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CHAPTER FOUR: KNOWLEDGE AND AWARENESS OF ALCOHOL CONTENT AND SENSIBLE DRINKING GUIDELINES
Introduction
4.1 Recent alcohol education and public information initiatives have at their root the idea that it is the responsibility of the individual to make informed choices about alcohol consumption, based on sound advice from the government on these recommended limits. In Scotland this has included campaigns such as the Scottish Government's Alcohol: Don't Push It initiative and the revamped alcohol section of the infoscotland website, which has a renewed focus on awareness of 'units' of alcohol and how these translate into different quantities of alcoholic drinks. In October 2007, Scotland held it's first Alcohol Awareness Week, a partnership between the Scottish Government, the alcohol industry and health professionals with the aim of raising awareness of the concept of units, sensible drinking levels and the unit content of different alcoholic drinks to help foster a culture of sensible drinking in Scotland. 32
4.2 The 2007 SSA included several questions designed to assess the extent to which these messages of moderation are being heard, and understood, in Scotland. In particular it explored the following key questions:
Key questions
- How aware are people in Scotland of the use of the term 'unit' to describe the alcohol content of drinks?
- To what extent are people able to correctly identify the number of units in standard measures of alcoholic drinks?
- Have people heard of government advice not to drink more than a certain number of units of alcohol a day?
- How aware are people in Scotland of the current government recommended maximum number of units per day for men and for women?
4.3 Questions on awareness of the term 'unit' and on current daily recommended units for men and women were taken from the Health Education Population Survey ( HEPS), an NHS Health Scotland study set up to monitor health related knowledge and attitudes in Scotland (incorporated into the Scottish Health Survey from 2008). Questions on the alcohol content of specific drinks were designed to compliment these by exploring awareness of the relationship between units and specific drinks in more detail. Taken together, these questions give an indication of the degree to which people in Scotland are aware of and able to apply the current government advice on sensible drinking limits.
Awareness of units
4.4 Since its introduction in 1987, the 'unit,' defined in the UK as 8 grams of pure alcohol, has increasingly formed the basis of public information drives on sensible drinking. SSA 2007 revealed a high level of public awareness of this term, with 95% having heard of measuring alcohol in units. This reflects findings from previous waves of the Health Education Population Survey, which found that in the ten years from 1996 to 2006 the percentage of respondents that did not know what a unit was fell from 15% to 7% ( NHS Health Scotland, 2006). 33
4.5 Awareness of the terminology of 'units' therefore appears high in Scotland. However, the effectiveness of promoting sensible drinking messages based around 'units' also depends on the public having a clear understanding of what this means in relation to their own alcohol consumption. A better indicator of public knowledge might therefore be the extent to which people are able to correctly identify the units in standard measures of different alcoholic drinks. Such a task has arguably become more difficult in recent years, complicated by increases in drink size and strength across the UK. In addition, evidence from the Scottish Health Survey 2003 shows that the most common drinking location mentioned by drinkers is now their own home, with 71% of male and 72% of female current drinkers reporting that this was where they usually were when they drank alcohol (Scottish Executive, 2005). With such a large percentage regularly drinking self poured measures in the home, and strengths of alcoholic drinks rising more steeply since the mid 1990s, the early guidance of one unit equating to half a pint of lager or a glass of wine has become increasingly problematic.
4.6 SSA 2007 asked how many units people thought there were in (a) a pint of normal strength beer (b) a single pub measure of spirits and (c) a normal bottle of wine. Figure 4.1 illustrates the difficulty many people face in accurately identifying the number of units in a given measure of alcoholic drink. Although it is encouraging that 54% of those who had heard of measuring alcohol in units and over half of all respondents are able to correctly identify the number of units in a pint of normal strength beer as 2 or 3 34, it is striking that a third either just do not know or have not heard about measuring alcohol in these terms.
Figure 4.1 Belief about number of units in a pint of normal strength beer (%)
Base: All respondents
Sample size: All who have heard of units = 1,415, All respondents = 1508
Note to table: This question (and subsequent questions about unit content of wine and spirits) was only asked of those who said they had heard of units at the previous question. The 'All respondents' figures include those who had not heard of units, to show levels of awareness of alcohol content across the population as a whole (not just among those who have heard of units).
4.7 Similar findings are apparent with respect to a single pub measure of spirits, for example whisky or gin. Whilst 59% of those who have heard of units (and 56% of all respondents) correctly answered 1 or 2 units, 35 again around a third of respondents did not know how to answer (Figure 4.2).
Figure 4.2 Belief about number of units in a single pub measure of spirits (%)
Base: All respondents
Sample size: All who have heard of units = 1,415, All respondents = 1508
4.8 However, the findings with respect to beer and spirits are relatively positive when compared with knowledge of the number of units in a normal bottle of wine. Larger wine glasses and rising strengths have made estimating the alcohol content of wine increasingly difficult. Although an average bottle of wine is now around 12% ABV with 9 units of alcohol in a 750ml bottle, many are stronger. 36 This difficulty is reflected in the fact that almost four in ten significantly underestimate the amount of alcohol in a bottle of wine as 7 units or fewer. Only 15% of all respondents identified the alcohol content 'correctly' as 8 to 10 units (Figure 4.3). 37 Strikingly a further four in ten either do not know the answer or have not heard of measuring wine in units. Taken together, these findings illustrate that many people are simply unable to identify the number of units in everyday measures of alcoholic drinks.
