A randomized controlled trial of the effectiveness of combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction communications

The prevalence of mandated and voluntary health information on alcohol products in Australia

OBJECTIVE

Regulations to restrict alcohol promotion and requirements for mandatory display of information about health risks associated with alcohol use have been minimal and hard-won in Australia. This study (i) outlines an approach to monitoring alcohol industry use of health messages on alcohol products and (ii) reports prevalence and nature of government-mandated health-related information and voluntary health messages on alcohol products.

METHODS

Images of 5,923 alcohol products sold in four large alcohol stores in Sydney were captured. Data were collected in-store and via web-scraping. Label content was extracted from the images.

RESULTS

There was high compliance (97%-99%) with government-mandated requirements other than the pregnancy warning label (63%). Presence of voluntary health-related messages was common (65%), but typically present in the form of DrinkWise (an industry-led social aspects/public relations organisation) statements that are unlikely to be effective.

CONCLUSIONS

This study provides a unique and systematic approach to examining alcohol industry compliance with government-mandated on-product information requirements and voluntary inclusion of other health-related messages.

IMPLICATIONS FOR PUBLIC HEALTH

The results demonstrate the need for ongoing monitoring to enforce alcohol industry compliance with Australia's existing and future labelling regulations and to assess the industry's voluntary use of other forms of health messaging.

Suboptimal uptake and placement of a mandatory alcohol pregnancy warning label in Australia

BACKGROUND

Mandatory pregnancy warning labels are an important public health measure to signal the harms of drinking alcohol during pregnancy. Ensuring these labels are salient is critical to enhancing their effectiveness. On 31 July 2020, Australia mandated that alcoholic beverages labelled from 1 August 2023 display a pregnancy warning label. This study assessed uptake and placement of this warning on alcohol containers after the policy start date.

METHODS

Between August and November 2023, data collectors obtained images of 4026 unique alcoholic beverages available for sale across four major Australian alcohol retailers in Sydney (three physical stores and one online store). Product images were investigated to assess overall uptake of the mandatory pregnancy warning label and its placement on products (i.e., front, side, back, top, or bottom). Analyses were conducted overall and stratified across six alcohol product categories.

RESULTS

Two-thirds (63 %) of products displayed the mandatory pregnancy warning label. Uptake was lowest for spirits (50 %), followed by wine (65 %), cider (79 %), premix drinks (79 %), beer (83 %), and other alcoholic beverages (e.g., sake and soju) (91 %). The mandatory pregnancy warning label was most commonly located on the back (88 %) and less commonly on the side (8 %), bottom (3 %), top (1 %), or front (0.3 %).

CONCLUSION

To increase uptake of the mandatory pregnancy warning label, policymakers should consider mandating that all alcoholic beverages available for sale, not just products labelled from 1 August 2023, display the warning. Existing requirements could be revised to ensure that the label is more prominently displayed.

The differential effects of parent-targeted alcohol harm-reduction campaigns with varying executional styles

INTRODUCTION

Parental provision of alcohol to children is associated with a range of negative outcomes. Public health campaigns discouraging this practice are required as part of a comprehensive approach to reduce alcohol-related harm among minors, however, limited research has examined the relative effectiveness of different messaging approaches. This study compared the effects of two campaigns with different executional styles on parents' intentions to provide alcohol to minors-one campaign used a fear-based approach and the other adopted a first-person narrative approach.

METHODS

The study used a repeated cross-sectional design. An independent samples t-test was used to compare the effects of two campaigns with alternative executional styles on parents' alcohol provision intentions. Two ordinal logistic generalised linear models were used to assess whether intentions effects differed according to parents' demographic and behavioural characteristics.

RESULTS

Both campaigns were effective at motivating parents to abstain from providing alcohol to minors. This outcome was particularly notable among female respondents and those who had never provided alcohol to their children. Older respondents and those who used less alcohol were more likely to intend to change their behaviours as a result of exposure to the fear-based campaign, while the campaign using a narrative approach was more effective with heavier drinkers.

DISCUSSION AND CONCLUSIONS

Overall strong performance of both campaigns combined with varying effectiveness by parent attributes highlights the utility of parent-focused campaigns targeting alcohol provision to minors. To best protect minors, continued investments are needed to develop suites of evidence-based campaigns that resonate with different parent subgroups.

