Project objectives

The aim of this project is to identify environmental stimuli that increase alcohol consumption and those that reduce it, in order to inform those with authority and responsibility to reduce alcohol consumption in populations to remove the former and the introduce the latter.

The objectives of the four studies that comprise this project are:

1. To estimate the immediate impact of alcohol marketing communications upon alcohol consumption, using evidence synthesis
2. To describe the impact of pro- and anti- alcohol advertising on alcohol consumption in young people, in a laboratory-based experiment
3. To describe the impact of glass design (shape, size and markings) on alcohol consumption, in laboratory-based and field experiments
4. To assess the impact of changes in bar environments on drinkers’ behaviour patterns including alcohol purchasing.

Brief Summary

1. To estimate the immediate impact of alcohol marketing communications upon alcohol consumption, using evidence synthesis

Methods

Electronic searches of nine databases, supplemented with reference list searches and forward citation tracking, were used to identify randomised, experimental studies assessing immediate effects of exposure to alcohol marketing communications on objective alcohol consumption (primary outcome), explicit or implicit alcohol-related cognitions, or selection without purchasing (secondary outcomes). Study limitations were assessed using the Cochrane Risk of Bias tool. Random and fixed effects meta-analyses were conducted to estimate effect sizes.

Results

Twenty four studies met the eligibility criteria. A meta-analysis integrating seven studies (758 participants, all students) found that viewing alcohol advertisements increased immediate alcohol consumption relative to viewing non-alcohol advertisements (SMD = 0.20, 95 % CI = 0.05, 0.34). A meta-analysis integrating six studies (631 participants, all students) did not find that viewing alcohol portrayals in television programmes or films increased consumption (SMD = 0.16, 95 % CI = −0.05, 0.37). Meta-analyses of secondary outcome data found that exposure to alcohol portrayals increased explicit alcohol-related cognitions, but did not find that exposure to alcohol advertisements influenced explicit or implicit alcohol-related cognitions. Confidence in results is diminished by underpowered analyses and unclear risk of bias.

Conclusions

Viewing alcohol advertisements (but not alcohol portrayals) may increase immediate alcohol consumption by small amounts, equivalent to between 0.39 and 2.67 alcohol units for males and between 0.25 and 1.69 units for females. The generalizability of this finding beyond students and to other marketing channels remains to be established.

2. To describe the impact of pro- and anti- alcohol advertising on alcohol consumption in young people, in a laboratory-based experiment

Methods

In a between-participants experiment set in a bar-laboratory, 204 young adults (aged 18–25) who self-reported as heavy drinkers were randomized to view one of three sets of 10 video advertisements that included either (1) alcohol-promoting, (2) alcohol-warning, or (3) non-alcohol advertisements. The primary outcome was the proportion of alcoholic beverages consumed in a sham taste test. Affective responses to advertisements, implicit alcohol approach bias, and alcohol attentional bias were assessed as secondary outcomes and possible mediators. Typical alcohol consumption, Internet use, and television use were measured as covariates.

Results

There was no main effect of condition on alcohol consumption. Participants exposed to alcohol-promoting advertisements showed increased positive affect and an increased approach/reduced avoidance bias towards alcohol relative to those exposed to non-alcohol advertisements. There was an indirect effect of exposure to alcohol-warning advertisements on reduced alcohol consumption via negative affect experienced in response to these advertisements.

Conclusions

Restricting alcohol-promoting advertising could remove a potential influence on positive alcohol-related emotions and cognitions among heavy-drinking young adults. Producing alcohol-warning advertising that generates negative emotion may be an effective strategy to reduce alcohol consumption.

3. To describe the impact of glass design (shape, size and markings) on alcohol consumption, in laboratory-based and field experiments

Methods

Seven studies were conducted in total. One study ran in three public houses in Bristol, and used an AB/BA crossover design to test the feasibility of manipulating glass shape in a naturalistic setting. Two within-subject online (n = 211) and laboratory (n = 96) experiments tested the effect of glass shape on the pouring accuracy to given volume targets. Two between-subject laboratory experiments (each n = 160) tested the effect of glass midpoint markings on the drinking rate of lager. Two within-subject (n = 112) and between-subjects (n = 160) laboratory experiments investigated the effect of nucleation on the likeability and drinking rate of lager respectively.

