Are zero and low alcohol alternative drinks just a drop in the ocean when it comes to tackling the real harms of alcohol?

Posted by Professor Peter Anderson, Professor Eileen Kaner and Dr Amy O’Donnell, Newcastle University

We’ve come a long way since Becks Blue was your go-to if you were looking for an alcohol-free alternative to beer.

The drinks industry now caters for a growing number of adults who are looking to reduce their alcohol consumption, or not drink at all. ‘Sober-curious’ and ‘Quit-Lit’ are buzzwords of our time, and Sober October and Dry January are now firm calendar fixtures for many.

Supermarkets offer shelves full of zero alcohol gin, 0% craft beer, prosecco – and more. A non-alcoholic Cobra with your curry? No problem. Even Guinness now offers an alcohol-free version.

They’re all a great alternative if you want to reduce or stop drinking, especially if you still want to ‘feel’ like you’re having a drink.

But who is this helping?

Our latest research has found that you’re more likely to buy zero or low alcohol alternatives if you’re younger, you fall into a higher earning bracket and you’re well-educated.

And that’s probably unsurprising, given that non-alcoholic alternatives aren’t cheap - and can sometimes be more expensive than their ‘normal’ equivalents.

For example, at the time of writing, a UK supermarket was selling a litre of Gordon’s Gin (37.5% ABV) at £15.99 a litre, alongside the new 0.0% version at £20 a litre. So if you want to switch, you’re going to have to pay a bit more.

It’s a similar story when it comes to other health-related behaviours, such as eating good quality, fresh food or having a gym membership, where those who are more affluent will lead the way – possibly because they can simply afford to.

Which leads to further questions – are zero or low alcohol drinks only able to make a small difference when it comes to harmful levels of drinking across all groups, including those who are economically disadvantaged? And - does the price and accessibility of these alternatives create some inequality in itself?

Headline findings from our study – do low or no alcohol drinks increase health inequalities?

We wanted to find out whether the purchase and consumption of zero or low alcohol beers differs by demographic and socio-economic characteristics.

To do so, we looked at purchase data from almost 80,000 households and surveys from over 100,000 adults, provided by Kantar World Panel.

We found that zero alcohol beer was more likely to be bought and drunk by younger people and more socio-economically advantaged consumers.

We also saw higher purchase levels in those who generally bought and drank the most alcohol – and this was higher in men, younger adults, and those with higher incomes.

Households that were more likely to buy low alcohol beer were also heavier buyers of alcohol overall, and more likely to be middle-aged (45-64 years).

We also found that for every purchase of a low or no alcohol alternative, there were just under 46 purchases of the alcoholic equivalent – so buying and drinking levels of the low or no alcohol products are still relatively low.

Proportion (%) of households that reported at least one purchase of zero alcohol beer (green, left vertical axis), low alcohol beer (orange, left vertical axis) and all other beer (red, right vertical axis) for any day that a household made an alcohol purchase by study day, 2015 to 2020. Data points: daily.

What does this mean?

The increasing availability of low or no alcohol alternatives might be a useful tool to reduce overall drinking in the more socially advantaged groups in society, but not so beneficial for the rest of the population.

Zero or low alcohol alternatives are great if you can afford them, but they’re not the whole answer when it comes to addressing the real issues around drinking alcohol – including some of the deeper and wider reasons that drive people to drink so much in the first place, the ready availability of alcohol, and its relatively low price.

In conclusion, we believe that promoting zero and low alcohol alternatives is not enough to address the harm done by alcohol, including alcohol-related health inequalities.

Additional evidence-based policy measures - such as a Minimum Unit Price and improved funding for alcohol treatment and intervention and prevention services - are needed to lessen harms of alcohol which are experienced by the most disadvantaged people in our society.

References

This blog is based on a paper published in September 2021 in the International Journal of Environmental Research and Public Health- ‘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.’ – by Peter Anderson, Amy O’Donnell, Dasa Kokole, Eva Jane Llopis, Eileen Kaner.

Professor Eileen Kaner, Professor Peter Anderson and Dr Amy O’Donnell are based at Newcastle University and members of the NIHR ARC North East and North Cumbria. This blog was produced by the NIHR ARC North East and North Cumbria on behalf of the report authors.

You can read the full paper, here.

