Developing alcohol labelling interventions: the "what", "who" and "how"

Excessive alcohol consumption is a growing problem in modern society and substantially contributes to the global burden of disease. It is estimated to cost the UK government in excess of £21 billion per year. Furthermore, the problem is not restricted to alcohol-dependent individuals as the NHS estimate that over 9 million individuals drink more than the recommended guidelines in England alone. It is therefore unsurprising that alcohol control strategies are a key area of interest for health professionals and policy makers.

Alcohol labels are currently under consideration by the UK Government and the European Union (EU) [2] and an EU Alcohol Strategy for 2016-2022 is expected to include recommendations to include information regarding calories, alcoholic units and the negative health consequences of heavy alcohol consumption. Providing consumers with health-relevant information will educate and promote healthier choices, such as choosing products with lower alcoholic units or reducing overall intake. Labelling interventions have been applied to cigarette and food packaging and have proven effective in encouraging positive behaviour change [3]. However, there is relatively little research investigating the effectiveness of alcohol labelling interventions on positive behaviour change. This work is essential as the effectiveness of labelling is entirely dependent on the right information being presented and it being delivered in the best way possible.

Across a series of stakeholder meetings (with publicans, policy-makers and health professions), online surveys and focus groups with alcohol consumers, we will explore what information should be presented and question the effects this information is likely to have. This will involve asking all parties about the information they think would be useful, effective and feasible. We will also provide information and gather opinion on the three main areas of product information currently under consideration: calories, alcoholic units and health warnings.

In additional to the fundamental question of "what" information should be provided, we will also consider how the effects of this information may differ among different consumer groups. This will enable us to develop interventions that are targeted to specific groups in which they are likely to be the most effective, thereby maximising impact. In addition, it is vital to consider unintended negative consequences that may be a unique characteristic of alcohol labelling. Particular areas of concern are calorie information promoting reduction in food intake rather than alcohol consumption, and alcohol unit or real-time feedback of drinking behaviour in young binge drinkers (who may use the information to "compete" with peers) increasing intake or drinking speed.

A final innovative (as-yet unexplored) question is how the information can be communicated to consumers beyond product labels. People often do not come into direct content with product labels when they drink in bars and clubs. We will explore novel methods of information delivery and assess their likely impact. This will include beer mats and menus which are already common in licensed premises and therefore can be rolled out easily and cheaply, However, we will also consider emerging technologies (e.g., digital stickers than can be placed on glasses) which will play an important role in the future of consumer communication. This will ensure that this project will be at the cutting edge of intervention design. This work will be a vital first step in the design and production of evidence-based labels (and other mediums of information delivery). These instruments will be used in future research that will assess if drinking behaviour and drinking attitudes are changed when consumers drink in their presence. Therefore in addition to creating the instruments, we will produce protocols for the research to be taken forward into the next phase of intervention development.

In England approximately 9 million individuals drink more than the recommended guidelines, according to NHS figures. Furthermore heavy episodic drinking (a.k.a., binge drinking) is common, particularly among young people, and is associated with increased risk of accidents, violence, alcohol abuse problems and ill-health. Excessive alcohol consumption substantially contributes to the global burden of disease, and is estimated to cost the UK government in excess of £21 billion annually.

Choice architecture interventions are designed to encourage healthier choices by changing aspects of the environment. For example, health warnings on cigarette packets have proven effective at changing knowledge and behaviours in ways that promote health. However, there is a serious lack of research investigating the nature and potential impact of labelling for alcohol products. The effectiveness of alcohol product labelling is entirely dependent on the quality of the information, for which there should be a sound evidence base. It is essential that we understand which types of information will be most effective, and identify any unintended consequences (such as calorie information reducing food intake rather than alcohol consumption).

This project will address this important gap in knowledge, by engaging a wide range of key stakeholders (brewers, the public, local authorities and clinicians) to gather informed opinion on the types of information that should be delivered, perceptions of feasibility, acceptability and impact. We will also address the additional questions of how the effects information may differ across consumer sub-types (in order to identify whether information can be tailored or targeted) and investigate novel and innovative methods of information delivery (introducing emerging technologies). These additional questions will be instrumental in maximising impact and reach of labelling interventions to be developed in the latter stages of this project.