Results (including findings in relation to the objectives)

The naturalistic feasibility study found that replacing glassware in public houses was feasible and could be enacted in a short space of time. Monetary takings were reduced by 24% (95% confidence interval: 77% reduction to 29% increase) when straight glasses were used as compared to curved glasses. In both the online and laboratory "pouring" studies, accuracy (or pouring to a specified volume) was greater for straight glasses compared to curved glasses. In the first midpoint marking study, total drinking time was similar from a curved glass with the midpoint marked and an unmarked glass. In the second midpoint marking study, there was weak statistical evidence suggesting that total drinking rate was slower with the glass with multiple volume marks compared to the unmarked glass. In the first nucleation study, participants reported that lagers in nucleated glasses were more visually appealing, refreshing and more bubbly/gassy than non-nucleated lagers. In the second study, there was no evidence for differences in the time taken to consume lagers from nucleated and non-nucleated glasses.

Conclusions

It is feasible to carry out a trial investigating glass shape in a naturalistic environment, and the reduction of sales of alcohol when served in straight glasses shows potential for this intervention to reduce alcohol consumption (although these findings need to be replicated in a larger study). The pouring accuracy of liquid volume is more accurate in straight glasses compared to curved glasses, possibly due to participants using height of the liquid within the glass as a proxy for volume judgments (i.e., this is a more accurate proxy when the glass is straight-sided as opposed to curved). This work suggested that providing drinkers with accurate volume information on glasses may attenuate the faster drinking rates from curved glasses. The studies that investigated this founds weak support for this; a glass with multiple volume marks marginally slowed drinking times. Lastly, nucleation appears to enhance the visual appeal and refreshment of lager but has no effect on drinking rate or a single alcoholic drink.

4. To assess the impact of changes in bar environments on drinkers’ behaviour patterns including alcohol purchasing

Design

A feasibility study was undertaken to ascertain whether changes to a campus bar environment could be made, whether measures of potential changes generated by these changes could be taken and to assess the extent of any observed changes.

Methods

A before-after design and mixed methods approach were employed. The study was conducted in the main student bar of a UK university campus over a seven week period: 2 weeks pre-intervention, 3 weeks during intervention, and 2 weeks post-intervention. The intervention comprised a number of environmental changes: reduced price of soft drinks, availability of free water, smaller glasses, waiting table service, and no alcohol-related advertising in the bar. Survey data were collected throughout the seven week period from 360 participating students to assess feasibility. Trained observers assessed fidelity and reported customer flow. Alcohol sales as a proportion of drinks sales were used to indirectly measure alcohol consumption. Sales data was also collected from the same period in each of the previous years (when no intervention was implemented).

Results (including findings in relation to the objectives)

Feedback from customers was positive, and the changes were well-received in the bar setting. The bar manager believed the waiting service was disruptive and this change was not continued in the final week of the intervention. Data collection from customers and trained observers and in relation to bar sales was successful. The percentage of money spent on drinks that was for alcohol dropped by 1.9% (95% CI: -1.1% to 4.9%) and the percentage of drinks that were alcohol-based dropped by x1.0% (95% CI: y-2.7% to z4.7%) between the pre-intervention and intervention periods. However, confidence intervals indicate uncertainty about whether variation in alcohol sales can be attributed to the intervention. Comparisons across years were not meaningful because alcohol sales differed markedly across the three years.

Discussion/Conclusions

The study was deemed feasible if clear communication, support from management, and sufficient planning were present. The barriers and solutions reported will inform future research targeting student drinking environments. It is difficult to interpret the effects on alcohol sales and we cannot conclude that the intervention was effective. Comparison across years may not be meaningful due to cohort effects. A definitive trial, across multiple bars is required to formally evaluate such an intervention. More pronounced changes may be required to make an appreciable different to alcohol sales.

Plain English summary

Background

Alcohol is the fifth leading cause of death and disability in the UK. The aim of this project was to identify environmental stimuli that increase alcohol consumption and those that reduce it, in order to inform those with authority and responsibility to reduce alcohol consumption in populations to remove the former and the introduce the latter.

