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Journal of Public Health Advance Access originally published online on December 18, 2006
Journal of Public Health 2007 29(1):13-16; doi:10.1093/pubmed/fdl080
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© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

How ‘sensible’ is the UK Sensible Drinking message? Preliminary findings amongst newly matriculated female university students in Scotland



Jan Gill, Senior Lecturer in Physiology and Pharmacology

Fiona O’May, Research Fellow
Faculty of Health and Social Sciences, Queen Margaret University College, Corstorphine, Edinburgh EH12 8TS, Scotland, UK

Address correspondence to Jan Gill, E-mail: jgill{at}qmuc.ac.uk

Background Current levels and patterns of alcohol drinking continue to cause concern, particularly amongst young females. Effective interventions remain elusive. The aim of this study was to investigate the levels of knowledge relating to UK ‘Sensible Drinking’ guidelines, definitions of binge drinking and attitude to drink labelling initiatives amongst female school leavers enrolling at university.

Methods Non-standardized questionnaires were administered and completed by researchers during the process of matriculation (response rate 94%; n = 180).

Results The survey revealed that recommended daily guidelines for women were not recalled by 54% of participants; 52% could not quote the unit content of their favoured alcoholic drink, whereas only 14% reported the use of the UK unit system to guide drinking. Personal quantitative definitions of binge drinking varied by a factor of 18.

Conclusion A rewording of the UK Sensible Drinking message to one recognizing the needs of different population groups and their particular language of consumption measure is timely.

Keywords: binge drinking, health messages, student drinking


   Introduction
TOP
 Introduction
Methods
 Results
 Discussion
 Contributors
 Competing interests
 Ethical approval
 Acknowledgements
 References
 
UK per capita alcohol consumption merits the dubious honour of a ranking within the top 10 alcohol-consuming countries in the world.1 For young women, the picture is particularly concerning. A recent UK population study suggests that while the drinking in young men has remained high but relatively stable, the average consumption in young women almost doubled within a 4-year period.2 In Scotland, female deaths due to alcoholic liver disease rose 424% in the period 1980–2003.3 Binge drinking, now recognized as essentially the normative pattern for consumption among young people, is reported to cost the United Kingdom £20 billion annually.4

The need to act and to develop effective, tailored interventions is clear. A major cornerstone of recent UK alcohol policy has been the Sensible Drinking message that recommends daily consumption limits (2–3 units for women and 3–4 units for men, where 1 unit is 8 g of alcohol).5 An explicit aim of this document was to limit sessional intake and thereby incidents of drunkenness. Eleven years on, statistics around alcohol consumption in general6,7 and female drinking in particular2,3 justify the need to question the effectiveness of this policy.

This pilot study has explored not only recall of the substance of the policy but, crucially, understanding of its content in relation to personal drink choices among female students matriculating into university year 1. Additionally, sources of alcohol education experienced by these women both within and outside the school environment, personal definitions of binge drinking and their reactions to a relatively recent form of alcohol education within the United Kingdom, drink container labelling, are documented.


   Methods
TOP
 Introduction
 Methods
Results
 Discussion
 Contributors
 Competing interests
 Ethical approval
 Acknowledgements
 References
 
Participants
During matriculation, first-year female undergraduate university students (n = 180) were approached and invited to participate in a questionnaire-based study (response rate = 94%). This represents 28.4% of all eligible students (exclusion criteria: secondary education completed out with United Kingdom/Eire or not in the preceding 4 years).

Measures
The 12-item non-standardized questionnaire was completed by researchers. Age, country of secondary education and drinker/non-drinker classification (non-drinker was defined as drinking <1–2 UK units per year) were noted. Also recorded were recency of school-based health education (SBHE) relating to alcohol, favoured options from a list of 10 potential information sources relating to alcohol education gained out with the school setting, recall of UK-recommended daily limits for alcohol consumption, use of the drink ‘unit’ system to monitor personal or friends’ drinking etc., personal definitions of binge drinking and their ‘opinion on the value of drink labelling’ (for this question, a photograph of a wine bottle label employed by one UK supermarket was shown). Finally, participants were asked to identify their preferred drink and then to quantify the UK unit content of its commercially available bottle/can. (The volume was specified).

An anonymized coding system for questionnaires was employed. Data were analysed using SPSS and Excel.


   Results
TOP
 Introduction
 Methods
 Results
Discussion
 Contributors
 Competing interests
 Ethical approval
 Acknowledgements
 References
 
Questionnaires were completed by 180 female students. Of those, 8.3% (n = 15) classified themselves as non-drinkers.

