Journal of Public Health Medicine
Vol. 24, No. 4, pp. 332–333 Printed in Great Britain
Short report Alcohol awareness and unit labelling Phil J. Webster-Harrison, Andy G. Barton, Hilary P. Sanders, Susan D. Anderson and Frank Dobbs
The benefits of ‘sensible drinking’ have been well researched and documented. The concept of health advice for alcohol consumption in units was suggested as far back as 1987. The government report Sensible drinking in 1995 acknowledged the unit as universal currency for discussing alcohol consumption. A brief report in the British Medical Journal in 19891 highlighted errors in applying the unit system and 12 years later in the British Journal of General Practice2 that general practitioners (GPs) and practice nurses frequently underestimate the unit content of alcoholic drinks. Health education advice in the United Kingdom has for many years been expressed in units – has this been received and understood by the public? Can they interpret this advice appropriately to gauge their drinking correctly? Should voluntary ‘unit labelling’ of alcoholic drinks by 50 per cent of the drinks industry be extended to 100 per cent by legislation? A survey assessed the knowledge of the basic current sensible drinking recommendations and gauged the accuracy with which respondents could assess the unit content of a range of alcoholic drinks. Keywords: units, alcohol, sensible drinking.
Methods and results A survey was carried out in three supermarkets, from three chains, inner-city, suburban and a large rural town. Shoppers were invited to participate unless volunteering they were teetotal. They were asked what they thought were the current recommendations for sensible drinking in units and whether they used the labels to gauge how much they were drinking. They were then shown a range of drinks in containers using standard per cent alcohol by volume (ABV) labelling and asked to state the number of units each contained. These were followed by similar drinks matched for the type, strength and volume, but ‘Unit labelled’; introducing an element of education and enabling subjects to form an opinion on the benefits of unit labelling. A total of 196 shoppers participated (49 per cent male and 51 per cent female). Sixteen per cent were aged 16–24, 42 per cent 25–44, 27 per cent 45–64 and 15 per cent over 65.
Of the 196, 149 highlighted a single drink preference and a 2 analysis showed strong evidence of a difference (p 0.001) in preferences between males and females. Males preferred bitter and lager (59 per cent) whereas females preferred wines and spirits (89 per cent). Fifty-nine per cent read the labels on containers to ascertain the alcohol content. Ninety-three per cent were in favour of all alcoholic drinks being ‘unit labelled’. Forty-six per cent had no idea of the current sensible drinking guidelines and only 23 per cent referred to a daily amount. (The recommendation since 1995.) However, of those able to answer, 90 per cent for males and 93 per cent for females gave levels that would not equate to higher than the sensible daily amount (49 per cent of total survey population). Forty-seven per cent of participants thought drinking wine is healthier than other forms of alcoholic drinks. The table illustrates that when the containers are labelled with the per cent ABV people underestimate the unit content by substantial amounts, especially for wine, gin and strong lager. The table also shows the wide range of answers given for non unit labelled containers and that the majority correctly identified the unit content of unit labelled containers. It appeared to the interviewers that errors in not correctly answering the unit
Phil J. Webster-Harrison, General Practitioner Portview Surgery, Higher Portview, Saltash PL12 4BU. Andy G. Barton, Coordinator Plymouth and South Devon Research and Development Support Unit, ITTC Building, Tamar Science Park, Plymouth PL6 8BX. Hilary P. Sanders, Senior Lecturer in Statistics Department of Mathematics and Statistics, University of Plymouth, Drake Circus, Plymouth PL4 8AA. Susan D. Anderson, RDSU Secretary Room N17, ITTC Building, Tamar Science Park, Derriford, Plymouth PL6 8BX. Frank Dobbs, Director Swarm Primarycare Research Network University of Plymouth, ITTC Building, Tamar Science Park, Plymouth PL6 8BX. Address correspondence to Dr P. J. Webster-Harrison. E-mail:
[email protected]
© Faculty of Public Health Medicine 2002
333
SHORT REPORT
Table Percentage of respondents estimating alcohol unit content to different levels of accuracy (males n 96, females n 100) Wine (9.4 units) 75 cl 12.5% ABV
Bitter (3.4 units) 2 cans 440 ml 3.8% ABV
Gin (26.3 units) 70 cl 37.5% ABV
Cider (3.3 units) 1 can 440 ml 7.5% ABV
Lager (7.4 units) 2 cans 440 ml 8.5% ABV
Correctly answered to within 10% of actual value (%) Males 11.5 Females 8
21 19
13.5 8
19 21
17.7 17
Underestimated number of units (%) Males Females
31 40
57 71
46 48
61 70
6 40
30 44
8 10
44 53
Estimating units from non unit-labelled drinks
75 83
Underestimated by at least one-third of actual (%) Males 53 Females 71 Range of answers (in units) Mean over- or underestimate (in units); all ages Is there any evidence that means estimated are different from – p
2–50
1–25
2–120
–2.07
0.0013
–3.0
9.4 0.001*
3.4 0.9
26.3 0.005*
Respondents identifying correctly the units in labelled drinks Males and females (%) 96.4 91.3
99.5
1–25 –0.0205 3.3 0.9 91.3
2–66 –0.92 7.4 0.016* 94.4
*Significantly different.
labelled drinks were related to difficulty in reading small print in the majority of cases.
Comments The wide range of estimates of unit content and the worrying percentage who underestimate unit content in per cent ABV labelled containers strongly supports recent calls2–4 that unit labelling should be obvious, large enough to read easily and made compulsory by government legislation. Only 23 per cent referred to a daily sensible drinking amount and 47 per cent held the unsubstantiated belief that drinking wine is healthier than other forms of alcohol, suggesting a need for more effective health education on the sensible drinking message.
References 1 Stockwell T, Stirling L. Estimating alcohol content of drinks: common errors in applying the unit system. Br Med J 1989; 298: 571–572. 2 Webster-Harrison PJ, Barton AG, Barton SM, Anderson SD. General practitioners’ and practice nurses’ knowledge of how much patients should and do drink. Br J Gen Pract 2001; 51: 218–220. 3 Getting tight on units of alcohol. Drug and Therapeutics Bulletin 2001; 39: 95. 4 Webster-Harrison PJ, Barton AG. Time has come for mandatory unit labelling. Br Med J 2002; 324: 738–739.
Accepted on 18 June 2002
