̽��ֱ�� of Cambridge - Gareth Hollands

Increasing availability of non-alcoholic drinks may reduce amount of alcohol purchased online

cjb250 — Thu, 30 Mar 2023 18:00:42 +0000

̽��ֱ��team used a simulated supermarket that presented shoppers with varying proportions of alcoholic and non-alcoholic drinks and asked them to select drinks to purchase for their next online shop. They found that shoppers who were exposed to more non-alcoholic drinks selected and purchased fewer units of alcohol. ̽��ֱ��findings are published in PLOS Medicine.

Excessive alcohol consumption is a major risk factor for a number of diseases, including cancer, heart disease and stroke. Encouraging people to change their behaviour could therefore have significant health benefits at both an individual and population level.

There is increasing evidence that people can be ‘nudged’ towards reducing their alcohol consumption by making small adjustments to their environment. For example, scientists at Cambridge’s Behaviour and Health Research Unit have previously shown that serving wine in smaller glasses – even while keeping the amount of wine in the glasses the same – led to people consuming less alcohol.

A recent analysis found that reducing the proportion of unhealthy snacks available can reduce how much of these food products people consume, though the evidence included was limited in both quality and quantity. ̽��ֱ��Cambridge team wanted to see if a similar approach might work to nudge people towards consuming fewer alcoholic drinks.

̽��ֱ��researchers recruited 737 adults living in England and Wales, all of whom regularly purchased alcohol online, to take part in the study. Of these, just over 600 completed the study and were included in the final analysis – 60% were female and the average (mean) age was 38.

Participants selected drinks from 64 options in a simulated online supermarket designed to look and function like a real online supermarket. Options included a range of beers, ciders, alcohol-free beer and cider alternatives, and soft drinks.

Participants were randomly assigned to one of three groups, each of which was presented with a different proportion of alcoholic and non-alcoholic drinks. 25% of the drinks seen by Group 1 were non-alcoholic. For Group 2, this increased to 50%, and for Group 3 the proportion of non-alcoholic drinks seen rose to 75%.

Those exposed to the highest proportion of non-alcoholic drinks (Group 3) selected fewer alcohol units, 17.5 units, compared to 29.4 units in those exposed to the lowest proportion of non-alcoholic drinks (Group 1) – equivalent to a reduction of about 41%.

Participants were then asked to actually purchase the same drinks in an online supermarket, Tesco, the largest national supermarket in the UK. Around two-thirds of participants completed this second stage, with 422 participants going on to purchase drinks. ̽��ֱ��researchers point out that ‘cart abandonment’ – where people do not purchase items they put in their shopping cart – is common in online shopping contexts.

̽��ֱ��researchers found that amongst participants exposed to the highest proportion of non-alcoholic drinks, 52% of the drinks purchased were alcoholic, compared to 70% of drinks that were purchased by those exposed to the lowest proportion of non-alcoholic drinks.

Lead author Dr Natasha Clarke said: “We created our simulated supermarket to be as close as possible to an actual online supermarket and found that increasing the proportion of non-alcoholic drinks that shoppers were exposed to made a meaningful difference to their alcohol selection. Though we’d need to confirm these findings using only a real online supermarket, they are very promising.”

While the current market for alcohol-free beer, wine and spirits represents only a small share of the global alcohol industry, it is rapidly growing. For example, low and no-alcohol beer currently accounts for 3% of the total beer market, but this is forecast to increase by nearly 13% per year over the next 3 years and is the fastest growing drinks segment in the UK.

Senior author Dr Gareth Hollands said: “Supermarkets typically stock a wider range of alcoholic drinks than non-alcoholic alternatives aimed at adults, but this is slowly changing. Our results suggest that if non-alcoholic options were to become the majority instead, we might expect to see substantial reductions in alcohol purchasing.”

Importantly, the overall number of drinks that participants selected and purchased remained similar between groups, suggesting that effects were a result of shifting people’s choices. This implies overall drink sales and potentially revenues may be relatively unchanged, dependent on the pricing of non-alcoholic drinks.

Professor Dame Theresa Marteau, Director of the Behaviour and Health Research Unit and a Bye-Fellow at Christ's College, said: “We all know that drinking too much alcohol is bad for us, but we’re often unaware of how much we are influenced by the environment around us. Making changes to this environment – from exposing people to a greater proportion of healthier options through to changing the sizes of the utensils we eat and drink from – can help us cut down on potentially unhealthy habits. Even relatively small changes can make a difference both to individuals and at a population level.”

