Increasing choice to encourage the selection of non-alcoholic, rather than alcoholic, drinks

Increasing the availability of healthier food increases its selection and consumption. Does the same hold true for alcohol? Dr Anna Blackwell, author of a study published today in BMC Public Health looks at whether greater availability of non-alcoholic drinks, compared to alcoholic drinks, increases their selection.

Whether we are meeting friends in a bar, eating out, or planning a night in at home, one of our first thoughts is often: ‘What shall I drink?’. The choice in bars, restaurants and supermarkets is often overwhelming, with long menus, details of tasting notes, and special offers to review. The one consistent feature is that alcohol is everywhere.

In England, the majority of adults drink alcohol, and around half do so every week. While the risk of harm remains low for many people, 1 in 3 men and 1 in 7 women drink above the current UK low-risk drinking guidelines (14 units/week). This increases the risk of developing alcohol-related illnesses, including mouth, throat and breast cancers, stroke and heart disease.

Making alcohol less affordable is one way to reduce consumption effectively. However, we are interested in other potential approaches. Specifically, we were interested in whether changing the drinking environment could influence drinking behavior. Previous research has shown that people are more likely to buy and eat healthier food if a proportion of less healthy meal or snack options are replaced with healthier options. Our study investigated whether altering the availability of non-alcoholic compared to alcoholic drink options would similarly impact people’s choices.

We asked 808 adult weekly beer drinkers to take part in an online study. They were asked to choose 1 drink, that they would like to have today, from a display of both non-alcoholic (soft drinks and alcohol-free beer) and alcoholic (beer) options. They were shown 1 of 4 possible drink displays that either had the same proportion of non-alcoholic and alcoholic drinks (2 of each, or 4 of each), or a higher or lower proportion of non-alcoholic drinks (6 non-alcoholic and 2 alcoholic, or 2 non-alcoholic and 6 alcoholic).

In real-world environments – such as a supermarket or busy bar – people often have to make quick choices about which drink they choose. Therefore, we also asked half of the drinkers to make their choice under a high time pressure.

The odds of drinkers choosing a non-alcoholic drink were 71% higher when both the total number of drinks and proportion of non-alcoholic options were increased

We found that the odds of drinkers choosing a non-alcoholic drink were 71% higher when both the total number of drinks and proportion of non-alcoholic options were increased, and 48% higher when the proportion of non-alcoholic options was increased. There was no evidence that increasing the number of non-alcoholic drinks increased their selection when the proportion of drink types remained the same. There was no evidence that giving drinkers a time limit affected the type of drink they chose.

As far as we are aware, this is the first evidence to suggest that interventions to increase the availability of non-alcoholic drinks – particularly their proportion relative to alcoholic drinks – could support a reduction in alcohol selection.

Although many bars and restaurants offer at least one type of alcohol-free beer, this is often kept in the fridge behind the bar, or at the back of a menu, and the range of non-alcoholic drinks is often limited. These alcohol alternatives lack visibility and it requires greater effort for customers to choose them. However, the market for these drinks is growing, which is providing greater choice, and over time, increasing exposure to non-alcoholic drinks could help shift social norms around drinking these products.

Interventions to increase the proportion of non-alcoholic drinks available are timely and of interest not only to policy makers, but also license holders and drinks manufacturers. Research in real-world settings is needed now to understand the potential impact on alcohol consumption.

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