The objectives of the four studies we conducted were:

1. To estimate the immediate impact of alcohol marketing communications upon alcohol consumption, using evidence synthesis
2. To describe the impact of pro- and anti- alcohol advertising on alcohol consumption in young people, in a laboratory-based experiment
3. To describe the impact of glass design (shape, size and markings) on alcohol consumption, in laboratory-based and field experiments
4. To assess the impact of changes in bar environments on drinkers’ behaviour patterns including alcohol purchasing.

Findings

1. Evidence from seven studies indicated that viewing alcohol advertisements may increase immediate alcohol consumption by small amounts, equivalent to between 0.39 and 2.67 alcohol units for males and between 0.25 and 1.69 units for females.
2. Anti-alcohol advertising that generated negative emotion was found to reduce alcohol consumption among heavy drinking young adults.
3. Glassware studies found that: using straight compared to curved glasses led to a 24% reduction in monetary takings; pouring accuracy is better when using straight compared to curved glasses; using midpoint markings led to slower drinking rate, though no difference in total drinking time; and that lager served in nucleated glasses was seen as more visually appealing than lager served in non-nucleated glasses.
4. Changes to a bar environment led to small, non-significant decreases in alcohol sales.

Implications

Overall, findings from this programme of research suggest that: restricting or removing alcohol advertising may have a small impact on reducing alcohol consumption; producing alcohol warning advertising that generates negative emotion could help to reduce alcohol consumption; using straight glasses with mid-point markings and without nucleation could help to reduce alcohol consumption, reduce drinking speed, and lessen the visual appeal of alcoholic beverages; and that making changes to bar environments is feasible but further research is needed to assess the impact of specific changes on alcohol consumption.

Dissemination

Academic Dissemination

Published articles

Brown KG, Stautz K*, Hollands GJ, Winpenny EM, Marteau TM (2016). The cognitive and behavioural impact of alcohol promoting and alcohol warning advertisements: an experimental study. Alcohol and Alcoholism, 51, 354-362. doi:10.1093/alcalc/agv104

Stautz K, Brown KG*, King SE, Shemilt I, Marteau TM (2016). Immediate effects of alcohol marketing communications and media portrayals on consumption and cognition: a systematic review and meta-analysis of experimental studies. BMC Public Health, 16:465. doi:10.1186/s12889-016-3116-8

Stautz K, Frings D, Albery IP, Moss AC, Marteau TM (2017). Impact of alcohol promoting and alcohol warning advertisements on alcohol consumption, affect, and implicit cognition in heavy drinking young adults: a laboratory-based randomized controlled trial. British Journal of Health Psychology, 22, 128-150. doi:10.1111/bjhp.12221

Stautz K, Marteau TM (2016). Viewing alcohol warning advertising reduces urges to drink in young adults: an online experiment. BMC Public Health, 16:530. doi:10.1186/s12889-016-3192-9

Troy, D. M., Attwood, A. S., Maynard, O. M., Scott-Samuel, N. E., Hickman, M., Marteau, T. M., & Munafò, M. R. (2016). Effect of glass markings on drinking rate in social alcohol drinkers. The European Journal of Public Health, ckw142. https://doi.org/10.1093/eurpub/ckw142

Troy, D. M., Maynard, O. M., Hickman, M., Attwood, A. S., & Munafò, M. R. (2015). The effect of glass shape on alcohol consumption in a naturalistic setting: a feasibility study. Pilot and Feasibility Studies, 1(1), 1-8. https://doi.org/10.1186/s40814-015-0022-2

Conference presentations

Stautz K, Brown KG, King SE, Shemilt I, Marteau TM (2015). Immediate effects of alcohol marketing communications on consumption and cognition: a systematic review and meta-analysis of experimental studies. Paper presented at the 11th Annual Scientific Meeting of the UK Society for Behavioural Medicine. Newcastle, UK.

Stautz K, Brown KG, Hollands GJ, Winpenny EM, Marteau TM (2015). Alcohol promoting and alcohol warning advertisements: impact on implicit cognition, emotion, and craving. Oral presentation at the 6th Annual Meeting of the European Society for Prevention Research. Ljubljana, Slovenia.

Stautz K, Brown KG, King SE, Shemilt I, Marteau TM (2015). Immediate effects of alcohol marketing communications on consumption and cognition: a systematic review and meta-analysis of experimental studies. Poster presented at the 6th Annual Meeting of the European Society for Prevention Research. Ljubljana, Slovenia.