Although some of the non-alcoholic drink options in the current study contained no sugar and were generally lower in calories than the alcoholic options – an average of 64 calories per non-alcoholic drink versus 233 calories per alcoholic drink – many soft drinks and alcohol-free alternatives still contain large amounts of sugar and calories. ̽��ֱ��researchers argue that, given the health risks associated with sugary drink consumption, continued regulation and policies to reduce sugar content and consumption from both alcoholic and non-alcoholic drinks is needed to mitigate these risks.

̽��ֱ��research was funded by Wellcome and carried out at the Behaviour and Health Research Unit, ̽��ֱ�� of Cambridge. Dr Clarke is now a Lecturer in Psychology at Bath Spa ̽��ֱ��. Dr Hollands is a Principal Research Fellow at UCL.

Reference
Clarke, N et al. Impact on alcohol selection and online purchasing of changing the proportion of available non-alcoholic versus alcoholic drinks: A randomised controlled trial. PLOS Med; 30 Mar 2023; DOI: 10.1371/journal.pmed.1004193

Increasing the proportion of non-alcoholic drinks on sale in online supermarkets could reduce the amount of alcohol people purchase, suggests a study published today led by researchers at the ̽��ֱ�� of Cambridge.

We all know that drinking too much alcohol is bad for us, but we’re often unaware of how much we are influenced by the environment around us

Theresa Marteau

aire images (Getty Images)

Hand holding a smartphone inside a cafeteria with an app to buy in the supermarket

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No evidence that genetic tests change people’s behaviour

cjb250 — Tue, 15 Mar 2016 23:30:30 +0000

Researchers at the Behaviour and Health Research Unit analysed a number of studies that looked at whether testing an individual’s DNA for genetic variants that increased their risk of developing so-called ‘common complex diseases’ influenced their health-related behaviour. Complex diseases are those such as heart disease, most cancers and diabetes, where no single gene causes the disease, but rather it is the interaction of dozens – possibly hundreds – of genes together with an individual’s environment and behaviour that leads to the disease.

Genome sequencing – reading an individual’s entire DNA – has opened up the potential to provide individuals with information on whether or not they carry genes known to increase their risk of disease. Such tests are controversial – knowing that an individual carries these variants does not mean that individual will develop the disease; however, proponents argue that if an individual knows that he or she is at a greater risk of a particular disease, they can make an informed decision about whether or not to change their behaviour.

In the early 2000s, several companies launched direct-to-consumer tests for a range of common complex disorders, and these tests continue to be sold in Canada, the United Kingdom, and other European countries. In 2013 in the United States, the Food and Drug Administration ordered the company 23andMe to stop selling its health-related testing kits because of concerns about their accuracy and usefulness, but in October 2015 the company resumed selling some health-related services.

̽��ֱ��Cambridge researchers examined over 10,000 abstracts from relevant studies and identified from these 18 studies that matched their criteria for inclusion in their analysis. By compiling the data, they found that informing individuals of their genetic risk had little or no effect on their health-related behaviour, particularly for smoking cessation and physical activity.

Professor Theresa Marteau, who led the study, says: “Expectations have been high that giving people information about their genetic risk will empower them to change their behaviour – to eat more healthily or to stop smoking, for example – but we have found no evidence that this is the case. But nor does the evidence support concerns that such information might demotivate people and discourage them from changing their behaviour.”

However, the researchers recognise that DNA testing may still play a role in improving people’s health. “DNA testing, alone or in combination with other assessments of disease risk, may help clinicians identify individuals at greatest risk and allow them to target interventions such as screening tests, surgery, and drug treatments,” explains co-author Dr Gareth Hollands.

̽��ֱ��team argue that these results are consistent with other evidence that risk communication typically has at best only a small effect on health behaviour.

̽��ֱ��study was funded by the Medical Research Council and the National Institute for Health Research.

Reference
Hollands, GJ et al. ̽��ֱ��impact of communicating genetic risks of disease on risk-reducing health behaviour: systematic review with meta-analysis. BMJ; 15 March 2016; DOI: 10.1136/bmj.i1102

Genetic tests that provide an estimate of an individual’s risk of developing diseases such as lung cancer and heart disease do not appear to motivate a change in behaviour to reduce the risk, according to a study led by the ̽��ֱ�� of Cambridge and published in ̽��ֱ��BMJ today.

