The effect of alcohol strength on alcohol consumption: a pilot study
Background: Excessive alcohol consumption can impair health, lead to intentional and non-intentional harm to the self and others and incurs a large financial burden on society. Effective interventions are required to reduce alcohol consumption and its associated harms at the population level. Replacing regular-strength alcohol with reduced-strength alcohol has the potential to reduce alcohol consumption and, therefore, mitigate alcohol-related harm. To date, there is no high-quality experimental evidence to suggest whether reducing the strength of alcohol is effective at reducing alcohol consumption. Before implementing a randomised controlled trial (RCT), its feasibility, and the acceptability of the intervention, need to be established. Aim: The primary aim of this research project was to establish the feasibility of a RCT to assess the effect of lager (a subtype of beer) strength on lager consumption in a single drinking occasion within licensed premises in the United Kingdom (UK). This project sought to obtain data to estimate key parameters required when designing a RCT and to provide initial insights into the acceptability of reducing the strength of alcohol as an intervention to reduce alcohol consumption. Method: The research project incorporated three stages of study, which utilised different designs. Study One: a single-blind taste discrimination experiment. Study Two: a double-blind randomised controlled crossover pilot trial based within licensed premises in the UK. Study Three: semi-structured qualitative telephone interviews. Findings: Study One: Nineteen frequent lager drinkers aged 18 years and over completed the taste experiment. Most participants (58%) reported that, out of a small range of regular-strength lager brands, Becks® (B) tasted most similar to the reduced-strength lager Bud Light® (BL). B was therefore instated as the control product for the pilot trial, alongside the pre-determined intervention product, BL. Study Two: Thirty-six frequent lager drinkers aged 18 years and over completed two pilot trial study sessions in one of four licensed premises. Results indicated that it is feasible to conduct a double-blind randomised controlled crossover trial to assess the effect of alcohol strength on alcohol consumption in a single drinking occasion within licensed premises in the UK. Sufficient data were obtained to estimate key parameters for a RCT. Study Three: A subsample of seven pilot trial participants each undertook a semi-structured telephone interview. Reflexive thematic analysis identified several factors associated with the acceptability of reducing the strength of alcohol as an intervention to reduce alcohol consumption. These included the taste of the reduced-strength product, freedom of choice, perceived intervention efficacy and perceived motives of the alcohol industry. Conclusion: Findings from this research project can be utilised to design a definitive RCT to assess the effect of alcohol strength on alcohol consumption in a single drinking occasion within licensed premises in the UK. The main limitations of this research project were that the pilot trial intervention and control products were not optimally matched, and they were not favourable to participants, and trial participants may have deviated from the study protocol as they were not officially observed. These limitations should be addressed, to the greatest extent possible, in the design stage of future studies.
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