants and roadside drinking stands. A two-step process identified recruitment venues. First, we administered surveys to bar patrons in entertainment regions of Chiang Mai asking about drinking venues. Second, study staff conducted participant observations during different days and times of the week in the 40 most popular venues as informed by the survey results. The observations were used to describe the venue's setting, potential participant characteristics, and to enumerate the number of under-aged patrons at each venue. The 10 venues with the highest density of the study population were selected as recruitment venues for all study participants. Peer recruiters approached bar patrons.
Potential participants who were interested in joining the study were asked to participate in the screening to determine if eligibility criteria were met: either 18 or 19 years old and could provide informed consent (confirmation that the participant understood the risks and benefits of being in the study). All eligible participants who were approached agreed to be in the study and appointments for the interview were made. The Institutional Review Board at Johns Hopkins Bloomberg School of Public Health and the Human Experimentation Committee at the Research Institute for Health Sciences, Chiang Mai University approved the study.
Data were collected confidentially in our study offices. Interviews were conducted with a guide that included open-ended questions about the following topics: past and current alcohol use, problems resulting from alcohol use and effect of the alcohol law on purchasing patterns. Interviewers utilised discussion guides, but the goal was to probe for responses elicited from the participants. Data relevant to this paper represent a small section of the interview material. Interviews lasted 45 min to 1.5 hours, were conducted in Thai and were recorded. The recordings were transcribed by one of three individuals and then translated into English. Each translated interview was checked by one of three authors who were fluent in both languages for accuracy. In the case of a disagreement, English-translated transcripts were checked against the Thai versions and interviewers were consulted for inconsistencies.
Data were analysed thematically in a multi-step process using the constant comparative method central to grounded theory . After reading several interviews for content comprehension, five interviews were chosen for open coding by three analysts. Resulting coding lists were compared and a synthesised coding list was developed. The resulting list was used to code the next five interviews, after which the code list was refined by collapsing smaller level codes into broader thematic categories. The list was then used to code the remaining interviews. As new themes emerged, the code list was refined and previously coded interviews were recoded. Analytic memos were written throughout the coding process to reflect on themes within and across interviews. Data were analysed through the qualitative coding software Atlas-ti (version 6). There were no major differences by gender, so this comparison was not included in the analysis.
Five themes emerged, two about the law itself: general perceptions of the reach of the law and recommendations for strengthening the law. The third, fourth and fifth themes pertained to reasons why participants chose specific locations to circumvent the law that prohibited the selling of alcohol to anyone under the age of 20: familiarity with shopkeepers, the need for shopkeepers to make money and therefore sell alcohol to underage youth, and locations where participants were not asked to produce identification to purchase alcohol.
Limited effect of change in minimum legal purchase age
Generally, participants believed the law had no effect on underage youth to purchase alcohol.
It doesn't really affect (us) as it is easy to sell and buy. Nobody pays much attention. (Female, 19)
More specifically, Thai youth believed that the law could not reach underage Thai drinkers, as it was too difficult to enforce selling policies, and as a result, underage youth would always be able to purchase alcohol.
I think the law doesn't affect (purchasing). (The law) cannot reach. (Male, 19)
Ease of purchasing by location
Participants circumvented the law by purchasing alcohol from individuals they knew. Grocery stores and supermarkets, both small and large, were cited as places where alcohol could be easily bought by underage youth.
Grocery stores, mini mart stores, and supermarkets are not very strict in checking when we buy the drinks. (Male, 19)
Overwhelmingly, participants rated local grocery stores in their neighbourhoods as the easiest location to purchase alcohol, due to the familiarity between the consumer and shop owner:
We know each other well already. It was the shop in front of my house area, so I can easily buy it. (Male, 19)
Additionally, participants tended to frequent local grocery stores, as it was less likely that local shopkeepers would hesitate selling alcohol to underage youth.
