Changes in acceptability, consideration, intention, and uptake of direct-to-consumer genetic tests in the Netherlands from 2017 to 2022.

Although the popularity of direct-to-consumer genetic tests (DTC-GT) for disease-related purposes increased, concerns persist whether consumers make well-informed decisions about their purchase. To better target pre- and post-test information materials, this study aims to determine the characteristics of people interested in undergoing DTC-GT. In addition, it aims to determine changes in acceptability, consideration, intention, and uptake of DTC-GT since 2017. An online cross-sectional survey was conducted in April 2022 with a representative sample of the Dutch adult population. Ordinal regression models and chi-squared tests were used to determine factors associated with DTC-GT acceptability, consideration and intention, and changes in outcomes since 2017, respectively. Of the 907 included respondents, 19.3% found DTC-GT acceptable, 29.4% considered taking a DTC-GT in the future, 6.2% intended to take a test within the coming year, and 0.9% had already tested. High education was associated with lower acceptability, consideration, intention, and higher awareness. Respondents with a chronic disease were less likely to find DTC-GT acceptable. Higher consideration was associated with having a partner, adopted/stepchildren, and lower age. Compared to 2017, in 2022 more respondents found DTC-GT totally unacceptable, while more considered testing, and fewer ruled out taking a test both in the next year and the future. Education status may play an important role in people's acceptability, consideration, intention, and awareness of disease-related DTC-GT in the Netherlands. Easy-to-understand public information materials should be promoted and guidance is needed to help with decision-making and result interpretation. Future research should focus on the best way to provide responsible guidance.

Designing and implementing an experimental survey on knowledge and perceptions about alcohol warning labels.

OBJECTIVES: This paper describes the design and implementation of an online survey experiment to investigate the effects of alcohol warning labels on alcohol-related knowledge, risk perceptions and intentions. METHOD: The survey collected self-reported data from 14 European countries through two waves of data collection with different recruitment strategies: dissemination via social media and public health agencies was followed by paid-for Facebook ads. The latter strategy was adopted to achieve broader population representation. Post-stratification weighting was used to match the sample to population demographics. RESULTS: The survey received over 34,000 visits and resulted in a sample size of 19,601 participants with complete data on key sociodemographic characteristics. The responses in the first wave were over-representing females and higher educated people, thus the dissemination was complemented by the paid-for Facebook ads targeting more diverse populations but had higher attrition rate. CONCLUSION: Experiments can be integrated into general population surveys. Pan-European results can be achieved with limited resources and a combination of sampling methods to compensate for different biases, and statistical adjustments.

How much do Europeans know about the link between alcohol use and cancer? Results from an online survey in 14 countries.

OBJECTIVE: In the EU, which has the highest drinking levels worldwide, cancer is the primary cause of alcohol-attributable deaths. Existing studies show gaps in public knowledge, but there is lack of systematic appraisal. The report presents original data from a cross-sectional survey conducted within the framework of an online experimental study in 14 European countries, which among other things assessed baseline knowledge of the alcohol-NCD link, particularly cancer. METHODS: Online questionnaire among adults who consume alcohol conducted in 14 countries in 2022-2023 using different recruitment strategies and applying population weights for the final sample. Baseline assessments measured participants' knowledge of alcohol-attributable health issues (with a specific focus on cancer). RESULTS: Baseline knowledge assessment showed that 90% indicated a causal role of alcohol for liver disease, 68% for heart diseases, and only 53% for cancer. Knowledge of specific alcohol-attributable cancer types was lower, with 39% aware of the link between alcohol use and colon cancer, 28% regarding oral cancer, and only 15% regarding female breast cancer. Knowledge levels varied across different countries and population groups. CONCLUSION: Most Europeans do not know which cancers can be caused by alcohol use and knowledge is low specifically for female breast cancer. More awareness raising and prevention efforts are needed, such as the placement of cancer-specific health warnings on alcohol container labels.

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.

Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany.

