Summary of the impact

This case study details an impact relating to health and welfare in which educational practices regarding the dissemination of responsible drinking messages has been influenced, and on public policy and services where this evidence has stimulated policy debate. Specifically, research led to (i) the withdrawal of the Drinkaware Trust's 5-year flagship campaign, Why let the good times go bad? (WLGTGB), and (ii) a recommendation from an independent review to a) involve academics in future campaign development and evaluation, and b) implement changes to the current campaign based on our findings.

Underpinning research

This case study represents a programme of research begun in 2000 and which continues to date, which has led to a body of knowledge examining the effects of social and individual thinking processes in the functioning of habitual behaviours, particularly those associated with the consumption of alcohol (1-5). A European Research Advisory Board (ERAB) grant (2008-9) was awarded to develop this research programme. The research was undertaken by Ian Albery (PI, Professor of Psychology, LSBU, 1999 to date) and Nicky Rycroft (Senior Lecturer, LSBU, 2005 to date) in collaboration with Tony Moss (Research Fellow, St George's, University of London, 2007-9). The research investigated (i) the role of implicit and explicit attentional processes and expectancy evaluations on drinking behaviour whilst individuals were either under the influence of alcohol or not, and (ii) how such processes are fundamental for understanding how people respond to alcohol-related cues (e.g. health promotion posters) in the real world.

Building on both the Dual-Process Model of the Alcohol-Behaviour Link for Social Drinking developed by Moss and Albery between 2004-7 (3), and work carried out during the ERAB grant, we then examined how drinkers respond to a responsibility-based alcohol-related health promotion campaign, i.e. the Drinkaware Trust's 5-year multi-million pound Why let the good times go bad? (WLGTGB) campaign (https://www.drinkaware.co.uk/) which focussed on binge drinking in 18-24 year olds. Drinkaware aims to provide information about the effects alcohol has on the lives of individuals to enable informed decisions to be made.

The research methodology adopted involved a series of five experiments in which Drinkaware posters were presented to drinkers either in a lab-based bar setting or mainstream experimental laboratory. The bar laboratory was specifically designed to mimic a realistic bar environment. Various measures of alcohol-related thinking (e.g. eye tracking, alcohol expectancies) and drinking behaviour (millilitres consumed via a taste preference task) were measured.

Key findings were:

1. Poster materials promoting responsible drinking led to increases in alcohol consumption compared to posters which did not contain a responsible drinking message.
2. The lowest drinking rates were amongst participants who received no form of responsible drinking advice.
3. Participants spent a minimal amount of time attending to the responsibility-based message and more time on positive imagery (as measured using eye tracking technology).
4. Young drinkers (16-19 year old students) exposed to the WLGTGB responsible drinking messages, without actively considering the messages that they contain, had stronger intentions to drink alcohol to the point of intoxication.
5. Intentions to both drink and get drunk were increased among young people who actively discussed the WLGTGB messages, compared to those who discussed general health messages.

The research findings were presented at the Federation of Drug and Alcohol Professionals National Seminar in 2011 (6) and at the City Health 2012 conference (7). That health promotion posters may have the opposite effect to the one intended (the boomerang effect), such that people exposed to such images actually consume more, intend to drink and become inebriated, and tend to ignore responsibility messages, is in line with previous work in a related area (8), and is also fundamental for understanding and evaluating public health messages. This work showed that it is possible to evaluate the immediate effects of public health materials in realistic settings, rather than simply relying on population-level measures which require an untested campaign such as the WLGTGB campaign to be launched nationally before any evaluation can be carried out.

References to the research

Grant details:

ERAB grant (ER 07 15; €80k; 2008-09; PI: Ian Albery)

Details of the impact

This case study is an example of impact in the area of health and welfare in which educational practice around the dissemination of responsible drinking messages has been changed, and on public policy and services whereby research evidence has stimulated policy debate. Specifically, a 5-year multi-million pound nationwide responsible drinking campaign developed by the Drinkaware Trust (Why let the good times go bad? WLGTGB) was suspended a full year early as a consequence of our research. Furthermore, our findings have demonstrably influenced the future direction of campaigns developed by the Drinkaware Trust, and shaped key recommendations in an independent review of Drinkaware's activities in this area.

