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Short-term effects of announcing revised lower risk national drinking guidelines on related awareness and knowledge: a trend analysis of monthly survey data in England
  1. John Holmes1,2,
  2. Jamie Brown2,3,4,
  3. Petra Meier1,2,
  4. Emma Beard2,3,4,
  5. Susan Michie2,3,
  6. Penny Buykx1,2
  1. 1Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  2. 2UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
  3. 3Department of Clinical, Educational and Health Psychology, University College London, London, UK
  4. 4Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
  1. Correspondence to Dr John Holmes; john.holmes{at}


Objectives To evaluate short-term effects of publishing revised lower risk national drinking guidelines on related awareness and knowledge. To examine where drinkers heard about guidelines over the same period.

Design Trend analysis of the Alcohol Toolkit Study, a monthly repeat cross-sectional national survey.

Setting England, November 2015 to May 2016.

Participants A total of 11 845 adults (18+) living in private households in England.

Intervention Publication of revised national drinking guidelines in January 2016 which reduced the male guideline by approximately one-third to 14 units per week.

Measurements Whether drinkers (1) had heard of drinking guidelines (awareness), (2) stated the guideline was above, exactly or below 14 units (knowledge) and (3) reported seeing the stated guideline number of units in the last month in each of 11 locations (exposure). Sociodemographics: sex, age (18–34, 35–64, 65+), social grade (AB, C1C2, DE). Alcohol consumption derived from graduated frequency questions: low risk (<14 units/week), increasing/high risk (14+ units/week).

Results Following publication of the guidelines, the proportion of drinkers aware of guidelines did not increase from its baseline level of 85.1% (CI 82.7% to 87.1%). However, the proportion of male drinkers saying the guideline was 14 units or less increased from 22.6% (CI 18.9% to 26.7%) in December to 43.3% (CI 38.9% to 47.8%) in January and was at 35.6% (CI 31.6% to 39.9%) in May. Last month exposure to the guidelines was below 25% in all locations except television/radio where exposure increased from 33% (CI 28.8% to 36.2%) in December to 65% (CI 61.2% to 68.3%) in January. Awareness and knowledge of guidelines was lowest in social grade DE and this gap remained after publication.

Conclusions Publication of new or revised lower risk drinking guidelines can improve drinkers’ knowledge of these guidelines within all sociodemographic groups; however, in the absence of sustained promotional activity, positive effects may not be maintained and social inequalities in awareness and knowledge of guidelines are likely to persist.

  • Alcohol
  • Drinking guidelines
  • Health promotion
  • Evaluation
  • Trend analysis

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  • Twitter Follow J Holmes at @JHolmesSheff and Jamie Brown at @jamiebrown10

  • Contributors JH led the research and drafted the manuscript. JB, PM, EB, SM and PB worked with JH to develop the overall research design, the design of the questionnaire and interpretation of the results. JB, EB and SM developed the Alcohol Toolkit Study design. JB, EB and PB contributed to design of the analysis and provided statistical support. All authors contributed to revisions to the manuscript.

  • Funding This work was funded by the National Institute for Health Research (NIHR) Public Health Research (PHR) Programme (Project Number: 15/63/01). Additional data collection was funded by the NIHR School for Public Health Research which also contributed funding for JH and PB. JB is funded by a fellowship from the Society for Study of Addiction.

  • Disclaimer The views and opinions expressed are those of the authors and do not necessarily reflect those of the PHR Programme, NIHR or the Department of Health.

  • Competing interests JH and PM were advisors to (and were previously members of) the UK Chief Medical Officers' Guidelines Development Group. JH, PM and PB were commissioned by Public Health England to provide an epidemiological modelling report which informed development of the new UK lower risk drinking guidelines and, at the time of writing, continue to provide advice to the UK Department of Health, Public Health England and the Guideline Development Group on matters relating to this report. JB and EB have received unrestricted research funding from Pfizer for studies relating to smoking cessation.

  • Ethics approval Ethical approval for the wider Alcohol Toolkit Study and for this evaluation of the UK lower risk drinking guidelines was granted by the University College London Ethics Committee and the University of Sheffield Ethics Committee, respectively.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The statistical code is available on request from the authors.