BACKGROUND: Although the detrimental health effects of alcohol are well established, consumption levels are high in many high-income countries such as Germany. Improving alcohol health literacy presents an integrated approach to alcohol prevention and an important complement to alcohol policy. Our aim was to identify and prioritize measures to enhance alcohol health literacy and hence to reduce alcohol consumption, using Germany as an example. METHODS: A series of recommendations for improving alcohol health literacy were derived from a review of the literature and subsequently rated by five experts. Recommendations were rated according to their likely impact on enhancing (a) alcohol health literacy and (b) reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC). RESULTS: Eleven recommendations were established for three areas of action: (1) education and information, (2) health care system, and (3) alcohol control policy. Education and information measures were rated high to increase alcohol health literacy but low to their impact on alcohol consumption, while this pattern was reversed for alcohol control policies. The ratings showed good agreement (ICC: 0.85-0.88). CONCLUSIONS: Improving alcohol health literacy and reducing alcohol consumption should be considered complementary and become part of a comprehensive alcohol strategy to curb the health, social, and economic burden of alcohol.

Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru.

Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.

Assessing the impact of providing digital product information on the health risks of alcoholic beverages to the consumer at point of sale: A pilot study.

INTRODUCTION: There is an ongoing policy debate in the European Union regarding the best method of providing information to consumers on the health risks of alcohol use. One of the proposed channels is via the provision of QR codes. This study tested the usage rate of QR codes placed on point-of-sale signs in a supermarket in Barcelona, Catalonia over a 1-week period. METHODS: Nine banners with beverage-specific health warnings in large text were prominently displayed in the alcohol section of a supermarket. Each banner provided a QR code of relatively large image size that linked to a government website providing further information on alcohol-related harms. A comparison was made between the number of visits to the website and the number of customers in the supermarket (number of unique sales receipts) in a single week. RESULTS: Only 6 out of 7079 customers scanned the QR code during the week, corresponding to a usage rate of 0.085%, less than 1 per 1000. The usage rate was 2.6 per 1000 among those who purchased alcohol. DISCUSSION AND CONCLUSIONS: Despite the availability of prominently displayed QR codes, the overwhelming majority of customers did not make use of the QR codes to obtain further information on alcohol-related harms. This corroborates the results from other studies investigating customers' use of QR codes to obtain additional product information. Based on the current evidence, providing online access to information through QR codes will likely not reach a significant portion of consumers.

Substitution of higher-strength beers with zero-alcohol beers: Interrupted time series analyses of Spanish household purchase data, 2017-2022. / Sustitución de cervezas de mayor graduación alcohólica por cervezas sin alcohol: Análisis de series temporales interrumpidas de datos de compra de los hogares españoles, 2017-2022.

In its action plan (2022-2030) to reduce the harmful use of alcohol, WHO calls on economic operators to "substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups". This paper investigates substitution within beer brands at the level of the consumer, based on Spanish household purchase data using interrupted time series analysis. For households (n = 1791, 9.1% of all households) that newly bought at least one of eleven branded zero-alcohol beers (responsible for over three-quarters of all zero-alcohol beer purchased), the associated purchases of all grams of alcohol after the first purchase of zero-alcohol beer were reduced by 5.5%, largely due to substituting every one litre of higher strength beer (ABV > 3.5%) with 0.75 litres of same-branded zero-alcohol beer (ABV = 0.0%). For households (n = 337, 1.8% of all households) that had never previously purchased a same-branded higher-strength beer, but newly purchasing a same-branded zero-alcohol beer, the associated purchases of all grams of alcohol after the first purchase of zero-alcohol beer were reduced by 14%; this reduction was largely due to such households' decreasing their associated purchases of wines and spirits. Thus, at the level of the consumer, based on Spanish household purchase data of branded zero-alcohol beers, the evidence behind WHO's call for substitution appears to be substantiated.