Exploring and describing alcohol harm reduction interventions: a scoping review of literature from the past decade in the western world

CONTEXT

Regular alcohol use is a predominant risk factor for disease, injury, and social harm. While robust evidence is advocating for implementing interventions to reduce the harms of illegal substance use, less literature is dedicated to identifying and understanding interventions aiming at reducing the various harms associated with alcohol.

OBJECTIVES

This review describes how alcohol harm reduction (AHR) interventions are currently conducted and analyzes the facilitators and barriers identified by the studies on their efficacy.

METHOD

This scoping review with evidence appraisal included articles published between 2011 and 2022, addressing one or more AHR interventions for population of at least 18 years (including alcohol user who have an addiction but also alcohol user with harmful drinking), conducted in North industrialized countries (Europe, Nort America, Australia).

RESULTS

Among the 61 articles selected, we identified several forms of support (face-to-face or remote, support in residential settings, structural interventions, and interventions created upon spontaneous initiatives), and strategies of intervention were also analyzed (the ones based upon learning and skill development, the ones based upon psychological support, the ones focusing upon socio-economic conditions, strategies focusing on the coordination and adaptation of the care system, and those strategies based on peer support). The facilitators linked to fundamental characteristics of the interventions were the promotion of empowerment and autonomy of beneficiaries, setting objectives tailored to individual needs, professionals harmonizing their values, evidence-based interventions taking into account cultural contexts, and comprehensive and holistic support. Practical facilitators from the intervention process consist of increasing the number of sessions, involvement, and formation of members of staff, disposing of the necessary resources, and using technological tools.

DISCUSSION

The sheer variety of AHR interventions demonstrates that this is a fertile field in terms of intervention design and innovation. This work illustrates the importance of designing effective, adapted harm reduction interventions, prioritizing interventions that make support more accessible to more people. This also prompts us to consider the potential benefits of invoking proportionate universalism in the design of AHR interventions in order to operationalize alcohol harm reduction philosophy. accessible to more people.

Development and validation of the Perceived Effectiveness of Nutrition Messages Scale

An understanding of the extent to which target audiences consider different nutrition-related messages to be effective could assist campaign developers design more persuasive communications. Accordingly, this study sought to develop and assess the utility of the Perceived Effectiveness of Nutrition Messages Scale (PENMS). A longitudinal online survey was completed by Australian adults (n = 5,014 at Time 1 and 2,880 at Time 2). At T1, respondents saw one of two messages promoting healthy eating. They were then administered the PENMS, and asked how likely they were to engage in the behaviour specified in the message. Respondents completed the PENMS again at T2. An exploratory factor analysis was performed on PENMS scores and measures of reliability and validity obtained. Two factors were identified: 'effects perceptions' (Factor 1) and 'message perceptions' (Factor 2). Internal consistency of scores was 0.82 for Factor 1 and 0.70 for Factor 2. Test re-test reliability was 0.76 and 0.69 for Factors 1 and 2, respectively. Scores on both factors were moderately correlated with behavioural intentions. The favourable results for PENMS scores suggest the scale may be a useful tool for assessing the extent to which target audiences consider different nutrition-related messages to be effective.

Public awareness of the alcohol-cancer link in the EU and UK: a scoping review

BACKGROUND

Alcohol increases cancer risk, but less is known about public awareness of this link. This scoping review summarizes recent findings on the public awareness of alcohol as a cancer risk factor in European Union and UK.

METHODS

Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched for papers containing data on awareness of alcohol as cancer risk factor in EU or UK published between January 2017 and December 2022, and complemented with grey literature searches.

RESULTS

In total, 45 studies were included covering 18 EU countries (Austria, Belgium, Cyprus, Czechia, Denmark, Finland, France, Germany, Hungary, Ireland, Italy, Netherlands, Poland, Romania, Slovakia, Slovenia, Spain, Sweden) and UK, presenting data collected between 2009 and 2022. Studies covered general population (17 studied a nationally representative sample), women, health professionals, patients and young people. Awareness of alcohol causing cancer in general was higher and studied more often than awareness of alcohol's impact on specific cancers. Among the EU general population, awareness of the link between alcohol and breast cancer ranged between 10% and 20%, head and neck cancer 15-25%, colorectal and oesophagus cancer 15-45% and liver cancer 40%. Awareness was higher among young people and specialized health professions and lower among women (the latter specifically for the breast cancer).

