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Groefsema MM, van Hooijdonk KJM, Voogt CV, Hendriks H, Vink JM. Consumption of alcohol-free and alcoholic beverages among Dutch university students: Substitution or addition? Drug Alcohol Rev 2024; 43:1545-1558. [PMID: 39056212 DOI: 10.1111/dar.13905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/24/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Alcohol-free drinks are suggested as healthy alternatives for alcohol consumption. To achieve benefits, alcohol-free beverages must be consumed as a substitute for alcoholic beverages, not in addition. This study examined in a student sample (i) the frequency/quantity of alcohol(-free) consumption; (ii) the relationship between alcohol-free and alcohol consumption; (iii) alcohol-free drinks as substitution or in addition to alcoholic drinks; and (iv) possible gender differences. METHODS Survey data regarding alcohol(-free) consumption (May-June 2022) of Dutch university students (N = 4.318, females 70.2%; males 28.5%, average age 22.6 years [SD = 2.4]). RESULTS (i) A total of 42.8% of the students indicated they had never consumed alcohol-free versus 10.1% who never consumed alcoholic beverages; (ii) the group who recently consumed alcohol-free also most often recently consumed alcoholic beverages (42.7%). The group that had never consumed alcohol-free drank on average more alcoholic beverages (M = 3.98 on a drinking day) compared to past and recent alcohol-free drinkers (respectively, M = 3.44 and M = 3.59). (iii) Most students (54.9%) reported drinking alcohol-free beverages in addition to alcohol, 17.4% indicated using it as a substitution. Students who consumed alcohol-free as 'substitution' were older, more often living alone or with a partner, less often living with parents and more often involved in a steady relationship compared to students who consumed in 'addition'. (iv) No prominent gender differences were found. DISCUSSION AND CONCLUSIONS The majority of students remained consuming the same number of alcoholic beverages since they started consuming alcohol-free beverages, pointing to an addition effect. A small group did use alcohol-free beverages as a substitute for their alcohol consumption.
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Affiliation(s)
- Martine M Groefsema
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | | | - Carmen V Voogt
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Hanneke Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Jacqueline M Vink
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Perman-Howe PR, Holmes J, Brown J, Kersbergen I. Characteristics of consumers of alcohol-free and low-alcohol drinks in Great Britain: A cross-sectional study. Drug Alcohol Rev 2024. [PMID: 39169566 DOI: 10.1111/dar.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/30/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION The impact of alcohol-free and low-alcohol (no/lo) drinks on public health and health inequalities depends on who consumes them and how they are consumed. This study aimed to estimate: (i) the proportions of adults in Great Britain who consume no/lo drinks at different frequencies and in different settings; and (ii) the associations between no/lo drink consumption and individual characteristics. METHOD Pooled data (N = 7691) from four waves of a repeat cross-sectional survey on alcohol use completed in 2022-2023 by adults (16+) resident in Great Britain were analysed using descriptive statistics and logistic regression models. RESULTS In all, 31.3% of adults reported ever consuming no/lo drinks and 9.8% reported drinking them weekly. Ever consumption of no/lo drinks was associated with: being an increasing risk drinker of alcohol relative to not drinking (ORadj: 3.96, 95% CI 3.27-4.80), being aged 16-24 compared with 65+ (ORadj:1.29, 95% CI 1.07-1.57), having previously smoked compared with having never smoked (ORadj:1.19, 95% CI 1.05-1.34) and living in a rural rather than urban area (ORadj:1.14, 95% CI 1.00-1.29). It was less likely among those in lower social grades or with lower educational qualifications; those living in Yorkshire and the Humber, and Scotland, compared with the South-East of England; and those using nicotine products. DISCUSSION AND CONCLUSIONS A third of adults in Great Britain have consumed no/lo drinks and approximately one in 10 do so weekly. Consumption is more common among riskier drinkers of alcohol and among more advantaged social groups, which may contribute to the sustaining or widening of health inequalities.