En su plan de acción (2022-2030) para reducir el uso nocivo del alcohol, la OMS pide a los operadores económicos que «sustituyan, siempre que sea posible, los productos con alto contenido de alcohol por productos sin alcohol y con bajo contenido alcohólico, con el objetivo de disminuir los niveles generales de consumo de alcohol en las poblaciones y los grupos de consumidores¼. Este articulo investiga la sustitución dentro de las marcas de cerveza a nivel del consumidor, a partir de los datos de compra de los hogares españoles mediante análisis de series temporales interrumpidas. Para los hogares (n = 1791, 9,1% de todos los hogares) que compraron recientemente al menos una de las once cervezas 0,0% (responsables de más de tres cuartas partes de toda la cerveza sin alcohol comprada), las compras asociadas de todos los gramos de alcohol después de la primera compra de la cerveza 0,0% se redujeron en un 5,5%, en gran parte debido a la sustitución de cada litro de cerveza con graduación alcohólica > 3,5% con 0,75 litros de cerveza 0,0% de la misma marca. Para los hogares (n = 337, 1,8% de todos los hogares) que nunca antes habían comprado una cerveza de mayor graduación de la misma marca, pero que compraron recientemente una cerveza 0,0% de la misma marca, las compras asociadas de todos los gramos de alcohol después de la primera compra de la cerveza 0,0% se redujeron en un 14%; esta reducción se debió en gran parte a que los hogares disminuyeron sus compras asociadas de vinos y licores. Así, a nivel del consumidor, en base a los datos de compra de cervezas 0,0% por parte de los hogares españoles, parece estar fundamentada la evidencia detrás del llamamiento de la OMS a la sustitución.

Protocol for a process evaluation of SCALA study - Intervention targeting scaling up of primary health care-based prevention and management of heavy drinking and comorbid depression in Latin America.

This paper describes the plan for a process evaluation of a quasi-experimental study testing the municipal level scale-up of primary health care-based measurement and brief advice programmes to reduce heavy drinking and comorbid depression in Colombia, Mexico, and Peru. The main aims of the evaluation are to assess the implementation of intervention components; mechanisms of impact that influenced the outcomes; and characteristics of the context that influenced implementation and outcomes. Based on this information, common drivers of successful outcomes will be identified. A range of data collection methods will be used: questionnaires; interviews; observations; logbooks; and document analysis. All participating providers will complete a pen-and-paper questionnaire at recruitment and two time points during the implementation period. Providers attending training will complete post-training questionnaires. Additionally, 1080 patients will be invited to self-complete a patient questionnaire. One-in-ten participating providers and fifteen other key stakeholders will participate in semi-structured interviews. Training sessions and community advisory board meetings will be observed by a neutral observer. Logbooks will be kept by local research teams to document events affecting the implementation. Project related documentation and other relevant reports describing the context will be examined.

Effects of Substitution of Higher-Alcohol Products with Lower-Alcohol Products on Population-Level Alcohol Purchases: ARIMA Analyses of Spanish Household Data.

In its action plan (2022−2030) to reduce the harmful use of alcohol, the WHO calls on economic operators to "substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups". This paper investigates substitution at the level of the consumer, based on Spanish household purchase data. ARIMA modelling of market research data of 1.29 million alcohol purchases from 18,954 Spanish households is used to study the potential impact of lower-strength alcohol products and the impact of beer prices in reducing household purchases of grams of alcohol between the 2nd quarter of 2017 and 1st quarter of 2022. Reducing the alcohol strength of existing higher-strength beers and wines had a much greater associated impact on reducing the purchases of all grams of alcohol than the relatively small increases in purchases of no-alcohol beers (ABV ≤ 1.0%) and zero-alcohol wines (ABV = 0.0%). For beers, the relative price per gram of alcohol decreased with the increasing ABV of the beer. Increasing the price per gram of alcohol in beers with an ABV > 3.5%, adjusted for the ABV of the beer, was associated with much greater increases in purchases of no-alcohol beers (ABV ≤ 1.0%) and much greater decreases in purchases of all grams of alcohol than decreases in the price of no-alcohol beers or increases in the price of beers with an ABV > 3.5% unadjusted for ABV. Thus, a key to reducing purchases of grams of alcohol, which also results in increased purchases of no-alcohol beers, is to increase the price of higher strength beers (ABV > 3.5%) with the price per gram of alcohol increasing as the ABV of the product increases.

Lower Strength Alcohol Products-A Realist Review-Based Road Map for European Policy Making.

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.

The Impact of Lower-Strength Alcohol Products on Alcohol Purchases by Spanish Households.