CONCLUSIONS

While awareness rates varied depending on the exact question wording, many studies showed low awareness of the alcohol-cancer link, especially for specific types such as breast and colon cancer. Public should be better informed about alcohol consumption-related cancer risk.

Evaluating an alcohol harm-reduction campaign advising drinkers of the alcohol-cancer link

INTRODUCTION

Public awareness of the alcohol-cancer link is low. Provision of this information could reduce alcohol consumption and related harms. The Spread campaign is a multi-media education campaign implemented in Western Australia to inform people about the carcinogenic properties of alcohol and associated harms. The aims of the present study were to (i) examine attitudinal and behavioural outcomes of the Spread campaign and (ii) identify demographic and drinking status factors associated with enactment of harm-reduction behaviours resulting from exposure.

METHOD

A cross sectional survey of Western Australian drinkers (consumed alcohol at least a few times in the previous 12 months, n = 760) examined campaign recognition, campaign perceptions, and behaviours resulting from campaign exposure. Chi-square analyses and a generalised linear model were used to identify demographic and alcohol-related factors associated with behavioural outcomes.

RESULTS

Around two-thirds of respondents recognised the campaign (65%), and of these, 22% reported successfully reducing how often or how much they drank due to seeing the campaign. Three quarters (73%) of all respondents considered the campaign message about the alcohol-cancer link to be believable. Respondents drinking at levels above the Australian guideline were less likely to have positive perceptions of the campaign than those complying with the guideline, but were more likely to report enacting the assessed harm-reduction behaviours as a result of campaign exposure.

DISCUSSION AND CONCLUSION

The results suggest that provision of information about the alcohol-cancer link has the potential to motivate reduced alcohol consumption. Implementing such campaigns could constitute an effective alcohol harm-reduction strategy.

Trends in and factors associated with parental provision of alcohol to minors in Western Australia, 2013-2019

INTRODUCTION

Some parents provide alcohol to their underage children, despite a range of negative outcomes being associated with this practice. The present study aimed to assess factors associated with and changes in parental provision behaviours from 2013 to 2019 in Western Australia.

METHODS

Annual cross-sectional online surveys were conducted (total n = 2635). Assessed variables included parents' demographic characteristics, alcohol use, awareness of the relevant Australian alcohol guideline, attitudes to parental provision of alcohol and provision behaviours. A binary logistic generalised linear model was used to identify factors associated with parental provision of alcohol.

RESULTS

Parental provision of alcohol prevalence decreased from 40% in 2013 to 27% in 2019. The following variables were significantly associated with parental provision: permissive attitudes to provision (β = 2.82); older parental age (β = 1.28); a lack of knowledge of the relevant guideline (β = 0.78); survey year (β = 0.083); and greater alcohol use (β = 1.12). Socioeconomic position was not associated with parental provision. Female parents were more likely to report that an adult in the household provided children with alcohol (β = 1.3) DISCUSSION AND CONCLUSIONS: The findings suggest that (i) although still commonplace, parental provision of alcohol to minors in Western Australia has declined over time; and (ii) the effectiveness of campaigns aiming to reduce this behaviour may be enhanced by targeting households with parents who are older and heavier drinkers and by including content that challenges permissive views on alcohol provision to minors.

Effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms and low-risk drinking guidelines, and in lowering alcohol consumption

AIMS

To evaluate the effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms (LTH) and low-risk drinking guidelines (LRDG), as well as in lowering alcohol consumption.

DESIGN

An 8-month longitudinal survey from February to October 2019, with three waves of on-line data collection (T0 before the campaign, T1 just after it ended and T2 6 months after it ended).

SETTING

France.

PARTICIPANTS

A total of 2538 adult drinkers (aged 18-75 years).

MEASUREMENTS

The main outcomes' variables were LTH knowledge (cancer, hypertension, brain haemorrhage), LRDG knowledge (two guidelines: 'maximum of two drinks a day' and 'minimum of 2 days without alcohol per week'), intention to reduce alcohol consumption and self-declared consumption with respect to the French LRDG. At T1, exposure to the campaign was measured using self-reported campaign recall.