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Affiliation(s)
- Parvati R Perman-Howe
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
| | | | - Inge Kersbergen
- School of Medicine and Population Health, The University of Sheffield, Sheffield, UK
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Booth L, Keric D, Bowden J, Bartram A, Sengupta A, Pettigrew S. Zero alcohol products and adolescents: A tool for harm reduction or a trojan horse? Appetite 2024:107582. [PMID: 38942148 DOI: 10.1016/j.appet.2024.107582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 06/05/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024]
Abstract
INTRODUCTION Zero alcohol products (ZAPs) could reduce alcohol-related harms by acting as a substitute for alcoholic beverages. However, concerns have been raised regarding the potential for these products to expose young people to additional alcohol-related stimuli, further normalising alcohol use and acting as a gateway to underage alcohol consumption. Scarce research has examined whether these concerns are warranted. METHOD This project comprised two parts involving Australian adolescents aged 15-17 years. Part 1 was a series of 5 online focus groups (n = 44) that provided initial insights into perceptions of and experiences with ZAPs. Part 2 was a national online survey (n = 679) that assessed the generalisability of the focus group findings and identified factors associated with ZAP-related attitudinal and behavioural outcomes. RESULTS ZAPs were found to be salient and attractive to Australian adolescents. Over a third of surveyed adolescents (37%) had tried ZAPs. The focus group participants and survey respondents generally perceived ZAPs in a positive light, seeing them as a useful alternative to alcohol for both adolescents and adults who want to circumvent social expectations to use alcohol. Some of the study participants acknowledged the potential for ZAPs to serve as a gateway to alcohol use and recommended reducing their visibility and accessibility. CONCLUSION ZAPs are likely exposing minors to additional alcohol-related stimuli potentially increasing their risk of underage alcohol consumption. Regulatory responses to ZAPS need to protect young people from the potential adverse consequences of ZAPs exposure while enabling the products to be used by adults as an alcohol substitute.
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Affiliation(s)
- Leon Booth
- The George Institute for Global Health, University of New South Wales, Level 18, International Tower 3, 300 Barangaroo Avenue, NSW, 2000, Australia.
| | - Danica Keric
- Cancer Council Western Australia, Level 1/420 Bagot Road, Subiaco, WA, 6008, Australia.
| | - Jacqueline Bowden
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia; Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, South Australia.
| | - Ashlea Bartram
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, South Australia; Flinders University, College of Medicine and Public Health, Flinders Health and Medical Research Institute, Adelaide, South Australia.
| | - Agnivo Sengupta
- The George Institute for Global Health, University of New South Wales, Level 18, International Tower 3, 300 Barangaroo Avenue, NSW, 2000, Australia.
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Level 18, International Tower 3, 300 Barangaroo Avenue, NSW, 2000, Australia.
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Bowdring MA, McCarthy DM, Fairbairn CE, Prochaska JJ. Non-alcoholic beverage consumption among US adults who consume alcohol. Addiction 2024; 119:1080-1089. [PMID: 38403280 DOI: 10.1111/add.16452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/23/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND AND AIMS Non-alcoholic beverages (NABs) that mimic alcohol without inducing intoxication, such as non-alcoholic beers, non-alcoholic wines and spirit-free drinks, are increasing in popularity. It is unknown whether NABs help to mitigate or stimulate alcohol use. The present study aimed to describe NAB consumption practices among US adults consuming alcohol, characterize who is likely to consume NABs and examine whether NAB use influences desire for and perceived consumption of alcohol. DESIGN AND PARTICIPANTS The survey study used data collected June-July 2023 from an on-line convenience sample. The first survey (n = 1906) assessed frequency of NAB consumption among US adults who consume alcohol. A second more detailed survey on use patterns was conducted with 466 respondents who reported past-year NAB consumption, of whom 153 (32.83%) screened positive on the CAGE questionnaire for alcohol use disorder (AUD). SETTING This study took place in the United States. MEASUREMENTS NAB consumption measures included type of NAB consumed, frequency, quantity, first consumption age, consumption reasons, consumption contexts and perceived effect on desire for and consumption of alcohol. Alcohol use measures included frequency, quantity and first consumption age. FINDINGS Past-year NAB use was endorsed by 28.44% of respondents (61.70% ever used). Non-alcoholic liquor/'mocktails' were the most common NAB type consumed (83.69%). Compared with respondents without AUD, those who screened positive for AUD were significantly more likely to consume NABs in an effort to decrease or abstain from drinking alcohol [adjusted odds ratio (AOR) = 3.54, 95% confidence interval (CI) = 2.24-5.58] and 67.97% endorsed less alcohol consumption (3.23% endorsed more) due to their NAB use. NAB consumption frequency and quantity were significantly positively predicted by alcohol consumption frequency (AOR = 1.46, 95% CI = 1.17-1.83) and quantity (β = 0.25, 95% CI = 0.15-0.35), respectively. CONCLUSION Adults who consume alcohol and screen positive for alcohol use disorder report drinking non-alcoholic beverages as a harm reduction strategy.