Independent consultants commissioned by the University to explore the impact of this research established that the Chairman of Alcohol Research UK (1), on hearing of the findings, discussed them with several senior civil servants within the Department of Health and, specifically, the draftsman of The Government's Alcohol Strategy. On becoming aware of the research the CEO of the Drinkaware Trust invited the research team to meet and discuss the implications of the work (2). These findings were subsequently discussed by the Drinkaware Board at their February 2013 meeting (3). In addition, the CEO of Drinkaware has indicated that these findings are directly influencing future campaigns currently being developed by Drinkaware (4).

In parallel, and as a condition of Drinkaware's Memorandum of Understanding with Government, an independent review panel was formed, and was tasked with examining the activities and effectiveness of Drinkaware. Submissions to the review panel were accepted until 31^st January 2013. This panel was chaired by Sir Hugh Taylor (Chairman of the Guy's and St Thomas' NHS Foundation Trust and former Permanent Secretary at the Department of Health) and comprised senior members of relevant stakeholder organisations, including: the Deputy Director of Alcohol and Drugs, the DoH; the CEO of Ipsos MORI; Corporate Relations Director, Heineken UK, and Chairman of the Alcohol Health Alliance. An independent consultancy, 23red, was commissioned to coordinate this review. The research team were contacted by email on the 7^th March 2013 (5) by 23red requesting permission to cite the findings of the evaluation study, which had been submitted to the review panel by the Alcohol Health Alliance UK (AHA). The AHA comprises a consortium of medical bodies (e.g. British Medical Association, the Royal Colleges of GPs, Nursing, Physicians, Psychiatrists and Surgeons) and alcohol/addiction charities (e.g. Action on Addiction, Alcohol Concern, the Institute of Alcohol Studies, British Liver Trust, Alcohol Focus Scotland, and the UK Faculty of Public Health). The findings of our research were also submitted by the Drinkaware Trust at the request of the independent review panel (5). The results of the independent review were published on 17^th April 2013 (6).

Key statements in the review demonstrate that our research had impact in the following ways:

1) The effectiveness of the campaign was called in to question by stakeholder respondents, notably AHA UK (5), and the review authors, specifically: "9.109 Most worryingly, the report of a study by London South Bank University, submitted to this review by two separate organisations in response to our call for evidence, suggest that the campaign may in fact, when used in situ, have the unintended consequence of causing young people to drink more." p.61

2) The report authors also make a clear recommendation that the methods used in our research to test the effectiveness of the campaign should be used in future: "9.113 ...the researchers have used an experimental methodology which we believe may be more likely to reflect true drinking behaviour than self-reported surveys. We would suggest that Drinkaware consider working with academics in this way both to understand whether these results are replicated and on the design of future studies." p.62

3) The Drinkaware Trust suspended the WLGTGB campaign as a direct result of the findings disseminated to and discussed with them: "9.114 We understand that Drinkaware has already suspended WLGTGB activity and is reviewing the approach in the light of this study" p.62

These comments made in the independent review led to the authors concluding that:

"9.203...in order to develop more effective marketing and communications in future Drinkaware should:

• Involve academics and experts more in strategic development and evaluation
• Implement changes to WLGTGB in light of recent research findings" p.79

These research findings have also had a wider impact and attracted the attention of a number of key stakeholder organisations, including Mentor UK and Public Health England (7).

Sources to corroborate the impact

1. Independent Consultants' (The Innovation Partnership) Interview Report (2013). Contact: Managing Director, The Innovation Partnership.
2. Statement (email 1): CEO, The Drinkaware Trust
3. Independent review of The Drinkaware Trust (2006-2012) — Appendices, 17 April 2013, www.independentreview.org.uk
4. Statement (email 2): CEO, The Drinkaware Trust
5. Statement (email): Researcher, Co-author Independent Review, 23red
6. Independent review of The Drinkaware Trust (2006-2012), 17 April 2013, www.independentreview.org.uk
7. Statement (email): Director of Programmes, Mentor UK