Trends in Public Awareness and Knowledge of Drinking Guidelines: a Representative Population Survey in England, 2016–2022
Journal article
Abstract
Aim
To examine trends in public awareness and knowledge of low-risk alcohol use guidelines in the UK since their revision in 2016. The improved low-risk alcohol use guidelines had moved from a daily to a weekly guideline, made the guideline the same for men and women, and reduced the guideline for men by around one-third.
Method
Data were from a representative, repeat cross-sectional survey.
The researchers analysed changes in awareness and knowledge of low-risk alcohol use guidelines among 8168 adult alcohol users between 2016 and 2022 and associations with sociodemographic characteristics, smoking status and level of alcohol consumption.
Results
The proportion of alcohol users aware of guidelines declined from 86.0% in 2016 to 81.7% in 2019, then increased during the COVID-19 pandemic, peaking at 91.6% in 2020.
The proportion of alcohol users who correctly identified the guideline as a maximum of exactly 14 units/week remained at around a quarter from 2016 to 2018.
The proportion of alcohol users who gave a figure of 14 units or fewer rose from 52.1% to 57.4%.
However, by 2022, guideline knowledge had worsened significantly, with these figures falling to 19.7% and 46.5%, respectively.
Changes over time were similar across subgroups.
Odds of guideline awareness and knowledge were higher among alcohol users who were aged ≥35, female, more educated and from more advantaged social grades.
Conclusions
The majority of adult alcohol users in the UK are aware of low-risk alcohol use guidelines.
However, 6 years since their announcement, knowledge of the revised low-risk alcohol use guidelines remains poor.
Less than a quarter know the recommended weekly limit and only around half think it is 14 units or less.
Inequalities have persisted over time, such that disadvantaged groups remain less likely to know the guidelines.
Discussion
Between 2016 and 2022, awareness of low-risk alcohol use guidelines was high, with more than 8 in 10 adult alcohol users in the UK saying they were aware of the guidelines.
However, knowledge of the guidelines was relatively poor:
- only around a quarter of alcohol users accurately recalled the recommended weekly limit as exactly 14 units per week, and
- around half thought it was 14 units or fewer.
Awareness of the guidelines did not increase significantly in the first few years following the announcement of the revised guidelines in January 2016:
- the proportion of adult alcohol users in the UK who were aware of the guidelines was stable between 2016 and 2018,
- but in 2019 awareness declined, and
- then in 2020 awareness increased to above-baseline levels.
The opposite pattern was observed for knowledge of the guidelines, with the proportion of alcohol users reporting the guideline to be 14 units per week or fewer increasing between 2016 and 2019, then declining. There was no improvement in inequalities in awareness and knowledge of the guidelines: disadvantaged groups remain less likely to be aware of or know the guidelines.
These results add to and extend previous evidence, which found no short-term effect of announcing the revised guidelines on awareness, but identified a modest increase in knowledge of the guidelines among men (for whom the recommended weekly limit changed).
Although the researchers saw little early change in awareness, their data suggest there may have been a more gradual increase in knowledge across the whole population of drinkers over the three years following the announcement of the revised guidelines.
2020 brought about more substantial changes: increased awareness of low-risk alcohol use guidelines but greater uncertainty relating to the recommended weekly limit. This may have been a COVID-19 effect. The pandemic was associated with changes in the adult alcohol user population in the UK. The increased size of the alcohol user population reflects a substantial proportion of never-alcohol users moving to occasional alcohol use during the pandemic; the researchers found these people have poorer knowledge of low-risk alcohol use guidelines, so their inclusion in the alcohol user population likely contributed to (but does not fully explain) the decline in knowledge observed.
The researchers also observed an increase in the proportion of alcohol users who had post-16 qualifications, indicating higher levels of education among pandemic alcohol users, which might partly account for the increase in guideline awareness. In addition, there was a shift from on-trade (i.e. licensed venues) to off-trade (i.e. shop-bought) alcohol use, which may have increased alcohol users’ exposure to guidelines on product labels. The pandemic may also have increased the salience of, or alcohol users’ interest in, their health and related information (including low-risk alcohol use guidelines).
In conclusion, 6 years since their announcement, knowledge of the revised drinking guidelines remains poor.
While the majority of adult alcohol users in the UK are aware of the guidelines, less than a quarter know the recommended weekly limit and only around half think it is 14 units or fewer.
These data suggest passive dissemination of guidelines remains a weak implementation approach: with little improvement in knowledge since the revised guidelines were announced, increasing public awareness of low-risk alcohol use guidelines warrants a more proactive approach.
Inequalities in awareness and knowledge of low-risk alcohol use guidelines have persisted over time, such that disadvantaged groups (who are at greater risk of alcohol harms) are less likely to know the guidelines. This suggests that, to date, activity to raise public awareness of the guidelines has not benefited those at highest risk.
Additional interventions targeted at or tailored for disadvantaged groups may be required to address this disparity.
2020 study on same subject
In January 2016, the UK announced and began implementing revised guidelines for low-risk alcohol use of 14 units (112 g) per week for men and women.
This was a reduction from the previous guidelines for men of 3–4 units (24–32 g) per day. But there was no large-scale promotion of the revised guidelines beyond the initial media announcement.
Announcing new UK low-risk alcohol use guidelines did not lead to a substantial or sustained reduction in alcohol use or a downturn in the long-term trend in alcohol consumption, but there was evidence of a temporary reduction in alcohol consumption.