Lower Strength Alcohol Products-A Realist Review-Based Road Map for European Policy Making

Abstract

This paper reports the result of a realist review based on a theory of change that substitution of higher strength alcohol products with lower strength alcohol products leads to decreases in overall levels of alcohol consumption in populations and consumer groups. The paper summarizes the results of 128 publications across twelve different themes. European consumers are increasingly buying and drinking lower strength alcohol products over time, with some two fifths doing so to drink less alcohol. It tends to be younger more socially advantaged men, and existing heavier buyers and drinkers of alcohol, who take up lower strength alcohol products. Substitution leads to a lower number of grams of alcohol bought and drunk. Although based on limited studies, buying and drinking lower strength products do not appear to act as gateways to buying and drinking higher strength products. Producer companies are increasing the availability of lower strength alcohol products, particularly for beer, with extra costs of production offset by income from sales. Lower strength alcohol products tend to be marketed as compliments to, rather than substitutes of, existing alcohol consumption, with, to date, the impact of such marketing not evaluated. Production of lower strength alcohol products could impair the impact of existing alcohol policy through alibi marketing (using the brand of lower strength products to promote higher strength products), broadened normalization of drinking cultures, and pressure to weaken policies. In addition to increasing the availability of lower strength products and improved labelling, the key policy that favours substitution of higher strength alcohol products with lower strength products is an alcohol tax based on the dose of alcohol across all products.

Keywords: household purchase data; lower strength alcohol products; realist review; substitution.

Figure 1

Logic model in which the review examines questions related to implementation, uptake of lower strength alcohol products that takes place at the levels of (i) producers, (ii) consumers, and (iii) policy-makers; within a context of (iv) who buys and drinks lower strength products and why, (v) the production of lower strength products, and (vi) policies that promote the uptake of lower strength products; with mechanisms of impact that are potentially beneficial through (vii) substitution, and potentially adverse with lower strength alcohol products acting as (viii) gateways to higher strength products, (ix) mediators of additional and alibi marketing, and (x) facilitators of increased interference by alcohol producers in alcohol policy; leading to outcomes of (xi) less alcohol drunk and (xii) improved health.