Title: Evaluating and responding to the public health impact of no and low alcohol drinks: A multi-method study of a complex intervention in a complex system
Funder: Department of Health and Social Care

Abstract: This project investigates whether non-alcoholic or low-alcohol drinks can improve people’s health. These drinks are beers, ciders, wines, spirits that are alcohol-free or contain a little alcohol. We call them no/lo drinks. _x000D_ _x000D_ No/lo drinks are increasingly popular, but whether they improve public health depends on many factors, such as: Who drinks them? Do people drink them instead of normal alcohol? Do they help or harm people in other ways? For example, adverting no/lo drinks could also advertise normal alcoholic drinks made by the same company. This might harm people by encouraging them to drink more alcohol. Adverts might also encourage children to drink earlier or make it harder for people with alcohol problems to stop drinking. _x000D_ _x000D_ Many organisations are trying to make it easier to buy no/lo drinks. For example: Alcohol companies are making and advertising new drinks. The government charges less tax on no/lo drinks. Some public health charities encourage people to try no/lo drinks if they want to reduce drinking. Each of these organisations also influences how the other organisations behave. We want to know more about what these organisations are doing to make no/lo drinks easier to buy. We also want to know how that influences health and what we could do in future to make sure that no/lo drinks improve health._x000D_ _x000D_ The project is split into four Work Packages (WP). _x000D_ _x000D_ WP1 will describe what alcohol companies, the UK government and other organisations do to make no/lo drinks easier to buy. It will investigate different sources of information between 2011 and 2025. These include company documents, adverts and interviews with people such as civil servants and campaigners. It will also investigate how alcohol businesses use no/lo drinks to influence Government policy._x000D_ _x000D_ WP2 will investigate if making no/lo drinks easier to buy causes people to buy and drink less alcohol. It will use market research and a survey. These will show who buys no/lo drinks, how much they pay for them, and if people buy less alcohol if they buy no/lo drinks. It will also investigate how this has changed between 2016 and 2025. _x000D_ _x000D_ WP3 will investigate how no/lo drinks might change how people drink and help or harm them in other ways. It will ask different groups about their experiences with no/lo drinks. These groups are young people, parents, pregnant women, people with alcohol problems and people who want to drink less. It will also use a survey to investigate why people drink no/lo drinks and if no/lo drinks help them to drink less._x000D_ _x000D_ WP4 will investigate if making no/lo drinks more common improves people’s health and closes the gap in health between richer and poorer people. It will use a computer model that estimates how many people die or go to hospital due to alcohol each year. This model will also test how different ways of promoting no/lo drinks influence people’s health. _x000D_ _x000D_ Our team has worked together for over ten years to research alcohol and health. Civil servants, public health charities and the public helped to design this project. The public will also help us to understand and share our results. This includes people with experience of alcohol problems. We will share our results with the media, health charities, governments, and international experts.

Lay abstract: AIM: This project aims to characterise, monitor and evaluate the public health impact of efforts to increase the availability and consumption of no- and low-alcohol (no/lo) drinks among adult alcohol consumers in Great Britain from 2011 to 2025. _x000D_ _x000D_ BACKGROUND: No/lo drinks are beers, ciders, wines and spirits containing less than 1.2% alcohol by volume. Sales of these drinks are increasing rapidly and this could have a transformative impact on public health if it means people consume fewer standard alcoholic drinks. However, there are many uncertainties and risks. People may increase their drinking by adding add no/lo drinks to their existing alcohol consumption, alcohol producers may use no/lo products to indirectly promote alcohol consumption and industry actors may use no/lo drinks to gain influence over wider alcohol policy by presenting themselves as effective contributors to improving public health._x000D_ _x000D_ RESEARCH DESIGN: The project will evaluate efforts to increase the availability and consumption of no/lo drinks as an ongoing complex intervention within a complex alcohol consumption system. It will use logic models, observational and qualitative designs, natural experiment evaluation methods and mathematical modelling to understand the contribution made by the intervention to changes in processes and outcomes across the alcohol consumption system._x000D_ _x000D_ METHODS: The project has four work packages (WPs):_x000D_ _x000D_ WP1 will characterise the intervention and its components using a wide range of data sources. It will: (i) co-produce an intervention theory of change via stakeholder workshops; (ii) establish a timeline of intervention activity by government, industry and others that captures the evolving nature of the intervention and its responses to feedback from the wider system; (iii) characterise the no/lo-related market and corporate political strategies of industry actors; (iv) conduct case studies of no/lo brand and product marketing and (v) develop a taxonomy of no/lo product types. _x000D_ _x000D_ WP2 will evaluate the impact of the intervention and its components on alcohol consumption. It will use market research datasets and survey data to: (i) describe and monitor trends in no/lo alcohol availability, sales and purchasing; (ii) test hypotheses regarding the impact of the intervention and its components on alcohol sales and purchasing; (iii) assess whether increased no/lo consumption reduces standard alcohol consumption._x000D_ _x000D_ WP3 will use cross-sectional survey data to examine the role of no/lo drinks in individuals’ attempts to reduce alcohol consumption. It will also use qualitative focus groups to explore how people embed no/lo drinks in everyday practices in ways that support positive or negative impacts on public health._x000D_ _x000D_ WP4 will adapt an established policy analysis tool to: (i) model the health, health inequality and health economic impact of the intervention and (ii) appraise the potential public health impact of policy options prioritised by stakeholders. _x000D_ _x000D_ IMPACT AND DISSEMINATION: The research is designed to deliver actionable evidence for stakeholders within government, other public bodies, third sector organisations and the public. Central to its dissemination approach is working closely with a stakeholder advisory group throughout the project to immerse members in our work, share emerging findings, discuss the evolving intervention context and respond flexibly to changing evidence needs.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL;STROKE