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Affiliation(s)
- Molly A Bowdring
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, USA
| | - Denis M McCarthy
- Department of Psychology, University of Missouri, 210 McAlester Hall, Columbia, MI, USA
| | - Catharine E Fairbairn
- Department of Psychology, University of Illinois at Urbana-Champaign, 603 East Daniel Street, Champaign, IL, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
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Harrison NJ, Norris CA, Bartram A, Murphy M, Pettigrew S, Dell AO, Room R, Miller C, Olver I, Bowshall M, Wright CJC, Jenkinson R, Bowden JA. "They start on the zero-alcohol and they wanna try the real thing": Parents' views on zero-alcohol beverages and their use by adolescents. Aust N Z J Public Health 2024; 48:100119. [PMID: 38438293 DOI: 10.1016/j.anzjph.2023.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/08/2023] [Accepted: 12/10/2023] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents' earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents' views on zero-alcohol beverages and their provision to adolescents. METHODS We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data. RESULTS Parents considered zero-alcohol beverages to be 'adult beverages' that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in 'appropriate' contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported. CONCLUSIONS Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents. IMPLICATIONS FOR PUBLIC HEALTH As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses.
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Affiliation(s)
- Nathan J Harrison
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - Christina A Norris
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ashlea Bartram
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Simone Pettigrew
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ally O Dell
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, School of Psychology & Public Health, La Trobe University, Bundoora, Victoria, Australia; Centre for Social Research on Alcohol and Drugs, Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Caroline Miller
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia; Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ian Olver
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia; School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | | | - Cassandra J C Wright
- Centre for Alcohol Policy Research, School of Psychology & Public Health, La Trobe University, Bundoora, Victoria, Australia; Menzies School of Health Research, Darwin, Northern Territory, Australia; Burnet Institute, Melbourne, Victoria, Australia
| | - Rebecca Jenkinson
- Burnet Institute, Melbourne, Victoria, Australia; Australian Human Rights Commission, Melbourne, Victoria, Australia
| | - Jacqueline A Bowden
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia; Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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De-Loyde K, Ferrar J, Pilling MA, Hollands GJ, Clarke N, Matthews JA, Maynard OM, Wood T, Heath C, Munafò MR, Attwood AS. The impact of introducing alcohol-free beer options in bars and public houses on alcohol sales and revenue: A randomised crossover field trial. Addiction 2024; 119:1071-1079. [PMID: 38508212 DOI: 10.1111/add.16449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
AIMS The study aimed to estimate the impact of introducing a draught alcohol-free beer, thereby increasing the relative availability of these products, on alcohol sales and monetary takings in bars and pubs in England. DESIGN Randomised crossover field trial. SETTING England. PARTICIPANTS Fourteen venues that did not previously sell draught alcohol-free beer. INTERVENTION AND COMPARATOR Venues completed two intervention periods and two control periods in a randomised order over 8 weeks. Intervention periods involved replacing one draught alcoholic beer with an alcohol-free beer. Control periods operated business as usual. MEASUREMENTS The primary outcome was mean weekly volume (in litres) of draught alcoholic beer sold. The secondary outcome was mean weekly revenue [in GBP (£)] from all drinks. Analyses adjusted for randomised order, special events, season and busyness. FINDINGS The adjusted mean difference in weekly sales of draught alcoholic beer was -20 L [95% confidence interval (CI) = -41 to +0.4], equivalent to a 4% reduction (95% CI = 8% reduction to 0.1% increase) in the volume of alcoholic draught beer sold when draught alcohol-free beer was available. Excluding venues that failed at least one fidelity check resulted in an adjusted mean difference of -29 L per week (95% CI = -53 to -5), equivalent to a 5% reduction (95% CI = 8% reduction to 0.8% reduction). The adjusted mean difference in weekly revenue was +61 GBP per week (95% CI = -328 to +450), equivalent to a 1% increase (95% CI = 5% decrease to 7% increase) when draught alcohol-free beer was available. CONCLUSIONS Introducing a draught alcohol-free beer in bars and pubs in England reduced the volume of draught alcoholic beer sold by 4% to 5%, with no evidence of the intervention impacting net revenue.