Expectations have been high that giving people information about their genetic risk will empower them to change their behaviour, but we have found no evidence that this is the case

Theresa Marteau

Shaury Nash

Alineando secuencias (cropped)

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Larger-sized portions, packages and tableware lead to higher consumption of food and drink

cjb250 — Mon, 14 Sep 2015 17:00:34 +0000

̽��ֱ��research, carried out by the ̽��ֱ�� of Cambridge and published in the Cochrane Database of Systematic Reviews, suggests that eliminating larger-sized portions from the diet completely could reduce energy intake by up to 16% among UK adults or 29% among US adults.

Overeating increases the risks of heart disease, diabetes, and many cancers, which are among the leading causes of ill health and premature death. However, the extent to which this overconsumption might be attributed to ‘overserving’ of larger-sized portions of food and drink has not been known.

As part of their systematic review of the evidence, researchers at the Behaviour and Health Research Unit combined results from 61 high quality studies, capturing data from 6,711 participants, to investigate the influence of portion, package and tableware size on food consumption. These results are published in the Cochrane Database of Systematic Reviews.

̽��ֱ��data showed that people consistently consume more food and drink when offered larger-sized portions, packages or tableware than when offered smaller-sized versions, suggesting that, if sustained reductions in exposure to large sizes could be achieved across the whole diet, this could reduce average daily energy consumed from food by 12% to 16% among adults in the UK (equivalent of up to 279 kcals per day) or by 22% to 29% among US adults (equivalent of up to 527 kcals per day). ̽��ֱ��researchers did not find that the size of this effect varied substantively between men and women, or by people’s body mass index, susceptibility to hunger, or tendency to consciously control their eating behaviour.

Dr Gareth Hollands from the Behaviour and Health Research Unit, who co-led the review, says: “It may seem obvious that the larger the portion size, the more people eat, but until this systematic review the evidence for this effect has been fragmented, so the overall picture has, until now, been unclear. There has also been a tendency to portray personal characteristics like being overweight or a lack of self-control as the main reason people overeat.

“In fact, the situation is far more complex. Our findings highlight the important role of environmental influences on food consumption. Helping people to avoid ‘overserving’ themselves or others with larger portions of food or drink by reducing their size, availability and appeal in shops, restaurants and in the home, is likely to be a good way of helping lots of people to reduce their risk of overeating.”

However, the researchers point out that large reductions are likely to be needed to achieve the changes in food consumption suggested by their results. Also, the review does not establish conclusively whether reducing portions at the smaller end of the size range can be as effective in reducing food consumption as reductions at the larger end of the range. Critically, there is also a current lack of evidence to establish whether meaningful short-term changes in the quantities of food people consume are likely to translate into sustained or meaningful reductions in consumption over the longer-term.

̽��ֱ��researchers highlight a range of potential actions that could be taken to reduce the size, availability or appeal of larger-sized portions, packages and tableware, including: upper-limits on serving sizes of energy-dense foods and drinks (for example, fatty foods, desserts and sugary drinks), or on the sizes of crockery, cutlery and glasses provided for use in their consumption; placing larger portion sizes further away from purchasers to make them less accessible; and demarcating single portion sizes in packaging through wrapping or a visual cue.

However, as Dr Hollands says: “With the notable exception of directly controlling the sizes of the foods people consume, reliable evidence as to the effectiveness of specific actions to reduce the size, availability or appeal of larger-sized food portions is currently lacking and urgently needed.”

Other potential actions include: restricting pricing practices whereby larger portion and package sizes cost less in relative (and sometimes absolute) monetary terms than smaller sizes and thus offer greater value for money to consumers; and restricting price promotions on larger portion and package sizes. ̽��ֱ��researchers suggest that some of the highlighted actions to limit portion size are likely to require regulation or legislation, helped by active demand from the public for changes to the food environment.

“At the moment, it is all too easy – and often better value for money – for us to eat or drink too much,” said Ian Shemilt, who co-led the review. “ ̽��ֱ��evidence is compelling now that actions that reduce the size, availability and appeal of large servings can make a difference to the amounts people eat and drink, and we hope that our findings will provide fresh impetus for discussions on how this can be achieved in a range of public sector and commercial settings.”

Reference
Hollands GJ, Shemilt I, et al. Portion, package or tableware size for changing selection and consumption of food, alcohol and tobacco. Cochrane Database of Systematic Reviews 2015, Issue 9.

A new review has produced the most conclusive evidence to date that people consume more food or non-alcoholic drinks when offered larger sized portions or when they use larger items of tableware.

There has... been a tendency to portray personal characteristics like being overweight or a lack of self-control as the main reason people overeat. In fact, the situation is far more complex

Gareth Hollands

Ewan Munro

Hawksmoor, Spitalfields, London

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