Evaluating and responding to the public health impact of no and low alcohol drinks: A multi-method study of a complex intervention in a complex system

AIM: This project aims to characterise, monitor and evaluate the public health impact of efforts to increase the availability and consumption of no- and low-alcohol (no/lo) drinks among adult alcohol consumers in Great Britain from 2011 to 2025.

BACKGROUND: No/lo drinks are beers, ciders, wines and spirits containing less than 1.2% alcohol by volume. Sales of these drinks are increasing rapidly and this could have a transformative impact on public health if it means people consume fewer standard alcoholic drinks. However, there are many uncertainties and risks.

People may increase their drinking by adding add no/lo drinks to their existing alcohol consumption, alcohol producers may use no/lo products to indirectly promote alcohol consumption and industry actors may use no/lo drinks to gain influence over wider alcohol policy by presenting themselves as effective contributors to improving public health.

RESEARCH DESIGN: The project will evaluate efforts to increase the availability and consumption of no/lo drinks as an ongoing complex intervention within a complex alcohol consumption system. It will use logic models, observational and qualitative designs, natural experiment evaluation methods and mathematical modelling to understand the contribution made by the intervention to changes in processes and outcomes across the alcohol consumption system.

METHODS: The project has four work packages (WPs):

WP1 will characterise the intervention and its components using a wide range of data sources. It will: (i) co-produce an intervention theory of change via stakeholder workshops; (ii) establish a timeline of intervention activity by government, industry and others that captures the evolving nature of the intervention and its responses to feedback from the wider system; (iii) characterise the no/lo-related market and corporate political strategies of industry actors; (iv) conduct case studies of no/lo brand and product marketing and (v) develop a taxonomy of no/lo product types.

WP2 will evaluate the impact of the intervention and its components on alcohol consumption. It will use market research datasets and survey data to: (i) describe and monitor trends in no/lo alcohol availability, sales and purchasing; (ii) test hypotheses regarding the impact of the intervention and its components on alcohol sales and purchasing; (iii) assess whether increased no/lo consumption reduces standard alcohol consumption.

WP3 will use cross-sectional survey data to examine the role of no/lo drinks in individuals’ attempts to reduce alcohol consumption. It will also use qualitative focus groups to explore how people embed no/lo drinks in everyday practices in ways that support positive or negative impacts on public health.

WP4 will adapt an established policy analysis tool to: (i) model the health, health inequality and health economic impact of the intervention and (ii) appraise the potential public health impact of policy options prioritised by stakeholders.

IMPACT AND DISSEMINATION: The research is designed to deliver actionable evidence for stakeholders within government, other public bodies, third sector organisations and the public. Central to its dissemination approach is working closely with a stakeholder advisory group throughout the project to immerse members in our work, share emerging findings, discuss the evolving intervention context and respond flexibly to changing evidence needs.