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Affiliation(s)
- Katie De-Loyde
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Jennifer Ferrar
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Mark A Pilling
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | | | - Joe A Matthews
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Olivia M Maynard
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
| | - Tiffany Wood
- Communities and Public Health People Directorate, Bristol City Council, Bristol, UK
| | - Carly Heath
- Communities and Public Health People Directorate, Bristol City Council, Bristol, UK
| | - Marcus R Munafò
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
| | - Angela S Attwood
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University of Bristol, Bristol, UK
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Bartram A, Harrison NJ, Norris CA, Christopher J, Bowden JA. Zero-alcohol beverages and brand extensions: A vehicle for promoting parent alcohol brands? Aust N Z J Public Health 2024; 48:100141. [PMID: 38503145 DOI: 10.1016/j.anzjph.2024.100141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Affiliation(s)
- Ashlea Bartram
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
| | - Nathan J Harrison
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Christina A Norris
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Joanne Christopher
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Jacqueline A Bowden
- National Centre for Education and Training on Addiction, Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Bury K, Keric D, Riesenberg D, Wellard-Cole L, Pettigrew S. Falling through the cracks: How do policies for alcohol marketing apply to zero alcohol products in Australia? Drug Alcohol Rev 2024; 43:393-406. [PMID: 37839061 DOI: 10.1111/dar.13757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023]
Abstract
ISSUES There is a decline in youth drinking, but also a causal link between alcohol marketing and drinking among young people. Therefore, novel alcohol marketing strategies should be scrutinised, particularly where children are exposed. This includes marketing for zero-alcohol products (ZAP) (containing 0.00% to 1.15% alcohol by volume), which has expanded considerably in recent times. This review examines how the current industry-managed regulatory approach to alcohol marketing applies to ZAPs in Western Australia. APPROACH The marketing mix (four Ps of marketing: product, promotion, place, price) was used as a framework to examine federal and state government policies and industry managed codes. Policies were included if they applied to marketing of alcohol products, for example, product labelling, promotion and advertising across various media, the place of purchase and pricing measures (taxation). KEY FINDINGS ZAPs were inconsistently defined, meaning that products between 0.05% and 1.15% alcohol by volume were covered under some but not all alcohol policy measures, and application to products under 0.5% alcohol by volume was limited. IMPLICATIONS Government policy should more clearly define alcohol marketing and whether ZAPs and other alcohol brand extensions should be treated in the same way as alcoholic products. CONCLUSION In Western Australia, the ways in which alcohol policy measures apply to ZAPs are limited and close attention must be paid to how ZAPs may provide additional marketing opportunities for the alcohol industry.
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Affiliation(s)
- Keira Bury
- Cancer Council Western Australia, Perth, Australia
| | - Danica Keric
- Cancer Council Western Australia, Perth, Australia
| | | | | | - Simone Pettigrew
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
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Davey C. 'It's kind of like weaning. I had to wean myself off of wine': Navigating no- and low-alcohol drinks as potential harm reduction tools and relapse triggers by women in recovery in the UK. Drug Alcohol Rev 2024; 43:156-164. [PMID: 37881105 DOI: 10.1111/dar.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/18/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Concerns have been raised that consumption of no- and low-alcohol drinks by those who are in recovery could lead to a relapse to past drinking behaviours. However, little is known regarding how individuals use these products to substitute alcohol and support their sobriety. METHODS This article draws on an ethnographic study of women's experiences of recovery within online sobriety communities in which semi-structured interviews were conducted with 25 UK-based women. The dataset was analysed and coded from a pragmatist feminist standpoint using a grounded theoretical approach to specifically address the research question: 'How do women in recovery navigate the protective and risk factors associated with no- and low-alcohol drinks through practices of consumption?' RESULTS Women in recovery navigate no- and low-alcohol drinks as potential harm-reduction tools and relapse triggers by engaging in nuanced practices of substitution. Contrasting examples include direct substitution and temporary avoidance in early recovery. DISCUSSION AND CONCLUSIONS Substitution practices are informed by the temporality of participants' recovery journeys, the social situation, and the products. Participants selectively replicate and resist their former drinking practices to balance their perceived harm-reduction benefits and relapse triggers of no- and low-alcohol drinks. Important considerations are raised for those in recovery who may want to use no- and low-alcohol drinks as a harm reduction tool, and for recovery modalities that promote them. It concludes with calls for more clarity regarding the definition and labelling of no- and low-alcohol drinks, and for a greater understanding of their use across different recovery cultures.