The average age of the drinkers (n = 165) was 18.45 (±0.7) years, whereas that of non-drinkers was significantly lower: 18.02 ± 0.46 years (Mann–Whitney U-test; P < 0.05). The legal age to buy alcohol is 18 years within the United Kingdom; 24% of drinkers and 60% of non-drinkers were below this age.

Sources of health education
Around two-fifths of all participants (39%, n = 70) claimed that they had received SBHE relating to alcohol drinking within the last year. One-quarter of participants (n = 45) claimed either ‘never’ or ‘could not remember’ receiving information. From the list of 10 options listed as sources of Sensible Drinking information received outside school, the average number ticked by participants was 2.3. The most popular was television (28% of all responses, n = 113) followed by parents (25%, n = 102) and then magazines (19%, n = 70).

Recall of UK daily Sensible Drinking guidelines
Over one-half of drinkers offered no value for the recommended daily consumption limits for males (58%, n = 95) or females (54%, n = 89). Among those claiming ‘never’ to have received SBHE (n = 23), the corresponding figures were 61% (n = 14) and 48% (n = 11), respectively. For comparison, figures for those who had received SBHE in the year before the study were 53% (n = 37) and 51% (n = 36). Recent SBHE did not appear to improve recall of the Sensible Drinking guidelines.

Only 4% of drinkers (n = 6) could quote the correct figures for males and 2% (n = 3) for females. Two respondents correctly quoted daily guidelines for both genders.

Favoured drinks and related knowledge
Drinkers (n = 165) were asked to identify the drink they consumed most frequently. The three most popular drinks consumed by 91% of this group were spirit (44% of drinkers, n = 73), Alcopops (‘designer’ spirit-based drinks) (27%, n = 44) and wine (20%, n = 33).

Participants were asked to state the unit content of the commercially available bottle of their favourite drink. Among wine drinkers, 45% (n = 15) offered no answer. A reasonably accurate answer (between 8 and 10 UK standard alcohol units corresponding to an alcohol by volume (ABV) of 10.7–13.3%) was offered by 30% (n = 10), underestimates of between 2 and 6 UK units by 18% (n = 6). Two respondents provided serious overestimates of 14–18 UK units.

A high percentage of spirit drinkers, 61% (n = 45), offered no answer. A content of ≤ 20 units was suggested by 21% (n = 15) of spirit drinkers. (Assuming an ABV of 40% and a volume of 700 ml, a bottle would contain 28 UK units.)

For Alcopops, 43.2% (n = 19) failed to respond, whereas 40.5% (n = 17) provided a relatively accurate answer of 1–2 UK units.

Overall, 52% (n = 86) of these drinkers failed to offer any estimate of the unit content of their preferred drink, whereas 13% (n = 21) seriously underestimated the unit content.

Personal definitions of binge drinking in terms of favourite drink
Of wine drinkers (n = 33), 24% defined binge drinking as drinking one-half to one bottle of wine, 36% as one to two bottles and 18% as two to four bottles. (This represents a range of 4–48 UK units; 32–384 g alcohol.)

For spirit drinkers (n = 73), binge drinking definitions ranged from 3 to 16 ‘shots’ or, for those using the ‘bottle’ as a measure, one-quarter to a half bottle (12% of spirit drinkers) and between one-half and two bottles of spirit, quoted by 42% (a range of 3–56 UK units; 24–448 g alcohol).

For those drinking Alcopops (n = 44), 2–4 bottles were seen as constituting binge drinking by 14%, 5 to <7 bottles by 36% and 7 up to 25 bottles by 43%. Within the United Kingdom, an average bottle of Alcopops contains 1.5 standard alcohol units (a range of 3–38 UK units; 24–304 g alcohol).

The drinkers who constituted each of the three popular drink groups were asked whether they ever used the UK standard alcohol unit system when buying or consuming drinks. Overall, 86% (n = 130) claimed not to use the UK unit system.

Attitude to drink label
The attitude of students to the Sensible Drinking information presented on the wine bottle label fell into four categories (Table 1). Overall, the ratio of favourable to unfavourable comments among drinkers was ~2:1.


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  		Table 1 Attitude to wine label displaying aspects of the UK Sensible Drinking guidelines and the UK unit content of the bottle

 


   Discussion
TOP
 Introduction
 Methods
 Results
 Discussion
Contributors
 Competing interests
 Ethical approval
 Acknowledgements
 References
 
At least three factors arguably will impact on the successful dissemination of a health education message: (i) awareness of the message, (ii) understanding of its substance and (iii) willingness to respond to it. This pilot study of young UK women reveals a sizeable number claiming to arrive at university with no recent school-based exposure to alcohol education. This finding, if replicated, has important implications for UK university authorities intent upon addressing alcohol abuse issues.

