How can we help drinkers make healthier choices?
by Guest Author on 17 Jan 2019
Many of us enjoy raising a glass when we celebrate, socialise or relax after work. But do you know, or even think, about what’s inside? According to Senior Research Associate Dr Anna Blackwell, probably not. Now that alcohol misuse is the biggest risk factor for ill health, disability and early death for 15 to 49-year-olds in England, Anna tells us why this needs to change.
There are carefully crafted cues all around you that influence your behaviour. Many of these come from industry, like the two-for-one deals or pretty bottles that make you more likely to choose one drink over another. Or the nice sofas and cosy atmosphere that might encourage you to stay longer in a bar then you’d planned.
Our group at the Tobacco and Alcohol Research Group (TARG), part of Bristol’s School of Psychological Science and the MRC Integrative Epidemiology Unit (MRC IEU), think we might be able to use similar methods to encourage people to make healthier choices. We call these ‘choice architecture’ or ‘nudge’ interventions. We spent 18 months developing an evidence base for alcohol labels, glasses and beer mats that could impact drinking.
Uncovering the knowledge gap
We surveyed 1,500 drinkers and asked them about their drinking habits, knowledge about harms related to alcohol use, and whether they could quantify the number of units (the alcohol content) in different drinks.
We discovered a vast knowledge gap between what people perceive to be the health risks associated with alcohol, and the reality. Respondents were aware of the risks of drink driving, drinking in pregnancy, and the link between heavy drinking and liver disease. But they were much less aware of the risk of cancers and heart disease.
We also found that people weren’t good at estimating how much they were drinking in units. This makes sense – it can be hard to judge. Wine glasses don’t come with units on. And even if we know we drank three pints of cider one evening, what does that really mean?
As well as finding it difficult to estimate how much they were drinking, most people didn’t know how this compared to the recommended guidelines. When we asked people to tell us the weekly drinking limit in units for men and women, only 11% got it right for both. Few people believed that drinking less would be beneficial for their health, and heavier drinkers were less confident they could change.
Innovative information delivery
As well as finding out what information should be on alcohol labels, we considered other ways messages could be delivered to drinkers in their environment and asked groups of drinkers for their feedback. We designed beer mats for pubs, which put alcohol content in the context of guideline amounts, and developed ideas for an innovative smart-glass that tells you how many units or calories are inside when you pour a drink (see video).
Alcohol is currently exempt from the labelling standards expected for food and soft drinks, which must have information about their ingredients and nutritional value, covering any drinks that have more than 1.2% alcohol by volume.
This means you have more information about the milk in your fridge than you do about a bottle of wine, even though the wine has much larger health ramifications and lacks nutritional value. Alcohol is also the second-highest energy-dense foodstuff, second only to fat.
We think that our beermats displaying calories could help. They give a sense of how much you’re drinking across many drinks. People are often shocked to discover that one night of binge drinking can be an entire days’ worth of our recommended calorie intake.
The big picture
I don’t think it’s about scaring people, judging them or telling them what to do. It’s about providing information that isn’t currently available and this should be done as part of a broader approach to reducing alcohol-related harm. Labelling is unlikely to immediately lead to behaviour change. But labelling can, and should, improve public knowledge, which is an essential first step to getting people thinking about alcohol in a different way.
I’m now working on a project called ‘Behaviour Change by Design’, with Bristol and Cambridge universities. We’re taking forward a number of these nudge interventions to help build up a further evidence base. I hope these will help drinkers make more informed choices in the future.
This work was funded by an MRC Public Health Intervention Development grant (reference: MR/N027450/1) and an Alcohol Research UK grant (SG 15/16 222). The Tobacco and Alcohol Research Group are part of the MRC Integrative Epidemiology Unit at the University of Bristol (MC_UU_12013/6).