Yes, (I can buy) from stores in the neighbourhood. They know me and it's easy to buy from there. (Female, 18)
Finally, grocery stores were chosen as preferred locations to purchase alcohol because of perceived lack of identification checks:
Sometimes, if I don't want to go out and want to drink with friends peacefully, I go to some grocery stores. It is easy to buy at a grocery store as they do not check anything. (Male, 19)
Perceived lack of checks was another reason underage youth went to local retail stores.
If buying from a small retail shop, it will be easier to buy because … I have been buying … nobody checks the age of the customer and prohibited time for selling. I think no (police) can take care and cover all of places. (Male, 19)
Money as a motivating factor for shop owners
Money was perceived to be the major reason why shop owners still sold to those under the age of 20:
It seems to have no effect to drinkers under 20 years old … the shop in the village surely wants to sell it. (Female, 18)
Participants believed that shop owners did not care whether or not an underage youth wanted to purchase alcohol, as described by a 19-year old man:
Stores don't care as they need the flow of money. They do not care as long as they can sell something off the shelf.
In the eyes of the participants, money was the ultimate motivation for any shop owner, and therefore, believed that shop owners would continue to sell alcohol to underage minors, regardless of the law.
Shop owners tend to disregard the law, as they are not strict, (and the shop owners) want to sell, and want to make money. (Male, 19)
In restaurants, even if the restaurant owner wanted to adhere to the new law, waitresses and waiters allowed underage youth to purchase in order to increase their tips:
They didn't check our age. We're their customers. They want to make their sales and just take the order and serve to us. The restaurant owner knows nothing about this. It's the waiter/waitress. (Female, 18)
Other participants went on to say that because alcohol is ubiquitous and a relatively easy way for local shops to make money, anyone could purchase alcohol, regardless of age:
(Alcohol beverages) are sold to every generation … any age can buy … they don't follow what the law says … They still sell alcohol. (Male, 19)
Money was so strong a motivator for shop sellers in the eyes of the participants that participants felt the law would not play a role in purchasing access, and that to be effective, the seller must be targeted strictly:
I think the law plays no role upon (underage age purchasing and consumption). Though a teenager under the age of 20 years old is not allowed to buy alcohol, but (shop sellers) just sell it to us. We have to focus on the seller. If shop sellers sell alcohol for kids at all ages, they'd go to buy it. But if not, they have no place to buy and to drink alcohol. (Female, 18)
Identification cards and underage purchase of alcohol
Although under the new law shopkeepers are prohibited in selling alcohol to anyone under the age of 20, many participants suggested that when they frequented shops where the owner was not familiar with the youth, shops did not ask for ID to purchase alcohol.
No ID card inspection. I've never been asked for ID card. No one does the inspection. (Male, 18)
Certain shops and bars that did ask for ID to purchase alcohol only asked the participant verbally if they were the minimum age.
At a store, they did not check my ID but they looked at my face and asked whether I was underage or not. (Male, 19)
Participant recommendations for reducing underage purchasing and consumption
Since this study interviewed underage youth, we asked about their opinions on how to strengthen the law. Participants overwhelmingly believed that the success of the law was dependent upon uniform enforcement among shop sellers and to be effective, all shopkeepers should check for identification and only sell to those that are of the legal age.
In my opinion, it depends on the shop owner whether they want to sell it to us or not. I think it is more like we can choose the place to go. If this place does not allow teenagers to (purchase) then we go to the place where underage can (buy) as there are many places available. (Male, 19)
Underage youth did acknowledge that their peers who drank caused harms and there was a need for a strict purchasing law:
I think it's good to have this law because people go out not only for fun but they fight and do some illegal stuff. There should be some serious inspection … (police have) not really (inspected seriously). (Female, 18)
Participants felt strongly that if the law that made it illegal to sell alcohol to anyone under the age of 20 were enforced sufficiently, it would help curb alcohol-related harms.