In its action plan (2022-2030) to reduce the harmful use of alcohol, the WHO calls on economic operators to "substitute, whenever possible, higher-alcohol products with no-alcohol and lower-alcohol products in their overall product portfolios, with the goal of decreasing the overall levels of alcohol consumption in populations and consumer groups". In this paper, we investigate substitution at the level of the consumer based on Spanish household purchase data. ARIMA modelling of market research data of 1.29 million alcohol purchases from 18,954 Spanish households is used to study the potential impact of lower-strength alcohol products on reducing household purchases of grams of alcohol between the second quarter of 2017 and the first quarter of 2022. For households that recently bought either no-alcohol beer or wine (ABV ≤ 0.5%), the subsequent associated purchases of higher-strength beers and wines, respectively, and total grams of alcohol were reduced, the more so the higher the volume of initial purchases of beers and wines. The introduction of 20% ABV variants of same-branded 40% ABV whisky and gin during early 2021 was associated with reduced purchases of grams of alcohol within all spirits and of total grams of alcohol as a result of switching from other spirits products to the 20% variants, although not associated with reduced purchases of grams of alcohol within all variants of the studied same-branded whisky and gin; instead, an increase was observed in this category. With respect to Spanish household purchase data, the evidence behind the WHO's call for substitution is substantiated. Further research across different jurisdictions is needed to provide ongoing monitoring of the impact of potential substitution on consumer behavior and public health, including unintended consequences, with findings from research informing future alcohol policies at all levels.

Tailoring an evidence-based clinical intervention and training package for the treatment and prevention of comorbid heavy drinking and depression in middle-income country settings: the development of the SCALA toolkit in Latin America.

BACKGROUND: Effective interventions exist for heavy drinking and depression but to date there has been limited translation into routine practice in global health systems. This evidence-to-practice gap is particularly evident in low- and middle-income countries. The international SCALA project (Scale-up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression in Latin America) sought to test the impact of multilevel implementation strategies on rates of primary health care-based measurement of alcohol consumption and identification of depression in Colombia, Mexico, and Peru. OBJECTIVE: To describe the process of development and cultural adaptation of the clinical intervention and training package. METHODS: We drew on Barrero and Castro's four-stage cultural adaption model: 1) information gathering, 2) preliminary adaption, 3) preliminary adaption tests, and 4) adaption refinement. The Tailored Implementation in Chronic Diseases checklist helped us identify potential factors that could affect implementation, with local stakeholder groups established to support the tailoring process, as per the Institute for Healthcare Improvement's Going to Scale Framework. RESULTS: In Stage 1, international best practice guidelines for preventing heavy drinking and depression, and intelligence on the local implementation context, were synthesised to provide an outline clinical intervention and training package. In Stage 2, feedback was gathered from local stakeholders and materials refined accordingly. These materials were piloted with local trainers in Stage 3, leading to further refinements including developing additional tools to support delivery in busy primary care settings. Stage 4 comprised further adaptions in response to real-world implementation, a period that coincided with the onset of the COVID-19 pandemic, including translating the intervention and training package for online delivery, and higher priority for depression screening in the clinical pathway. CONCLUSION: Our experience highlights the importance of meaningful engagement with local communities, alongside the need for continuous tailoring and adaptation, and collaborative decision-making.

Effect of Community Support on the Implementation of Primary Health Care-Based Measurement of Alcohol Consumption.

Alcohol measurement delivered by health care providers in primary health care settings is an efficacious and cost-effective intervention to reduce alcohol consumption among patients. However, this intervention is not yet routinely implemented in practice. Community support has been recommended as a strategy to stimulate the delivery of alcohol measurement by health care providers, yet evidence on the effectiveness of community support in this regard is scarce. The current study used a pre-post quasi-experimental design in order to investigate the effect of community support in three Latin American municipalities in Colombia, Mexico, and Peru on health care providers' rates of measuring alcohol consumption in their patients. The analysis is based on the first 5 months of implementation. Moreover, the study explored possible mechanisms underlying the effects of community support, through health care providers' awareness of support, as well as their attitudes, subjective norms, self-efficacy, and subsequent intention toward delivering the intervention. An ANOVA test indicated that community support had a significant effect on health care providers' rates of measuring alcohol consumption in their patients (F (1, 259) = 4.56, p = 0.034, ηp2 = 0.018). Moreover, a path analysis showed that community support had a significant indirect positive effect on providers' self-efficacy to deliver the intervention (b = 0.07, p = 0.008), which was mediated through awareness of support. Specifically, provision of community support resulted in a higher awareness of support among health care providers (b = 0.31, p < 0.001), which then led to higher self-efficacy to deliver brief alcohol advice (b = 0.23, p = 0.010). Results indicate that adoption of an alcohol measurement intervention by health care providers may be aided by community support, by directly impacting the rates of alcohol measurement sessions, and by increasing providers' self-efficacy to deliver this intervention, through increased awareness of support. Trial Registration ID: NCT03524599; Registered 15 May 2018; https://clinicaltrials.gov/ct2/show/NCT03524599.