FINDINGS

In T1, we observed significant positive interactions between exposure group based on campaign recall and survey waves on knowledge of (i) the 'maximum two drinks a day' guideline [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.08-1.62, P = 0.008], (ii) brain haemorrhage (aOR = 1.80, 95% CI = 1.44-2.25, P < 0.001) and (iii) hypertension (aOR = 1.41, 95% CI = 1.09-1.81, P = 0.008) risks. Campaign exposure was also associated with a significant decrease in at-risk drinking in women (aOR = 0.67, 95% CI = 0.50-0.88, P = 0.004). No significant interaction was observed at T1 for the knowledge of the 'minimum of 2 days without alcohol a week' guideline, or of cancer risk. At T2, no significant interaction was observed for the main outcomes' variables.

CONCLUSIONS

There appears to be an association between exposure to a 2019 French mass-media campaign to raise knowledge of long-term alcohol-related harms and low-risk drinking guidelines and reduce alcohol consumption and (i) improved knowledge of the 'maximum two drinks per day guideline', (ii) knowledge of the risks of hypertension and brain haemorrhage and (iii) a reduction in the proportion of people exceeding low-risk drinking guidelines (in the general population only). These associations were only observed over the short term and, in some cases, only for certain segments of the population.

Gamblers' perceptions of responsibility for gambling harm: a critical qualitative inquiry

BACKGROUND

Gambling has traditionally been conceptualised as an issue of addiction and personal responsibility. While there are now clear public health models that recognise that gambling harm is caused by a range of socio-cultural, environmental, commercial and political determinants, government and industry messages about gambling are still largely personal responsibility focused. Given the well-recognised issues associated with personal responsibility paradigms, this study sought to understand how gamblers themselves conceptualised responsibility for gambling harm.

METHODS

A qualitatively led online panel survey was conducted with 363 adult gamblers in New South Wales and Victoria, Australia. Participants were asked to respond to what they thought were the causes of gambling harm, and what could be done to prevent harm. A reflexive thematic analysis was conducted.

RESULTS

Six common tropes were constructed from gamblers' responses: (1) Gambling in moderation; (2) Personal responsibility for rational behaviour; (3) Character flaws; (4) Personal responsibility to seek help; (5) More education is needed; and (6) Governments are responsible for action - but motivation and efficacy are questioned. Gamblers primarily understood gambling harm as being a matter of personal responsibility, and government responsibility was generally seen as limited to providing information to facilitate informed gambling choices.

CONCLUSIONS

This study demonstrates that gamblers' perceptions of gambling harm are similar to the personal responsibility framings and tropes present in industry and government messaging strategies. Refocusing public communication strategies away from 'responsible gambling' messaging, and towards evidence-based approaches, will be an important part of addressing the harms associated with gambling.

Understanding and Overcoming Barriers to Drink Counting

Objectives: Drink counting has been found to be an effective protective behavioral strategy (PBS) to reduce alcohol consumption. However, little is known about attitudes to this strategy and barriers and facilitators to its use. The aim of this study was to explicate these factors and draw comparisons with less efficacious PBSs. Method: In Stage 1, 1,703 Australian drinkers were surveyed about their perceptions of five PBSs ("Count the number of drinks you have," "Drink slowly rather than gulping or sculling," "Refuse an alcoholic drink you are offered because you don't really want it," "Avoid trying to 'keep up' or 'outdrink' others," and "Decide not to exceed a certain number of drinks"). Respondents reported perceived believability, relevance, ease of use, effectiveness, barriers, and facilitators. In Stage 2, 10 focus groups were conducted with drinkers to identify potential methods of effectively promoting drink counting. Results: Overall, drink counting was rated less favorably than the less-efficacious PBSs, indicating a need to inform drinkers of the importance and feasibility of this strategy to encourage its use. The main identified barriers were a lack of awareness of the long-term harms associated with alcohol use, social factors (e.g., peer pressure), and difficulty counting when intoxicated. Participants suggested improving drinkers' understanding of alcohol-related harms and developing mechanisms to assist with counting. Conclusion: To encourage drink counting, information campaigns are needed to educate the community about the long-term risks of alcohol use. Evidenced-based mechanisms to facilitate drink counting may be welcomed by drinkers.