Stautz K, Brown KG, King SE, Shemilt I, Marteau TM (2015). Immediate effects of alcohol marketing communications on consumption and cognition: a systematic review and meta-analysis of experimental studies. Poster presented at the 36th Annual Meeting of the Society of Behavioural Medicine. San Antonio, TX, USA.

Brown KG, Stautz K, Hollands GJ, Winpenny EM, Marteau TM (2014). The cognitive and behavioural impact of pro-alcohol and anti-alcohol advertisements. Paper presented at the 10th Annual Scientific Meeting of the UK Society for Behavioural Medicine. Nottingham, UK.

Troy et al (2016). Effect of Glass Markings on Drinking Rate in Social Alcohol Drinkers. UKCRC16 Annual Conference, University East Anglia.

Troy et al (2015). Effect of Glass Markings on Drinking Rate in Social Alcohol Drinkers. UKCRC15 Annual Conference, Edinburgh.

Troy et al (2015). Shaping Alcohol Behaviour Change: It’s in your Hands. British Psychological Society Annual Meeting, Liverpool.

Troy et al (2016). Shaping Alcohol Behaviour Change: It’s in your Hands. Pre-conference workshop, PHE Annual Conference, University of Warwick.

Troy et al (2016). Effect of Glass Markings on Drinking Rate in Social Alcohol Drinkers. Research Society on Alcoholism, New Orleans, USA.

Troy et al (2015). Effect of Glass Markings on Drinking Rate in Social Alcohol Drinkers. Public Health England (PHE) Annual Conference, University of Warwick.

Maynard et al (2014). Glass half full: investigating the impact of glass shape on drinking behaviour in a real-world setting. Public Health England (PHE) Annual Conference, University of Warwick.

Non-academic dissemination

Press releases

A press release was circulated to coincide with a talk at the 2015 British Psychological Society annual meeting. This resulted in articles in the Daily Mail (weblink), the Daily Telegraph (weblink) and Newsweek magazine (weblink).

Institution’s website

News items on the University of Bristol School of Psychology website (http://www.bristol.ac.uk/expsych/news/).

Public talks

Bristol Bright Night (2014) Troy, D. Looking Through the Drinking Glass

Pint of Science (2015) Troy, D. The Science of Pints

Pint of Science (2016) Attwood, A. & Maynard O.M. The Science of your Pint

Bristol Beer Week (2016) Attwood, A. & Maynard O.M. The Science of your Pint

Science stalls / demonstrations

Einstein’s Garden at the Green Man Festival (2014 & 2015)

Bristol Bright Night (2014)

After-Hours Events at the At-Bristol Science Centre (2014-2017)

News and Social Media

BMC Series Blog – Does alcohol marketing influence alcohol consumption? (http://blogs.biomedcentral.com/bmcseriesblog/2016/06/09/alcohol-marketing-influence-alcohol-consumption/)

Blog entries on the Tobacco and Alcohol Research Group blog (http://targ.blogs.ilrt.org/)

Facebook and Twitter were used to publicise conference presentations and publications.

Public involvement

A number of people were not in favour of having a blanket change in glasses (and some patrons of the public houses requested that their drinks be served in "normal" glasses during straight-glass nights). This confirmed our decision to instead explore marking the glasses. So, more generally, gauging public opinion of this work and any subsequent intervention is extremely important, as influencing change - particularly policy-related change - will be severely hampered without public support.

Impact

This research programme has the potential to impact local alcohol licensing policy. We have received communication from Bristol City Council that if convincing evidence was presented from a large naturalistic trial that glass shape influences the speed of drinking, they would consider using that knowledge to create new licensing conditions, which they review every five years. Depending on when in the review cycle the evidence becomes available, future research may have an immediate impact on public health policy. We expect that they would be similarly receptive to other glassware based interventions being developed from this project that would be effective in slowing/reducing alcohol consumption in the on-licence trade.

 

This project was funded by the National Institute for Health Research School for Public Health Research (SPHR-SWP-ALC-WP4)

 Department of Health Disclaimer

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Public Health Research, NIHR, NHS or the Department of Health.