Non-alcoholic beer in the European Union and UK: Availability and apparent consumption.

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.

Training primary health care providers in Colombia, Mexico and Peru to increase alcohol screening: Mixed-methods process evaluation of implementation strategy.

Background: Initial results from the SCALA study demonstrated that training primary health care providers is an effective implementation strategy to increase alcohol screening in Colombia, Mexico and Peru, but did not show evidence of superior performance for the standard compared to the shorter training arm. This paper elaborates on those outcomes by examining the relationship of training-related process evaluation indicators with the alcohol screening practice. Methods: A mix of convergent and exploratory mixed-methods design was employed. Data sources included training documentation, post-training questionnaires, observation forms, self-report forms and interviews. Available quantitative data were compared on outcome measure - providers' alcohol screening. Results: Training reach was high: three hundred fifty-two providers (72.3% of all eligible) participated in one or more training or booster sessions. Country differences in session length reflected adaptation to previous topic knowledge and experience of the providers. Overall, 49% of attendees conducted alcohol screening in practice. A higher dose received was positively associated with screening, but there was no difference between standard and short training arms. Although the training sessions were well received by participants, satisfaction with training and perceived utility for practice were not associated with screening. Profession, but not age or gender, was associated with screening: in Colombia and Mexico, doctors and psychologists were more likely to screen (although the latter represented only a small proportion of the sample) and in Peru, only psychologists. Conclusions: The SCALA training programme was well received by the participants and led to half of the participating providers conducting alcohol screening in their primary health care practice. The dose received and the professional role were the key factors associated with conducting the alcohol screening in practice.Plain Language Summary: Primary health care providers can play an important role in detecting heavy drinkers among their consulting patients, and training can be an effective implementation strategy to increase alcohol screening and detection. Existing training literature predominantly focuses on evaluating trainings in high-income countries, or evaluating their effectiveness rather than implementation. As part of SCALA (Scale-up of Prevention and Management of Alcohol Use Disorders in Latin America) study, we evaluated training as implementation strategy to increase alcohol screening in primary health care in a middle-income context. Overall, 72.3% of eligible providers attended the training and 49% of training attendees conducted alcohol screening in practice after attending the training. Our process evaluation suggests that simple intervention with sufficient time to practice, adapted to limited provider availability, is optimal to balance training feasibility and effectiveness; that booster sessions are especially important in context with lower organizational or structural support; and that ongoing training refinement during the implementation period is necessary.

Impact of minimum unit pricing on shifting purchases from higher to lower strength beers in Scotland: Controlled interrupted time series analyses, 2015-2020.

INTRODUCTION: On 1 May 2018 Scotland introduced a minimum unit price (MUP) of GB50 pence per unit of alcohol (8 g) sold. We analysed household purchase data to assess the impact of MUP in shifting purchases from higher to lower strength beers. METHODS: Data from Kantar Worldpanel's household shopping panel, with 75 376 households and 4.76 million alcohol purchases, 2015-2020. We undertook interrupted time series analyses of the impact of introducing MUP in Scotland on changes in the proportion of the volume of purchased beer with an alcohol by volume (ABV) ≤3.5% using purchases in England as control. We analysed the moderating impact of the volume of purchased beer with an ABV ≤3.5% on the size of the associated impact of MUP in reducing purchases of grams of alcohol within beer. RESULTS: MUP was associated with a relative increase in the proportion of the volume of beer purchased with an ABV ≤3.5%, Scotland minus England, of 10.9% (95% CI 10.6-11.1), following a 43.6% (95% CI 40.1-47.1) increase in the volume of beer purchased with an ABV ≤3.5%, and a 9.6% (95% CI 9.4-9.8) decrease in the volume of beer purchased with an ABV >3.5%. MUP was associated with reduced purchases of grams of alcohol within beer by 8% (95% CI 7.8-8.3), increasing to 9.6% (95% CI 9.3-9.9), when accounting for the moderating impact of shifts to lower strength beer. DISCUSSION AND CONCLUSIONS: MUP seems an effective policy to reduce off-trade purchases of alcohol and encourage shifts to lower strength beers.