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Affiliation(s)
- Claire Davey
- Faculty of Arts, Humanities and Education, Canterbury Christ Church University, Canterbury, UK
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Clarke N, Blackwell AKM, Ferrar J, De-Loyde K, Pilling MA, Munafò MR, Marteau TM, Hollands GJ. Impact on alcohol selection and online purchasing of changing the proportion of available non-alcoholic versus alcoholic drinks: A randomised controlled trial. PLoS Med 2023; 20:e1004193. [PMID: 36996190 PMCID: PMC10062674 DOI: 10.1371/journal.pmed.1004193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 02/08/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Increasing the availability of non-alcoholic options is a promising population-level intervention to reduce alcohol consumption, currently unassessed in naturalistic settings. This study in an online retail context aimed to estimate the impact of increasing the proportion of non-alcoholic (relative to alcoholic) drinks, on selection and purchasing of alcohol. METHODS AND RESULTS Adults (n = 737) residing in England and Wales who regularly purchased alcohol online were recruited between March and July 2021. Participants were randomly assigned to one of 3 groups: "25% non-alcoholic/75% alcoholic"; "50% non-alcoholic/50% alcoholic"; and "75% non-alcoholic/25% alcoholic," then selected drinks in a simulated online supermarket, before purchasing them in an actual online supermarket. The primary outcome was the number of alcohol units selected (with intention to purchase); secondary outcomes included actual purchasing. A total of 607 participants (60% female, mean age = 38 years [range: 18 to 76]) completed the study and were included in the primary analysis. In the first part of a hurdle model, a greater proportion of participants in the "75% non-alcoholic" group did not select any alcohol (13.1%) compared to the "25% non-alcoholic" group (3.4%; 95% confidence interval [CI] -2.09, -0.63; p < 0.001). There was no evidence of a difference between the "75% non-alcoholic" and the "50% non-alcoholic" (7.2%) groups (95% CI 0.10, 1.34; p = 0.022) or between the "50% non-alcoholic" and the "25% non-alcoholic" groups (95% CI -1.44, 0.17; p = 0.121). In the second part of a hurdle model in participants (559/607) selecting any drinks containing alcohol, the "75% non-alcoholic" group selected fewer alcohol units compared to the "50% non-alcoholic" (95% CI -0.44, -0.14; p < 0.001) and "25% non-alcoholic" (95% CI -0.54, -0.24; p < 0.001) groups, with no evidence of a difference between the "50% non-alcoholic" and "25% non-alcoholic" groups (95% CI -0.24, 0.05; p = 0.178). Overall, across all participants, 17.46 units (95% CI 15.24, 19.68) were selected in the "75% non-alcoholic" group; 25.51 units (95% CI 22.60, 28.43) in the "50% non-alcoholic" group; and 29.40 units (95% CI 26.39, 32.42) in the "25% non-alcoholic" group. This corresponds to 8.1 fewer units (a 32% reduction) in the "75% non-alcoholic" compared to the "50% non-alcoholic" group, and 11.9 fewer alcohol units (41% reduction) compared to the "25% non-alcoholic" group; 3.9 fewer units (13% reduction) were selected in the "50% non-alcoholic" group than in the "25% non-alcoholic" group. For all other outcomes, alcohol selection and purchasing were consistently lowest in the "75% non-alcoholic" group. Study limitations include the setting not being entirely naturalistic due to using a simulated online supermarket as well as an actual online supermarket, and that there was substantial dropout between selection and purchasing. CONCLUSIONS This study provides evidence that substantially increasing the proportion of non-alcoholic drinks-from 25% to 50% or 75%-meaningfully reduces alcohol selection and purchasing. Further studies are warranted to assess whether these effects are realised in a range of real-world settings. TRIAL REGISTRATION ISRCTN: 11004483; OSF: https://osf.io/qfupw.
