Effects on alcohol consumption of announcing and implementing revised UK low-risk drinking guidelines: findings from an interrupted time series analysis
Original research
Abstract
Background
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.
There was no large-scale promotion of the revised guidelines beyond the initial media announcement.
This paper evaluates the effect of announcing the revised guidelines on alcohol consumption among adults in England.
Methods
Data come from a monthly repeat cross-sectional survey of approximately 1700 adults living in private households in England collected between March 2014 and October 2017. The primary outcomes are change in level and time trend of participants’ Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) scores.
Results
In December 2015, the modelled average AUDIT-C score was 2.719 out of 12 and was decreasing by 0.003 each month.
After January 2016, AUDIT-C scores increased immediately but non-significantly to 2.720 and the trend changed significantly such that scores subsequently increased by 0.005 each month, equivalent to 0.5% of the population increasing their AUDIT-C score by 1 point each month.
Secondary analyses indicated the change in trend began 7 months before the guideline announcement and that AUDIT-C scores reduced significantly but temporarily for 4 months after the announcement.
Conclusions
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.
Discussion and meaning
These findings suggest that announcing and implementing revised UK low-risk alcohol use guidelines in January 2016 did not lead to substantial or sustained changes in alcohol consumption. There was, however, some evidence of a small short-term reduction in consumption lasting 4 months.
The results also suggest there were no substantial or sustained changes in any other key measures, such as alcohol users’ awareness of, knowledge of, or exposure to guidelines or their preparedness to change their alcohol use behaviour.
Although the primary and secondary analyses did detect some significant changes in outcome measures, notably in alcohol-related hospital admissions, these were not confirmed by alternative outcome measures and were often not present after controlling for confounding or in robustness checks.
The results may not generalise to scenarios where health authorities actively promote low-risk alcohol use guidelines after announcing them or do not link the guidelines to cancer risks. However, sustained promotional activity is uncommon in most countries, while using health risks to communicate guidelines is commonplace. Therefore, the researchers are likely to be evaluating a typical intervention scenario.
Although the lack of impact from the new guidelines may be attributed to their limited promotion, it also aligns with a wider literature on the ineffectiveness of providing alcohol-related health information. Studies of mass media campaigns, mandatory health warning labels for alcoholic products and school-based education programmes all suggest that such interventions have little impact on alcohol consumption.
This contrasts with evidence from other areas of public health, including smoking, nutrition and physical activity, where some information-based approaches, particularly mass media campaigns and health warnings, have been effective in certain contexts.
The research literature offers three broad explanations for this.
First, that alcohol-related health promotion is undermined in an environment where pro-alcohol marketing is highly prevalent. Second, that alcohol-related health promotion is often poorly designed. For example, labels may be difficult to read or easy to ignore and messages may have little regard for alcohol users’ understanding of key concepts such as units or standard alcoholic drinks. Third, that alcohol users reject alcohol-related health promotion because it aligns poorly with their alcohol use practices and motivations and gives little regard to positive or pleasurable aspects of alcohol use.
These explanations suggest that, as was the case with information-based approaches to tobacco control, promoting low-risk alcohol use guidelines may only be an effective intervention within wider strategies that introduce effective alcohol control measures.
Nonetheless, materials to promote low-risk alcohol use guidelines can be improved by increasing their visibility and making it easier for alcohol users to understand, assimilate and use key concepts.
