Title: The effectiveness of promotional campaigns associated with revised UK drinking guidelines: A prospective evaluation
Funder: Department of Health and Social Care

Abstract: This study aims to evaluate the impact of promoting revised UK lower risk drinking guidelines (DG) on alcohol consumption behaviour. The UK Government’s 2012 Alcohol Strategy emphasised supporting drinkers to make healthier choices. To help achieve this goal, a review of the DG began in 2013 and is on-going. A likely realistic date for publishing new DG is March/April 2016 and Department of Health have stated that revisions to the DG will be made. Despite their national and international prominence, evidence reviews have highlighted a lack of rigorous evaluations of the impact promoting DG has on alcohol-related behaviour or factors theorised to influence behaviour (e.g. motivations). Evaluation opportunities are rare as DG are revised infrequently and, between revisions, promotional activity is typically low-level and insufficiently predictable to permit prospective data collection. The current UK review provides a valuable opportunity as large-scale promotion of revised DG can be anticipated following their publication. A prospective evaluation will be undertaken to estimate the impact of promoting revised DG on alcohol consumption behaviour among adults living in households in England. It will further seek to evidence a clear causal chain for observed effects by documenting news coverage of the revised guidelines, individual-level exposure to that the guidelines, impacts on capability, opportunity and motivation to change behaviour and effects on behaviour itself. Data on individual-level outcome measures will come from the Alcohol Toolkit Study (ATS). The NIHR-funded ATS collects monthly repeat cross-sectional data from nationally-representative samples of approximately 1,800 adults living in private households in England. It began in March 2014 and the analysis will use data up to October 2017, thus covering 24 months pre-intervention and 19 months post intervention. To facilitate secondary analyses aiming to validate findings and strengthen conclusions, new questions will be added to the ATS for 24 consecutive months (Nov 2015-Oct 2017). These will provide additional alcohol consumption measures, data on exposure to DG and measures of capability, opportunity and motivation to change behaviour. The primary analysis will use segmented regression within an interrupted time series design. It will test whether the level or trend of alcohol consumption behaviour (measured using AUDIT-C score) changes post-publication of revised guidelines. Secondary analyses will repeat these analyses using alternative outcome measures and also apply different analytical approaches (e.g. difference-in-difference analysis). Effects will be estimated for the population as a whole and for subgroups defined by age, gender and socioeconomic status. Mechanisms of effect will be examined using pathway analyses. These will test theorised relationships between capability, opportunity and motivation to change behaviour and behaviour itself. The promotion of DG rather than their publication is the active component of the intervention. As no substantial promotional activity is planned, the public will be exposed to the revised guidelines primarily through news media. The project will review news coverage of the revised guidelines to identify the scale and content of this coverage in England before and after the revised guidelines are announced.

Lay abstract: Alcohol is a major public health problem. In the UK, there were 8,416 deaths and over a million hospital admissions due to alcohol in 2013. Treating alcohol-related problems costs the NHS approximately £3.5 billion a year. Internationally, a common approach to reducing alcohol consumption is to publish low risk drinking guidelines (DG). These aim to tell the public about the risks of drinking above a particular amount of alcohol and encourage healthier drinking behaviours. DG are promoted in various ways including TV advertising campaigns, putting information on bottle labels and by doctors discussing drinking with their patients. Despite their widespread use, little is known about whether promoting DG affects people’s behaviour or how they think about alcohol. Research opportunities are rare as DG are not updated very often and the last UK revisions occurred in 1995. However, in 2012, the UK Government’s Alcohol Strategy announced that the country’s DG would be reviewed. That review is on-going and new DG may be published in early 2016. We propose to evaluate what impact promoting the new DG has on the alcohol consumption of adults living in England. We will also examine whether there are any impacts on the way people think about alcohol (e.g. their knowledge of the risks of heavy drinking or how motivated they feel to drink less). The way people think about alcohol is important as changing this may be a first step to changing behaviour. Information on the impacts of promoting revised DG will come from survey data collected each month between March 2014 and October 2017. We will examine whether there are changes over time in how much people drink or in the way they think about alcohol. We will also collect data on how changes to the guidelines are reported by news outlets to help us to understand any changes over time in the survey data. A discussion group of adult drinkers from the general public has been established by the UK Centre for Tobacco and Alcohol Studies. This group will be asked to contribute to the project by, for example, advising on survey questions and suggesting additional areas for research based on the guidelines that are published and the promotional activity that occurs. The discussion group will also be asked to contribute to the interpretation of findings and identifying the key messages which should be communicated from the project. The results of the study will help governments when making decisions about which alcohol policies are most effective in improving public health. People running campaigns promoting public health guidance will also benefit by learning about the effects of different types of guidance. The results of the study will be communicated to a wide range of people by publishing papers in scientific journals and presenting to national and international conferences attended by different groups who may be interested (including the general public). We will make particular efforts to ensure people who promote public health guidance hear about the project so they can use the findings when designing promotional material. Finally, our research team has a strong track record in attracting news coverage of our work which helps the general public to hear about it. We will work with Sheffield’s media team to promote our findings to journalists.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;8.3 POLICY, ETHICS AND RESEARCH GOVERNANCE
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL;STROKE