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Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- School of Sciences, Bath Spa University, Bath, United Kingdom
| | - Anna K. M. Blackwell
- School of Psychological Science, Tobacco and Alcohol Research Group, University of Bristol, Bristol, United Kingdom
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Jennifer Ferrar
- School of Psychological Science, Tobacco and Alcohol Research Group, University of Bristol, Bristol, United Kingdom
| | - Katie De-Loyde
- School of Psychological Science, Tobacco and Alcohol Research Group, University of Bristol, Bristol, United Kingdom
| | - Mark A. Pilling
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Marcus R. Munafò
- School of Psychological Science, Tobacco and Alcohol Research Group, University of Bristol, Bristol, United Kingdom
| | - Theresa M. Marteau
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Gareth J. Hollands
- Behaviour and Health Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- EPPI Centre, UCL Social Research Institute, University College London, London, United Kingdom
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11
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Khamis AA, Idris A, Abdellatif A, Mohd Rom NA, Khamis T, Ab Karim MS, Janasekaran S, Abd Rashid RB. Development and Performance Evaluation of an IoT-Integrated Breath Analyzer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1319. [PMID: 36674075 PMCID: PMC9859467 DOI: 10.3390/ijerph20021319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Although alcohol consumption may produce effects that can be beneficial or harmful, alcohol consumption prevails among communities around the globe. Additionally, alcohol consumption patterns may be associated with several factors among communities and individuals. Numerous technologies and methods are implemented to enhance the detection and tracking of alcohol consumption, such as vehicle-integrated and wearable devices. In this paper, we present a cellular-based Internet of Things (IoT) implementation in a breath analyzer to enable data collection from multiple users via a single device. Cellular technology using hypertext transfer protocol (HTTP) was implemented as an IoT gateway. IoT integration enabled the direct retrieval of information from a database relative to the device and direct upload of data from the device onto the database. A manually developed threshold algorithm was implemented to quantify alcohol concentrations within a range from 0 to 200 mcg/100 mL breath alcohol content using electrochemical reactions in a fuel-cell sensor. Two data collections were performed: one was used for the development of the model and was split into two sets for model development and on-machine validation, and another was used as an experimental verification test. An overall accuracy of 98.16% was achieved, and relative standard deviations within the range from 1.41% to 2.69% were achieved, indicating the reliable repeatability of the results. The implication of this paper is that the developed device (an IoT-integrated breath analyzer) may provide practical assistance for healthcare representatives and researchers when conducting studies involving the detection and data collection of alcohol consumption patterns.
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Affiliation(s)
- Abd Alghani Khamis
- Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Aida Idris
- Department of Management, Faculty of Business and Economics, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Abdallah Abdellatif
- Department of Electrical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | | | - Taha Khamis
- Center for Applied Biomechanics (CAB), Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Mohd Sayuti Ab Karim
- Centre of Advanced Manufacturing and Material Processing (AMMP), Department of Mechanical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Shamini Janasekaran
- Centre for Advanced Materials and Intelligent Manufacturing, Faculty of Engineering, Built Environment & IT, SEGi University Sdn Bhd, Petaling Jaya 47810, Malaysia
| | - Rusdi Bin Abd Rashid
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia
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12
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Myles CC, Weil BV, Wiley D, Watson B. Representations of Low(er) Alcohol (Craft) Beer in the United States. Nutrients 2022; 14:4952. [PMID: 36500982 PMCID: PMC9736915 DOI: 10.3390/nu14234952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Given increasing social interest in health and wellness, rising cultural trends toward sobriety and moderating alcohol intake, and improvements in brewing technology, low(er) alcohol beer is a rising segment in the beer industry for both craft and larger-scale producers. In this paper, we assess the representation of low(er) alcohol beer among craft brewers in the United States. Using a novel quantitatively-informed qualitative analytical approach, we surveyed a randomized, non-representative sample of 400 craft brewery websites in the United States to assess the relative presence of low(er) alcohol beers as well as how these brews are represented by the breweries themselves. To do so, we recorded, both numerically and via website screenshots, the lowest ABV beverage on offer and noted the beer type, the beer name, and the ABV. Ales were the most prominent style of beer on offer, accounting for 62% of the low(er) ABV beers identified. Only 15.5% of the breweries surveyed in this study offered a beer with an ABV of less than 4%; however, an additional 67.9% offered a beer with an ABV of less than 5%. The representations of these low(er) alcohol products focused mostly on taste, health, and demographic indicators.
