23 November 2022 In General Health

This review summarises the evidence on the impact of serving and container size on how much people drink, interventions that have the potential to reduce alcohol consumption across populations, thereby improving health. A rapid search identified 10 published reports of 15 studies and 1 review. Four studies focused on serving size, eight studies and the review on glass size, two studies on bottle size and one on both glass and bottle size. Twelve studies and the review focused on wine, one study on beer and two on both. All were conducted in England, by just two research groups. Removing the largest serving size of wine decreased wine sales by 7.6% (95% CI -12.3%, -2.9%) in a study in 21 licenced premises, reflecting findings from two prior studies in semi-naturalistic settings. Adding a serving size for beer that was a size smaller than the largest was assessed in one study in 13 licenced premises, with no evident effect. Reducing the size of wine glasses in restaurants decreased wine sales by 7.3% (95% CI -13.5%, -1.5%) in a mega-analysis of eight datasets from studies in five licensed premises. Using smaller wine glasses at home may also reduce consumption, but the evidence from just one study is less certain. No studies have assessed the impact of glass size for drinking beer. The effect of bottles smaller than the standard 750 mL on wine consumed at home was assessed in two studies: 500 mL bottles reduced consumption by 4.5% (95% CI -7.9%, -1.0%) in one study, but in another, using 375 mL bottles there was no evident effect. No studies assessed the impact of bottle or other container size for drinking beer. Reducing the size of servings, glasses and bottles could reduce wine consumption across populations. The impact of similar interventions for reducing consumption of other alcoholic drinks awaits evaluation. Further studies are also warranted to assess the generalisability of existing evidence.

22 February 2019 In Drinking & Driving

BACKGROUND: Drink driving is an important risk factor for road traffic accidents (RTAs), which cause high levels of morbidity and mortality globally. Lowering the permitted blood alcohol concentration (BAC) for drivers is a common public health intervention that is enacted in countries and jurisdictions across the world. In Scotland, on Dec 5, 2014, the BAC limit for drivers was reduced from 0.08 g/dL to 0.05 g/dL. We therefore aimed to evaluate the effects of this change on RTAs and alcohol consumption.

METHODS: In this natural experiment, we used an observational, comparative interrupted time-series design by use of data on RTAs and alcohol consumption in Scotland (the interventional group) and England and Wales (the control group). We obtained weekly counts of RTAs from police accident records and we estimated weekly off-trade (eg, in supermarkets and convenience stores) and 4-weekly on-trade (eg, in bars and restaurants) alcohol consumption from market research data. We also used data from automated traffic counters as denominators to calculate RTA rates. We estimated the effect of the intervention on RTAs by use of negative binomial panel regression and on alcohol consumption outcomes by use of seasonal autoregressive integrated moving average models. Our primary outcome was weekly rates of RTAs in Scotland, England, and Wales. This study is registered with ISRCTN, number ISRCTN38602189.

FINDINGS: We assessed the weekly rate of RTAs and alcohol consumption between Jan 1, 2013, and Dec 31, 2016, before and after the BAC limit came into effect on Dec 5, 2014. After the reduction in BAC limits for drivers in Scotland, we found no significant change in weekly RTA rates after adjustment for seasonality and underlying temporal trend (rate ratio 1.01, 95% CI 0.94-1.08; p=0.77) or after adjustment for seasonality, the underlying temporal trend, and the driver characteristics of age, sex, and socioeconomic deprivation (1.00, 0.96-1.06; p=0.73). Relative to RTAs in England and Wales, where the reduction in BAC limit for drivers did not occur, we found a 7% increase in weekly RTA rates in Scotland after this reduction in BAC limit for drivers (1.07, 1.02-1.13; p=0.007 in the fully-adjusted model). Similar findings were observed for serious or fatal RTAs and single-vehicle night-time RTAs. The change in legislation in Scotland was associated with no change in alcohol consumption, measured by per-capita off-trade sales (-0.3%, -1.7 to 1.1; p=0.71), but a 0.7% decrease in alcohol consumption measured by per-capita on-trade sales (-0.7%, -0.8 to -0.5; p<0.0001).

INTERPRETATION: Lowering the driving BAC limit to 0.05 g/dL from 0.08 g/dL in Scotland was not associated with a reduction in RTAs, but this change was associated with a small reduction in per-capita alcohol consumption from on-trade alcohol sales. One plausible explanation is that the legislative change was not suitably enforced-for example with random breath testing measures. Our findings suggest that changing the legal BAC limit for drivers in isolation does not improve RTA outcomes. These findings have significant policy implications internationally as several countries and jurisdictions consider a similar reduction in the BAC limit for drivers.

FUNDING: National Institute for Health Research Public Health Research Programme.

04 December 2014 In Social and Cultural Aspects

I'm worried about the way the debate on alcohol pricing is being conducted. We seem to have adopted a Manichean worldview, where gallant public health scientists fight an industry that wields enormous power over government and cares not for the health of its customers. This attitude will not lead to good public health policies.Gornall's desire to rubbish any criticism of minimal pricing makes him confuse important political and moral arguments with critiques of the evidence. The idea that we behave virtuously only when an angelic government makes us do so is the first step towards an Orwellian nightmare. This argument should not be casually dismissed because of a tenuous association with industry lobbying.Then there is the allegation that industry has conspired to corrupt the evidence on pricing. It implies we can't trust any opposition because most will have been sponsored by industry vested interests. No doubt we should be wary of lobbying, but we should also judge arguments on their merit and not their sponsor. Anti-alcohol campaigners think the Sheffield model and the Canadian evidence are robust and applicable to England because industry doesn't like them. But the evidence isn't that good or that reliable, as people like me have argued since it was first published.The most disturbing thing is that the lack of critical thinking around minimal pricing has made people believe it is a magic bullet for such a deeply rooted problem as alcohol misuse. To combat alcohol misuse, we need a range of harder, less headline grabbing policies that will have more effect in the long term.By not criticising the arguments for minimal pricing, we are also ignoring signs that people's behaviour has already improved, without them being forced to change by government. Alcohol consumption has fallen in England in the past decade even among the young. But these facts are rarely discussed because they would undermine lobbying for further restrictions like minimal pricing.

04 December 2014 In Liver Disease

The slow epidemic of liver disease in the UK over the past 30 years is a result of increased consumption of strong cheap alcohol. When we examined alcohol consumption in 404 subjects with a range of liver disease, we confirmed that patients with alcohol-related cirrhosis drank huge amounts of cheap alcohol, with a mean weekly consumption of 146 units in men and 142 in women at a median price of 33p/unit compared with pound1.10 for low-risk drinkers. For the patients in our study, the impact of a minimum unit price of 50p/unit on spending on alcohol would be 200 times higher for patients with liver disease who were drinking at harmful levels than for low-risk drinkers. As a health policy, a minimum unit price for alcohol is exquisitely targeted at the heaviest drinkers, for whom the impact of alcohol-related illness is most devastating.

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