The current study examines the effect of one aspect of the alcohol control laws, the illegality of selling alcohol to anyone under the age of 20, on underage Thai bar patrons by exploring the relationship between the law and youths' ability to purchase alcohol. We were interested in providing insight on how to strengthen efforts to control accessibility, as controlling accessibility can mitigate corresponding issues, such as excessive consumption. Our study found that underage youth perceived that money was the ultimate motivator for shop sellers to sell to underage youth, found it relatively easy to purchase alcohol in locations close to their neighbourhoods where there was familiarity between the youth and shop owner, and identification card checks were infrequent and not uniformly conducted.
Underage drinking has been recognised as a national priority issue in Thailand and the Alcoholic Beverage Control Act  has the potential to impact underage consumption. However, adherence to the act by shop sellers must be monitored and enforced strictly to effectively reduce alcohol-related harms . As the Act prohibits the sale of alcohol to anyone under the age of 20, the punishment of violating the law targets alcohol businesses and sellers. The law states that if an individual sells alcoholic beverages to those under the age of 20, such an act is punishable with an imprisonment of not exceeding one year or a fine of not exceeding 20 000 Baht, or both .
A number of other countries have implemented control laws and evidence exists that such laws, in conjunction with other control laws including minimum legal drinking age laws, can influence underage alcohol-related traffic fatalities [13-16]. Changes in youth alcohol consumption-related problems, such as traffic accidents, follow after enactment of stricter alcohol control policies [17-19] and imply that more comprehensive policies, especially policies that limit the availability of alcohol, have the power to reduce consumption and resulting societal harms by youth . These studies suggest that a law that prohibits the selling of alcohol to those under the age of 20, in conjunction with other control policies, has the potential to limit accessibility and therefore resulting consumption among underage Thais. However, such laws must be implemented systematically and comprehensively, and implementation must include the necessary funding needed to ensure effective enforcement of the law.
Regarding implementation, the Act established the Alcohol Beverage Control Committee, whose tasks include presenting ideas to the Committee or the Minister regarding the issuance of announcement or regulations necessary for execution of the law, as well as providing advice to and coordinating with government and private organisations relating to the control of alcohol beverage . To control alcohol, the Committee could look to other international examples where targeted alcohol-related law enforcement activities have significantly reduced negative individual and public health outcomes of alcohol use through the threat of hefty financial penalties and potential prison terms for sellers . Collaboration between shopkeepers and enforcement officials is necessary to strengthen the law, and further information to understand if the punishment is being dispensed or severe enough is crucial. A next step would be exploring and determining the feasibility of various incentives to shopkeepers to dissuade them from selling alcohol to underage youth.
As there is limited information available about the drinking patterns of adolescents in Thailand , our study points to additional research that could inform our understanding of illicit drinking among youth. Future efforts in understanding the effects of the law could be to identify the burden of harms experienced by and perpetuated by underage bar patrons. Bars and other public drinking environments have been identified as locations with high concentrations of heavy drinkers . Assessing if the consequences of consumption of underage bar patrons differ from underage consuming outside of bars would be helpful in informing future intervention efforts and identifying most-at-risk populations.
This study is subject to limitations. The analysis was limited to a sample recruited from bars, limiting generalisation beyond underage bar patrons. Further research should recruit from venues that have more stringent entrance policies and should include the views of retailers and law enforcement officials. However, our findings can provide information on how underage Thais can purchase alcohol in general. Although we recruited from drinking establishments, this study asked the participants about all locations where they could purchase alcohol. Additionally, as we only interviewed underage youth about alcohol purchasing, participants may have felt pressure to respond in a particular manner because the behaviour is illegal. Finally, because the data were collected in Thai, there is a language translation limitation.
Alcoholic beverages have been consumed in Thailand for thousands of years  and an increase in consumption in the future is likely . In order to curb consumption, it is clear that data regarding the effectiveness of alcohol control policies are needed. This is the first study of its kind to explore the effects of the new law that prohibits selling alcohol to anyone under the age of 20 among underage Thai bar patrons, and will be informative to policymakers in strengthening the national comprehensive and effective response to alcohol purchasing and resulting consumption among underage youth.
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