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Affiliation(s)
- Colleen C. Myles
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX 78666, USA
| | - Bren Vander Weil
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX 78666, USA
| | - Delorean Wiley
- Department of Geography and Environmental Studies, Texas State University, San Marcos, TX 78666, USA
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13
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“Doctor, Can I Drink an Alcohol-Free Beer?” Low-Alcohol and Alcohol-Free Drinks in People with Heavy Drinking or Alcohol Use Disorders: Systematic Review of the Literature. Nutrients 2022; 14:nu14193925. [PMID: 36235578 PMCID: PMC9571501 DOI: 10.3390/nu14193925] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022] Open
Abstract
No- and low-alcohol drinks (NoLo) have been proposed as a potential way forward for the reduction in the alcohol burden of disease. So far, there is scarce synthesized evidence on the effects of these products on people with alcohol use disorder (AUD), or with a heavy or high-risk drinking pattern. The aim of the present study is to systematically review the evidence of the use of NoLo drinks in these populations. A total of 4045 records were screened and 10 studies were included in the review. Craving and desire to drink have been found to increase after the consumption of NoLo drinks in patients with AUD. The increase in craving correlates with the severity of alcohol dependence. In addition, in this population, alcohol-related cues might trigger physiological responses similar to those experienced when using alcohol. Furthermore, as mentioned, in some of the studies, consumption was shown to increase as the %ABV or verbal descriptors indicate lower alcohol. Last, according to the epidemiological data, heavy drinkers tend to use NoLo drinks on top of their usual alcohol consumption rather than as part of regular drinking patterns. Further studies should be conducted in people with AUD or people with a high-risk drinking pattern to provide new insight to guide clinicians, patients, and other stakeholders to make evidence-based informed decisions.
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14
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Anderson P, Kokole D, Jané Llopis E, Burton R, Lachenmeier DW. Lower Strength Alcohol Products-A Realist Review-Based Road Map for European Policy Making. Nutrients 2022; 14:3779. [PMID: 36145155 PMCID: PMC9500668 DOI: 10.3390/nu14183779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/08/2022] [Indexed: 12/16/2022] Open
Abstract
This paper reports the result of a realist review based on a theory of change that substitution of higher strength alcohol products with lower strength alcohol products leads to decreases in overall levels of alcohol consumption in populations and consumer groups. The paper summarizes the results of 128 publications across twelve different themes. European consumers are increasingly buying and drinking lower strength alcohol products over time, with some two fifths doing so to drink less alcohol. It tends to be younger more socially advantaged men, and existing heavier buyers and drinkers of alcohol, who take up lower strength alcohol products. Substitution leads to a lower number of grams of alcohol bought and drunk. Although based on limited studies, buying and drinking lower strength products do not appear to act as gateways to buying and drinking higher strength products. Producer companies are increasing the availability of lower strength alcohol products, particularly for beer, with extra costs of production offset by income from sales. Lower strength alcohol products tend to be marketed as compliments to, rather than substitutes of, existing alcohol consumption, with, to date, the impact of such marketing not evaluated. Production of lower strength alcohol products could impair the impact of existing alcohol policy through alibi marketing (using the brand of lower strength products to promote higher strength products), broadened normalization of drinking cultures, and pressure to weaken policies. In addition to increasing the availability of lower strength products and improved labelling, the key policy that favours substitution of higher strength alcohol products with lower strength products is an alcohol tax based on the dose of alcohol across all products.
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Affiliation(s)
- Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK
| | - Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Eva Jané Llopis
- ESADE Business School, Ramon Llull University, 08034 Barcelona, Spain
| | - Robyn Burton
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London SE5 8AF, UK
| | - Dirk W. Lachenmeier
- Chemisches und Veterinäruntersuchungsamt (CVUA) Karlsruhe, Weissenburger Straße 3, 76187 Karlsruhe, Germany
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15
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Jané Llopis E, O'Donnell A, Kaner E, Anderson P. Are Lower-Strength Beers Gateways to Higher-Strength Beers? Time Series Analyses of Household Purchases from 64,280 British Households, 2015-2018. Alcohol Alcohol 2022; 57:520-528. [PMID: 35512687 PMCID: PMC9270994 DOI: 10.1093/alcalc/agac025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Abstract
Aims Buying and consuming no- (per cent alcohol by volume, ABV = 0.0%) and low- (ABV = >0.0% and ≤ 3.5%) alcohol beers could reduce alcohol consumption but only if they replace buying and drinking higher-strength beers. We assess whether buying new no- and low-alcohol beers increases or decreases British household purchases of same-branded higher strength beers. Methods Generalized linear models and interrupted time series analyses, using purchase data of 64,280 British households from Kantar Worldpanel’s household shopping panel, 2015–2018. We investigate the extent to which the launch of six new no- and low-alcohol beers affected the likelihood and volume of purchases of same-branded higher-strength beers. Results Households that had never previously bought a same-branded higher-strength beer but bought a new same-branded no- or low-alcohol beer were less than one-third as likely to go on and newly buy the same-branded higher-strength product. When they did later buy the higher-strength product, they bought half as much volume as households that had not bought a new same-branded no- or low-alcohol beer. For households that had previously purchased a higher-strength beer, the introduction of the new same-branded no- or low-alcohol beer was associated with decreased purchases of the volume of the higher-strength beer by, on average, one-fifth. Conclusions The increased availability of new no- and low-alcohol beers does not seem to be a gateway to purchasing same-branded higher-strength beers but rather seems to replace purchases of these higher-strength products. Thus, introduction of new no- and low-alcohol beers could contribute to reducing alcohol consumption.
