The Role of Alcohol and Drug Availability and Laws and Norms in Explaining Cross-National Differences in Alcohol and Drug Use in Mumbai, India; Melbourne, Australia and; Seattle/ Tacoma in Washington State, USA

Introduction: Although there are important questions regarding the effects of modernization and globalization on young people in rapidly developing countries such as India, there have been few well-conducted comparative studies. Mumbai is one of the fastest modernizing cities in India. Previous cross-national comparative papers from the present study have reported lower rates of alcohol use in Mumbai adolescents, relative to matched samples in Seattle/ Tacoma, in Washington State in the US, and Melbourne/ Geelong in Victoria, Australia. The present paper will extend prior findings by cross-nationally comparing potentially modifiable influences in the areas of alcohol and drug availability and laws and norms.

 Methods: A representative sample of 3,500 Mumbai students in school years equating with US Grade 5, 7 and 9 were surveyed in 2010 using a sample designed to be representative of Mumbai, India with funding from the India University Research Grants Scheme. Sampling methods, survey procedures and instruments were matched to enable cross-national comparison with same-aged student cohorts surveyed in Washington State, U.S., (N = 2,866) and Victoria, Australia (N = 2,864) in 2002 in the International Youth Development Study. Analyses compared the prevalence of alcohol and drug use and risk and protective factors in urban segments of matched age and gender cohorts. Associations were examined between rates of alcohol use and risk factors related to alcohol and drug availability and laws and norms.

 Results: The results showed lower rates of alcohol, tobacco and other drug use in Mumbai. For example amongst Grade 5 boys (av age 11 years) rates of lifetime alcohol use were 4.1% (95% Confidence Interval [CI:] 2.4 - 6.9%) in Mumbai; 57.3% (CI: 51.4 - 62.9%) in Melbourne and; 25.4% (CI: 21.1 - 30.3%) in Seattle/ Tacoma. Based on preliminary analyses, the results showed that the levels on risk factors for alcohol and drug availability and laws and norms were lowest in Seattle/ Tacoma and highest in Mumbai, with Melbourne intermediate between these extremes. Associations between alcohol and drug use and risk factors related to alcohol and drug availability and laws and norms were in similar directions in each country, although were slightly weaker in Mumbai compared to Seattle/ Tacoma and Melbourne.

 Conclusions: These analyses are discussed with reference to differing policy options for adolescent alcohol and drug availability that are adopted in Mumbai, Seattle/ Tacoma and Melbourne. The findings have implications for scientific understanding of adolescent development and for planning international prevention programs. The high levels of risk in Mumbai forecast the possibility of future increases in adolescent alcohol and drug use.