Other linked research that may be useful for readers:

• Impact of low and no alcohol beers on purchases of alcohol: interrupted time series analysis of British household shopping data, 2015–2018 – BMJ Open, October 2020
• Effectiveness of brief alcohol interventions in primary care settings – Cochrane Review, 2018
• The relationship between alcohol-related hospital admission and specialist alcohol treatment provision across local authorities in England since passage of the Health and Social Care Act 2012 – Cambridge University Press, July 2020

Winter is coming? Surviving the final months of a PhD

Posted by Amy O'Donnell

At the end of 2012, I officially stopped being a full-time funded PhD student, and re-entered the world of the tax-paying worker (staying here at Newcastle University – thanks for having me!). In theory, of course, this means I should be about to submit my leather bound, gold embossed thesis to some lucky examiners. Sadly, I’m not quite there (although, come April, a couple of eminent academics should beware of the ominous thud through their letterbox).

Apparently, these final months of frantic write-up will be quite the endurance test: the tough hardship of George R.R. Martin’s never-ending winter compared to those halcyon summer days of first and second year studentdom. I’ve been warned that I will basically have to give my children up for adoption, withdraw from polite society and hole myself up in some ivory tower for the interim (which is starting to feel like a pledge to the Night’s Watch but I’ll put the poorly-disguised Game of Thrones references aside for a moment).

 Sorry, one more totally undisguised Game of Thrones reference

In some ways, these warnings are starting to come true. I can’t remember the last weekend I didn’t do at least a day’s work and my school runs are down to the absolute bare minimum (I almost forgot Children in Need costumes!!!). I am constantly thinking about deadlines, drafts and discussion sections (sometimes way too early in the morning for my liking). And yet, I’m not even remotely hating any of this. Far from it. I can honestly say I’m loving my PhD more than ever and, if anything, dreading the whole adventure coming to an end. It’s all finally (mostly) making sense, and of all the elements that comprise the mysterious business of research, writing is definitely my favourite. I’ve also been getting ‘out there’ more, including being lucky enough to enjoy a fantastic conference trip to Barcelona, emboldened by a sense of possibly having something to say at long last.

Of course, the ‘party’ is far from over. About 30,000 words away from being over to be precise, and I intend to enjoy everyone one of them. Returning to Game of Thrones, I read somewhere that there are around 1,500,000 words in the five tomes of the Song of Ice and Fire series so far, and I’ve read and enjoyed most of them. Much like the PhD, all its left me with is a desperate need to see how things finish. So on that note, I’ll leave the final word to the marvellous George R.R. Martin:

“Some battles are won with swords and spears, others with quills and ravens.”

Older and wiser? Musings from a ‘mature’ PhD student

Posted by Amy O'Donnell

Recent posts from Martin White and Dorothy Newbury-Birch have sent me musing (and no, before you ask, this isn’t yet another PhD distraction, I promise!).

On the one hand Martin’s first tip in his "From PhD to PI in ten easy steps" is to do your PhD young; on the other, Dorothy writes convincingly about how you might juggle 'mature' study with the domestic stuff that grown-ups tend to have to manage.

So where does this leave me I wondered? I've just turned forty, have two school age children, five pets (do they count?) and to throw into the mix, am currently facing a somewhat challenging time due to my partner's (lack of) employment situation.

Times are indeed tough. And believe me I often look at my younger, child-free peers rather enviously, imagining all the amazing progress I’d achieve if I didn't have after school activities to organise four nights out of five, weekends packed with football matches and Stagecoach, and general mortgage related-stress.

But when I seriously ask myself - “Should I have done this sooner? Could I have done this sooner?” - the answer to both questions is a resounding "No".

For starters, I think that the long and confused path I've taken to get this far has provided me with an invaluable skillset and bundles of what they call ‘life’ experience. I've worked in public affairs so I have a keen sense of the need to stay policy-relevant; I used to manage the BBC corporate diary (yes really) so bureaucracy and seniority doesn't faze me (mostly); and I spent most of my thirties at the rough end of the contract research wedge: bid-writing and mega-quick project turnarounds were my bread-and-butter.

Along the way, I think I've become a better and more seasoned writer and I've developed a deep-rooted passion for tackling social and economic inequalities. In particular, as a mother, I feel a sense of urgency to see things change for the better before my boys have to go out and face the big bad world. Personally, I really don't think I was ready before now. And I also think that with the current focus on translational research, those of us who have actually worked outside academia might have a valuable role to play in bridging the cultural divide.

Of course I understand this will undoubtedly limit my long term opportunities (unless I plan on working to 80…which is possibly not too ridiculous a prospect under the current government). Things haven't always gone quite to plan with the PhD either, so I haven't (yet) rattled off those all-essential publications. But, future academic employers, I do think I've still got lots to offer. Come January 2013, let's hope someone else does too.

Don't give up

Posted by Amy O'Donnell

Before I embarked on my PhD in public health, I spent eight long years at the coalface of policy research. My chosen specialist subject: promoting the participation of under-represented groups in the labour market.