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Affiliation(s)
- Eva Jané Llopis
- ESADE Business School, Ramon Llull University, Barcelona 08034, Spain.,Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6200 MD, Netherlands.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| | - Peter Anderson
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6200 MD, Netherlands.,Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
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16
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Anderson P, O’Donnell A, Jané Llopis E, Kaner E. The impact of lower strength alcohol products on alcohol purchases: ARIMA analyses based on 4 million purchases by 69 803 households, 2015-2019. J Public Health (Oxf) 2022; 44:e567-e577. [PMID: 35470372 PMCID: PMC9715288 DOI: 10.1093/pubmed/fdac052] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lowering the strength of alcohol products could lead to less alcohol being bought and drunk. In its prevention White Paper, the UK Government aims to promote a significant increase in the availability of alcohol-free and low-alcohol products by 2025. METHODS Through descriptive analysis and ARIMA modelling of >4 million alcohol purchases from 69 803 British households, we study the potential impact of lower strength alcohol products in reducing household purchases of grams of alcohol over 2015-2019. Households are divided into predominantly beer, wine or spirits purchasers. RESULTS Over 5 years, there were decreases in purchases of grams of alcohol within beer amongst beer-purchasing households and increases in purchases of grams of alcohol within wine and spirits amongst, respectively, wine- and spirits-purchasing households. Almost all the changes were due to beer-purchasing households buying less regular strength beer, and wine and spirits-purchasing households buying, respectively, more regular strength wine and spirits, rather than increases in purchases of no- and low-alcohol products. CONCLUSIONS In general, lower strength alcohol products have not contributed to British households buying fewer grams of alcohol over the 5-year follow-up period during 2015-2019.
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Affiliation(s)
| | - Amy O’Donnell
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
| | - Eva Jané Llopis
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6200 MD, Netherlands,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, M5S 2S1, ON, Canada,ESADE Business School, Ramon Llull University, Barcelona, 08034, Spain
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne NE2 4AX, UK
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17
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Kokole D, Jané Llopis E, Anderson P. Non-alcoholic beer in the European Union and UK: Availability and apparent consumption. Drug Alcohol Rev 2021; 41:550-560. [PMID: 34957634 PMCID: PMC9305855 DOI: 10.1111/dar.13429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/24/2023]
Abstract
Introduction Market research indicates an increasing interest in low‐ and no‐alcohol drinks in Europe, but there is no systematic overview of their availability and consumption. In this article, we present data on the availability and apparent consumption of non‐alcoholic beer in the European Union and the UK. Methods We use Sold production, exports and imports by PRODCOM list (NACE Rev. 2) dataset, available in Eurostat, to extract the available data on sold production, exports and imports of non‐alcoholic beer in the EU‐27 (total and country‐level) and the UK between 2013 and 2019, and additionally calculate the apparent consumption. Results Between 2013 and 2019, the sold production volume in the EU increased from 0.59 to 1.38 billion litres, the value from 0.42 to 1.28 billion EUR and value per litre from 0.72 to 0.93 EUR/L. In 2019, the share of non‐alcoholic beer represented 3.8% of all beer volume and 4.1% of all beer value produced. Five countries accounted for 80.8% of sold production volume: Germany, the Netherlands, Spain, Poland and Czechia. The Netherlands and Germany were the largest exporters, while importing was distributed more equally. Per capita, average apparent consumption (2017–2019) was highest in Czechia, followed by the Netherlands, Spain, Luxembourg and Germany. Discussion and Conclusions Our results show the increasing availability of non‐alcoholic beer in the EU‐27, although overall changes seem to be driven by a small number of countries. More research is needed at the country‐level on no‐ and low‐alcohol consumption trends and drivers, and their impact on alcohol‐related harm reduction.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Eva Jané Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,University of Ramon Llull, ESADE, Barcelona, Spain.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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