Is Buying and Drinking Zero and Low Alcohol Beer a Higher Socio-Economic Phenomenon? Analysis of British Survey Data, 2015-2018 and Household Purchase Data 2015-2020.

Zero and low alcohol products, particularly beer, are gaining consideration as a method to reduce consumption of ethanol. We do not know if this approach is likely to increase or decrease health inequalities. The aim of the study was to determine if the purchase and consumption of zero and low alcohol beers differs by demographic and socio-economic characteristics of consumers. Based on British household purchase data from 79,411 households and on British survey data of more than 104,635 adult (18+) respondents, we estimated the likelihood of buying and drinking zero (ABV = 0.0%) and low alcohol (ABV > 0.0% and ≤ 3.5%) beer by a range of socio-demographic characteristics. We found that buying and consuming zero alcohol beer is much more likely to occur in younger age groups, in more affluent households, and in those with higher social grades, with gaps in buying zero alcohol beer between households in higher and lower social grades widening between 2015 and 2020. Buying and drinking low alcohol beer had less consistent relationships with socio-demographic characteristics, but was strongly driven by households that normally buy and drink the most alcohol. Common to many health-related behaviours, it seems that it is the more affluent that lead the way in choosing zero or low alcohol products. Whilst the increased availability of zero and low alcohol products might be a useful tool to reduce overall ethanol consumption in the more socially advantageous part of society, it may be less beneficial for the rest of the population. Other evidence-based alcohol policy measures that lessen health inequalities, need to go hand-in-hand with those promoting the uptake of zero and low alcohol beer.

Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review.

Alcohol is toxic to human health. In addition to providing nutritional information, labels on alcohol products can be used to communicate warnings on alcohol-related harms to consumers. This scoping review examined novel or enhanced health warning labels to assess the current state of the research and the key studied characteristics of labels, along with their impact on the studied outcomes. Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched between January 2010 and April 2021, and 27 papers were included in the review. The results found that most studies were undertaken in English-speaking populations, with the majority conducted online or in the laboratory setting as opposed to the real world. Seventy percent of the papers included at least one cancer-related message, in most instances referring either to cancer in general or to bowel cancer. Evidence from the only real-world long-term labelling intervention demonstrated that alcohol health warning labels designed to be visible and contain novel and specific information have the potential to be part of an effective labelling strategy. Alcohol health warning labels should be seen as tools to raise awareness on alcohol-related risks, being part of wider alcohol policy approaches.

Production, Consumption, and Potential Public Health Impact of Low- and No-Alcohol Products: Results of a Scoping Review.

Switching from higher strength to low- and no-alcohol products could result in consumers buying and drinking fewer grams of ethanol. We undertook a scoping review with systematic searches of English language publications between 1 January 2010 and 17 January 2021 using PubMed and Web of Science, covering production, consumption, and policy drivers related to low- and no-alcohol products. Seventy publications were included in our review. We found no publications comparing a life cycle assessment of health and environmental impacts between alcohol-free and regular-strength products. Three publications of low- and no-alcohol beers found only limited penetration of sales compared with higher strength beers. Two publications from only one jurisdiction (Great Britain) suggested that sales of no- and low-alcohol beers replaced rather than added to sales of higher strength beers. Eight publications indicated that taste, prior experiences, brand, health and wellbeing issues, price differentials, and overall decreases in the social stigma associated with drinking alcohol-free beverages were drivers of the purchase and consumption of low- and no-alcohol beers and wines. Three papers indicated confusion amongst consumers with respect to the labelling of low- and no-alcohol products. One paper indicated that the introduction of a minimum unit price in both Scotland and Wales favoured shifts in purchases from higher- to lower-strength beers. The evidence base for the potential beneficial health impact of low- and no-alcohol products is very limited and needs considerable expansion. At present, the evidence base could be considered inadequate to inform policy.