A huge part of that research agenda was engaging with so-called ‘hard-to-reach’ groups to find out their views and experiences of economic and social exclusion. So those eight years saw me reaching out to countless ethnic minority support groups and more fieldwork with long-term benefit claimants than I care to remember. Truly, I had the whole research-engagement agenda licked.

Don't give up

Or so I thought. Right up until the point I started recruiting participants for my doctorate.

For the record, my PhD examines whether we can use routinely collected data to assess the delivery of alcohol interventions in primary care. The fieldwork involves data extraction in 20 GP practices plus interviews with GPs themselves.

I’ve done scores of lone parent interviews. I’ve tracked down Muslim community representatives in the far reaches of Scotland. I’ve recruited peer researchers to access the insular gypsy and traveller community. Bring on the full-time, paid professionals in their permanent, accessible venues!

Turns out that when you don’t have any research funds, when you’re not part of the exclusive Primary Care Research Network, and when you can’t actually get anyone to answer your emails, it’s actually pretty damn difficult to get GPs to take part in your research.

Of course I didn’t quite appreciate this at the start when I posted out my pretty, ethics committee-approved recruitment letters to a select sample of practices and waited for the offers to flood in. They’ll soon come-a-calling, I though, and I’ll go skipping merrily off to collect my data. But they didn’t, so I couldn’t.

Slowly, two key issues emerged. First, I was hardly alone in this endeavour. There are simply zillions of us health researchers trying to grab a few minutes of GPs’ precious time. Understandably, the research that makes financial sense, or reflects a particular interest of the practice tends to take priority. Second, recruiting GPs in the middle of the most significant shake-up of the NHS since its foundation was never going to be easy.

But after many long months of unanswered letters and emails, and playing phone-tag with elusive practice managers, I am delighted to announce that I now have 15 practices recruited and have actually started my GP interviews.

So what happened?

All I can suggest is that I just tried harder. So instead of tens of emails to practice managers, I sent hundreds. I forgot my pride and pestered every friend, family member and colleague I could think of who might be able to help. I fine tuned my data requirements so that I could truthfully assure practice staff that I really would take up as little as possible of their busy day. I offered to visit for a ‘quick chat’ at anytime, anyplace, and with anyone that might listen. I was friendly, positive and professional.

Most of all, I just didn’t give up.

Systematically unsystematic: confessions of a novice reviewer

Posted by Amy O'Donnell

Two years ago, I somehow found myself agreeing – nay proposing – that I should do a systematic review as part of my PhD.

For those unfamiliar with the term (*searches Wikipedia*) a systematic review involves a literature search focused on a clearly formulated question that aims to identify, appraise and synthesise all high quality research evidence relevant to that question.

As far as I was concerned, the findings would usefully inform the other elements of my research, the process would enable me to learn valuable new skills, and the material might even be publishable. What was not to like?

Well for starters there was finding out exactly how to do it (the starting point turns out to be a 281 page guide that drops vaguely menacing terms like ‘stochastic’, ‘bootstrapping’ and a whole bunch of ‘a priori’s). Then there were the hours of screen time trawling through journal abstracts, thousands of which were irrelevant to my research. Throughout, I was keenly aware that the path from conception to realisation was littered with the exhausted shells of well-intentioned PhD researchers.

Fast forward to today, and I am only now (almost) in a position to start writing that elusive final report. So I ask myself – as indeed my supervisors have asked on numerous occasions – just what went wrong?

Well aside from the dithering, the various displacement activities (another colour-coded spreadsheet anyone?) and a general lack of get-up-and-go, I think it all boils down to one major problem.

I didn’t really know what I was looking for.

Sorry, where am I supposed to be going?

Don’t get me wrong, I had a vague idea. But it turns out that a vague idea just won’t cut the mustard when it comes to navigating your way through the twenty-one million plus records available via PubMed. Without a clear question to be answered or hypothesis to be tested, you are looking for the proverbial needle in a haystack. I didn’t know what literature to keep in, and what to throw out. I couldn’t articulate exactly what the review would contribute to my research. And I simply hadn’t thought carefully enough about how I would synthesise the results at the end of the whole process.

I confess it took the shame of failing my second year assessment to wake me up to this sorry state of affairs. But after several months of repeated trips back to the drawing board, and countless discussions with supervisors and other colleagues, I think I’ve finally got it. It’s not perfect, it’s going to be hellish to write up, and I’m annoyed with myself because I know I could have (should have) got here far more quickly and far less painfully. But it’s giving me some relevant and useable material, and I’ve learned a lot. Which I guess is the point.

As poet Edward Hodnett (sort of) wrote “If you do not ask the right questions, you don’t have a hope in hell of getting the right answers”.