Very few women could accurately recall UK Sensible Drinking daily guidelines (a characteristic of students noted by others8,9). Crucially, a sizeable majority were relatively ignorant of the alcohol unit content of the commercially available volume of their favourite drink. The value of setting health guidelines must be challenged if the yardstick is poorly employed.

Many women claimed that the UK Sensible Drinking message did not influence their drinking behaviour. This may reflect limited exposure to the message but possibly a belief that the message is irrelevant. A prime aim of drinking within this population group may simply be to get drunk.10,11 The contrasts between the health educators’ view of drinking behaviour and that held by students may be further illustrated by the disparity between the definitions favoured by each for the term binge drinking. Within many UK government publications, a common definition is the consumption of ≥6 UK units by a woman in one session.12 This contrasts sharply with the quantities reported here. However, where the behavioural effect is sought, quantities are possibly irrelevant. The maximum levels of sessional consumption reported here are likely exaggerated, but to use one term to classify all consumption of >6 UK units is unhelpful and potentially dangerous.

Future initiatives designed to inform this population group should explore further the potential impact of television, parents, magazines and drink labelling information.


   Contributors
TOP
 Introduction
 Methods
 Results
 Discussion
 Contributors
Competing interests
 Ethical approval
 Acknowledgements
 References
 
J.G. and F.O’M. designed the project; both authors contributed to the questionnaire, organized the survey and undertook the data analysis; J.G. was responsible for initial and subsequent drafts, with F.O’M. contributing; J.G. is guarantor.


   Competing interests
TOP
 Introduction
 Methods
 Results
 Discussion
 Contributors
 Competing interests
Ethical approval
 Acknowledgements
 References
 
Neither of the authors has competing interests.


   Ethical approval
TOP
 Introduction
 Methods
 Results
 Discussion
 Contributors
 Competing interests
 Ethical approval
Acknowledgements
 References
 
Favourable opinion was granted by Queen Margaret University College Research Ethics Committee.


   Acknowledgements
TOP
 Introduction
 Methods
 Results
 Discussion
 Contributors
 Competing interests
 Ethical approval
 Acknowledgements
References
 
This study was funded by a small grant funded by Queen Margaret University College Research Committee. The contribution of the following researchers is also gratefully acknowledged: Sally May, Ian Chisholm, Maria Chow and Laura Sutherland.


   References
TOP
 Introduction
 Methods
 Results
 Discussion
 Contributors
 Competing interests
 Ethical approval
 Acknowledgements
 References
 

  1. HM Customs and Excise. Alcohol Factsheet: November 2004, London, UK: HM Customs and Excise, 2004.
  2. Rickards L, Fox K, Roberts C et al. Living in Britain: Results from the General Household Survey, 31. London, UK: The Stationery Office, 2004.
  3. NHS National Services Scotland. Alcohol Statistics Scotland 2005. Edinburgh, Scotland, UK: ISD Scotland Publications, 2005.
  4. Cabinet Office. Alcohol Harm and Reduction Strategy for England. London, UK: Prime Minister’s Strategy Unit, Cabinet Office, 2004.
  5. Department of Health. Department of Health Sensible Drinking: The Report of an Inter-departmental Working Group. London, UK: Department of Health, 1995.
  6. Scottish Executive. The Scottish Health Survey 2003. Edinburgh, Scotland, UK: Scottish Executive, 2005.
  7. Anderson P, Baumberg B. Alcohol in Europe. A Public Health Perspective. A report for the European Commission. Institute of Alcohol Studies, UK, June 2006.
  8. Granville-Chapman JE, Yu K, White PD. A follow-up survey of alcohol consumption and knowledge in medical students. Alcohol Alcohol 2001;36:540–3.[Abstract/Free Full Text]
  9. Hasking P, Shortell C, Machalek M. University students’ knowledge of alcoholic drinks and their perception of alcohol-related harm. J Drug Educ 2005;35:95–109.[CrossRef][Web of Science][Medline]
  10. Weitzman ER, Nelson TF, Wechsler H. Taking up binge drinking in college: the influence of person, social group and environment. J Adolesc Health 2003;32:26–35.[CrossRef][Web of Science][Medline]
  11. Gill JS, Donaghy M, Guise J et al. Descriptors and accounts of female undergraduate drinking in Scotland. Health Educ Res in press.
  12. Lader D, Goddard E. Drinking: adults’ behaviour and knowledge in 2004. A report on research using the ONS Omnibus Survey produced by the Office for National Statistics on behalf of the Department of Health. London, UK: Department of Health, 2004.

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This Article
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