Understanding the effectiveness of advertisements about the long-term harms of alcohol and low-risk drinking guidelines: A mediation analysis

https://doi.org/10.1016/j.socscimed.2020.113596Get rights and content

Highlights

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    Uses experimental design with one-week follow-up to examine message effects.

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    Correct estimates of low-risk drinking levels mediate effects on intentions.

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    Negative attitudes towards drinking mediate effects on intentions and behaviour.

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    Low-risk drinking guideline messages should be added to the end of advertisements.

Abstract

Rationale

Many people overestimate the amount of alcohol that increases their risk of harm and so may not perceive any need to change their drinking behaviour. Several countries have developed low-risk drinking guidelines, yet awareness of these guidelines remains low. Furthermore, mass media campaigns about alcohol-related harms may have limited impact if people do not perceive their current consumption as potentially harmful. Integrating drinking guidelines into media campaigns about alcohol's harms can concurrently provide drinkers with information about low-risk drinking levels and compelling reasons to comply.

Objective

Our aim was to build understanding of the effectiveness of messages about the long-term harms of drinking and low-risk drinking guidelines, by testing the mediating effects of estimates of harmful drinking levels and attitudes towards drinking alcohol on subsequent intentions and behaviours.

Method

In an online experiment conducted in 2016, n = 1156 Australian adult monthly drinkers were randomly assigned to view advertisements for non-alcohol products (NON-ALC; control), advertisements featuring long-term harms of alcohol (LTH), or LTH advertisements plus a guideline message (LTH + G). Immediately following exposure, we measured estimates of harmful drinking levels and attitudes towards drinking alcohol. One week later, we measured intentions to drink less and behavioural compliance with the guideline.

Results

Compared to NON-ALC advertisements, exposure to LTH + G advertisements increased (i) the proportion of respondents who correctly estimated harmful drinking levels, which in turn, strengthened intentions to drink less (42% of the total effect was mediated), and (ii) negative attitudes, which in turn, also increased intentions to drink less (35% mediated) and behavioural compliance (24% mediated). Compared to NON-ALC, LTH advertisements increased negative attitudes, which in turn strengthened intentions to drink less (53% mediated).

Conclusions

When paired with effective alcohol harm reduction television advertisements, messages promoting low-risk drinking guidelines can increase drinkers’ intentions to reduce their alcohol consumption and compliance with low-risk drinking guidelines.

Section snippets

Credit author statement

Emily Brennan: Conceptualization, Methodology, Investigation, Writing – original draft, Writing – review & editing, Funding acquisition. Danielle AJM Schoenaker: Formal analysis, Investigation, Writing – original draft, Writing – review & editing, Validation, Visualisation. Kimberley Dunstone: Project administration, Conceptualization, Methodology, Data curation, Investigation, Writing – review & editing. Michael D Slater: Conceptualization, Methodology, Writing – review & editing, Funding

Participants and study design

A sample of Australian adult participants was recruited through an online non-probability panel accredited under the International Organization for Standardization's standards for Market, Opinion and Social Research (AS ISO, 20252). Participants were eligible if they had consumed alcohol at least twice per month on average during the past year, were not currently pregnant or planning to become so, and did not work in health promotion, market research, advertising, or the alcohol industry.

Participant characteristics

Of 1858 participants who were assigned to one of the three relevant conditions at Time 1, 702 (37.8%) did not complete the follow-up survey (at all or within the eligible time period of ≤14 days). The non-completion rate was similar across the conditions (NON-ALC 35.0%, LTH 40.8%, and LTH + G 37.5%; χ2 = 4.45, p = 0.108) and the baseline characteristics of those lost to follow-up did not differ significantly between conditions (data not shown).

Participant characteristics are presented in Table 1

Discussion

Our study aimed to examine whether the effects of messages about the long-term harms of drinking and low-risk drinking guidelines on drinking-related intentions and behaviours are mediated through estimates of harmful drinking levels and attitudes towards drinking alcohol. Findings indicate that one important pathway through which long-term harm advertisements may affect subsequent intentions and behaviours is by increasing negative attitudes towards drinking alcohol (see Fig. 1, Fig. 2 and

Limitations

One limitation is that we only examined two potential mediators of the effect of the advertisements and guidelines on intentions and behaviours. Other potential mediators include beliefs about whether it is morally right or wrong to comply with recommended low-risk drinking levels (Pavey et al., 2018), and negative feelings elicited by the messages (Stautz and Marteau, 2016). We were only able to examine the effects of one mediator per model; yet, given the small correlation between correct

Conclusions

These results provide additional evidence supporting a campaign strategy that seamlessly incorporates low-risk drinking guideline messages into the end of effective alcohol harm reduction television advertisements, so that drinkers are concurrently provided with compelling reasons to reduce their alcohol consumption and information about the low-risk consumption level they should be aiming for. We recommend that such advertisements increasingly be used by governments and public health agencies

Declaration of competing interest

EB, KD, SJD, HGD and MAW report holding grants from Australian National Health and Medical Research Council (NHMRC) during the conduct of the study, and MAW holds a Principal Research Fellowship from the NHMRC. This study assessed drinkers’ responses to the NHMRC guidelines for low-risk drinking; NHMRC provided no input into study design or interpretation. EB, KD, SJD, HD and MAW are employed by a non-profit organisation that conducts public health research, interventions and advocacy aimed at

Acknowledgements

This work was supported by a competitive and independently reviewed Australian National Health and Medical Research Council project grant number 1070689. NHMRC provided no input into study design or interpretation.

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