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The review identified 997 eligible articles from 29 publications. Drinking guidelines were mentioned regularly in news articles across the study period, and the number of articles per week peaked when the revised guidelines were announced in January 2016. The peak was largely due to articles discussing the guidelines directly, whereas outside this period articles were more likely to mention the guidelines in the context of more general news about alcohol or health.
Drinkers in social grades D and E were less likely than those in grades A and B to be aware of and know the guidelines; find it more difficult to drink at moderate levels and are less motivated to do so; and are less sure where to get advice on cutting down. Increasing and high-risk drinkers are more likely than moderate drinkers to be aware of and exposed to the guidelines but are not more likely to know what they are. Increasing and high-risk drinkers are also less likely to say that 2 units is the most that they can drink without harming their health; find it harder to drink at moderate levels and are less motivated to do so; and are less likely to track their units.
This report includes direct quotations from media and in places, where copyright permission could not be obtained, comments have been paraphrased by the authors (see Chapter 3). These statements include a range of opinions that relate to the quoted source and do not reflect the views of authors or funders.
The GDG also revised the guidance in two other key areas. First, it updated the guidance on drinking alcohol during pregnancy. Previously, the guidance in Scotland was that women should not drink during pregnancy, whereas the guidance in England was that women should not drink more than 1 or 2 units once or twice per week. The revised guidance removed this inconsistency and took a precautionary approach that recommended:
Despite this now-broad literature, only one briefly reported study to date has examined how news media report on drinking guidelines.102 This is an important oversight as TV, radio, newspapers and magazines are the primary places where the public report seeing drinking guidelines when revisions are announced.46 At such times, guidelines are discussed prominently by news outlets within ordinary news reports, opinion pieces and editorials. At other times, news media continue to expose the public to drinking guidelines by mentioning them within stories about alcohol-related health risks, drinking trends and lifestyle topics. Such repeated exposure aids awareness and recall of guidelines in the absence of active promotion via mass media campaigns. For example, evaluations of alcohol health warning labels in the USA found higher rates of awareness and recall of the health warnings among heavier drinkers and argued that this was because they see the label more often.103 Debate within news media may also inform public opinion and responses to drinking guidelines, but, given the wide variety of roles that the media play in public debate, this is unlikely to be a straightforward or unidirectional process.79 Moreover, differences in news media reports across publications and platforms may play an important role in determining who is exposed to guidelines and informing their attitudes towards them as engagement with news outlets and content is socially patterned.76
Drinking guidelines were mentioned regularly in news articles across the study period. Figure 3 shows that the number of articles per week peaked when the revised guidelines were announced in January 2016. There were also many smaller peaks that occurred when guidelines were mentioned in articles related to general alcohol- or health-related topics, as shown in Figure 4, whereas guidelines were mentioned only infrequently in articles unrelated to alcohol or health.
One specific method used to evidence inconsistencies in advice is to cite drinking guidelines from other countries. This argument was common partly because a scientific paper published shortly after the UK revisions were announced highlighted large variation in guidelines internationally and also showed that the UK guideline for men was low by international standards.9 Articles often used this information to point out that different countries come up with different guidelines using the same underlying evidence, suggesting that there are other factors in play that are assumed not to be scientific. Notably, prior to the guidelines change, articles often gave examples of other countries with lower guidelines, whereas after the guidelines changed articles gave examples of countries with much higher guidelines, although this partly reflects there being few countries with lower guidelines than the UK after the revisions. This criticism came forward in quotations from representatives of the alcohol industry, but also in opinion pieces by writers who are not affiliated with the alcohol industry and as single-line illustrations of guidelines. The safe alcohol limits in Canada and Australia have already been reduced to lower than in the UK to account for the new evidence on health risks from drinking. In Canada, men are now advised to drink no more than 15 units a week and women just 10, while Australia tells all adults not to exceed 2 units per day. A Department of Health and Social Care spokesperson confirmed that the UK guidelines will be revised later this year (paraphrased).134
In addition to examining time trends in behavioural influences, we also examined the social patterning of these influences and identified important inequalities. In particular, drinkers in social grade DE were the least likely to be aware of guidelines or to know what the guideline is. They also found it more difficult to drink moderately, were less motivated to do so and were less sure where to get advice on cutting down. Taken together, these findings suggest that drinkers of lower socioeconomic status are less able and less likely than their counterparts of higher socioeconomic status to use the revised drinking guidelines to make responsible and healthy choices about alcohol consumption. As drinkers of lower socioeconomic status also suffer greater harm from alcohol despite drinking less, on average,161,185 it is likely that these differences will contribute to the perpetuation and, possibly, exacerbation of alcohol-related health inequalities.
The lack of promotional activity beyond the initial announcement of the revised guidelines means that our conclusions regarding the effectiveness of promoting drinking guidelines as a behaviour change intervention have only limited generalisability to scenarios where more extensive promotion takes place. Our results are likely to remain useful evidence as limited promotional activity is common in other countries, such as Australia.102 However, our results will be less useful in informing the likely effectiveness of future promotional campaigns.
Finally, the drinking guidelines examined here were developed for the UK as a whole. This study focused on England only as this is the sampling frame for the ATS. It is possible that the guidelines had a larger effect in Scotland, Wales or Northern Ireland where the wider alcohol policy context is different, particularly in Scotland, which has followed a more public health-oriented approach to alcohol policy in recent years.194 It is also possible that promotional activity was more extensive in these contexts, although we are not aware of any large-scale campaigns beyond the Count 14 campaign mentioned in Promotional activities outside the study period, which fell outside the study period. The evaluation of the Count 14 campaign may provide insights into whether or not Scotland differs from England on key outcome measures.
Finally, greater attention is needed to the design of drinking guidelines themselves. As we have discussed elsewhere, guidelines are often designed with reference, or at least explicit reference, only to formal epidemiological evidence.188 This is particularly true of the guideline consumption threshold. Little consideration or evidence is brought to bear on questions regarding whether or not guidelines and the consumption threshold are appropriate to achieve the desired effect. This omission is particularly concerning where guidelines are conceived as a behaviour change intervention, as in the UK,5 but remains important where the purpose of guidelines is to communicate scientific evidence to the public, as reducing an extensive and nuanced evidence base to a single number is inevitably a simplification of that evidence and different approaches may communicate the full implications of the evidence in better or worse ways. The EU-funded Reducing Alcohol Related Harm project made best practice recommendations for the development of drinking guidelines in 2017,8 but these appear to be based primarily on epidemiological considerations and do not engage with considerations drawn from the wider scientific literature, such as how drinkers actually use guidelines in practice, how guidelines intersect with positive motivations for drinking (e.g. pleasure) and how the effectiveness of drinking guidelines is shaped by their acceptability and credibility within public debate. 041b061a72