Figure 4.3 Belief about number of units in a normal bottle of wine (%)
Base: All respondents
Sample size: All who have heard of units = 1,415, All respondents = 1508
Awareness of government advice on daily limits
4.9 Public awareness of the actual unit content of different drinks thus appears patchy at best, but to what extent are people aware of how many units they should be drinking? SSA 2007 included additional questions on awareness of government guidelines or thresholds for daily drinking. In 1995 the Department of Health published the paper Sensible Drinking: the report of an interdepartmental working group which raised concerns that the weekly recommended limits of 21 units for men and 14 units for women might actually encourage binge drinking as people 'saved up' their weekly unit allowance for one or two sessions (Department of Health, 1995). This concern was behind the shift in UK wide alcohol policy towards daily consumption limits set at no more than 3 to 4 units a day for men and no more than 2 to 3 units a day for women. 38 However, there is some evidence to suggest that awareness of the daily limits is still low compared to the longer established weekly benchmarks. From 2001 to 2006 the HEPS survey gave respondents the choice of answering awareness questions based on weekly or daily limits. In 2006 only around 1 in 4 responded with a daily figure, leading some to suggest that awareness of more recent daily guidelines is lower ( NHS Health Scotland, 2006).
4.10 The findings from SSA 2007 suggest that this is not in fact the case. An encouraging 93% say yes when asked whether they have heard of government advice not to drink more than a certain number of units of alcohol a day. However, as with the findings on 'units,' awareness does not necessarily translate into detailed knowledge. For example, whilst over a third correctly identify the daily upper limit for men as 3 or 4 units, 12% underestimate and 13% overestimate the limit. Another 4 in 10 are unable to answer or have not heard of this advice (Figure 4.4).
Figure 4.4 Awareness of recommended daily limit for men (%)
Base: All respondents
Sample size: 1508
4.11 Overall a higher proportion (41%) are able to correctly identify the daily limit of 2 to 3 units for women (Figure 4.5). Nevertheless, the fact that only a third correctly identify the limits for men, and 4 in 10 for women, is evidence that the safe drinking message has not been absorbed as widely as might have been hoped. 39
Figure 4.5 Awareness of recommended daily limit for women (%)
Base: All respondents
Sample size: 1508
Factors associated with correctly identifying units in drinks
4.12 The remainder of this chapter explores which factors are significantly associated with correctly identifying the number of units in drinks and the recommended maximum number of units per day for men and women. The data presented here are informed by logistic regression analysis, used to identify those factors that are significantly and independently related to the ability to identify the correct number of units in given measures of beer, spirits and wine and the correct daily limits for men and women. Full details of this analysis are included in Annex B.
Sex and age
4.13 Women are significantly less likely to know the number of units in a pint of normal strength beer than men (Figure 4.6). This pattern is reversed for wine, with women slightly more likely to identify the correct number of units in a normal bottle. 40 Evidence from the 2003 Scottish Health Survey shows that for men, the reported usual weekly consumption of alcohol was largely made up of beer (9 units) followed by spirits (4 units) and wine (2 units). For women, spirits and wine formed the majority of units drunk (2 units each) followed by beer (1 unit) (Scottish Executive, 2005). It is possible therefore that patterns of knowledge may reflect the consumption patterns of the sexes to some extent.
Figure 4.6 Percentage correctly identifying the number of units in beer and wine, by sex (%)
Base: All respondents
Sample size: Men = 645, Women = 863
4.14 Older people are the least likely to know the number of units in measures of beer and spirits. The percentage of those aged 65 and over giving the correct answer for these measures is 24% and 33 % respectively, compared with 55% and 64% among 40-60 year olds (Table 4.1). This is particularly significant given recent research by the NHS Health Scotland Alcohol and Ageing Working Group that raised concerns about the potential health implications of the 'baby boomer' generation carrying their relatively high levels of alcohol consumption into old age ( NHS Health Scotland, 2007). Public information campaigns surrounding alcohol have tended to focus on the young but this provides some evidence to suggest that a wider approach may be needed.
Table 4.1 Correctly identifying units of alcohol in a pint of normal strength beer and single pub measure of spirits, by age, 2007 (cell %)
| Beer | Spirits | Sample size |
|---|
Age | | | |
|---|
18-29 | 58 | 52 | 181 |
|---|
30-39 | 68 | 65 | 253 |
|---|
40-64 | 55 | 64 | 705 |
|---|
65+ | 24 | 33 | 366 |
|---|
Income, education and class4.15 Those in higher income brackets are much more likely than those on low incomes to know the correct number of units across all three alcohol drink types. For example, 76% of those with incomes of £38,000 or more knew the number of units in a pint of beer, compared with only 34% of those earning £9,999 or less (Figure 4.7). Correspondingly, employers, managers and professionals are more likely to know the number of units in a measure of spirits than those in routine or semi routine employment. Thus there is a clear socioeconomic gradient in terms of knowledge and awareness of the alcohol content of drinks.
Figure 4.7 Percentage correctly identifying the number of units in beer, spirits and wine, by income (%)
Base: All respondents
Sample size: £9,999 or less = 269, £10k-£22,999 = 376, £23k-37,999 = 263, £38k+ = 323
4.16 Findings with respect to education are perhaps unsurprising given the focus on knowledge and awareness. Seventy-one per cent of those with a degree or higher education are able to correctly identify the number of units in a measure of spirits, compared to 35% of those with no qualifications. However, given the recent media focus on educated, middle class wine drinkers, it is interesting that neither education nor socio economic classification appears to have any significant bearing on the ability to correctly identify the number of units in a bottle of wine.
Frequency of drinking
4.17 Frequency of drinking is strongly related to the ability of respondents to correctly identify the units in all three measures. For example, only 39% of those who drink once or twice a month or less knew how many units there were in a pint of beer, compared to 68% of those who drink on 3 or 4 days a week or more (Figure 4.8). There is an argument that lack of knowledge of units among those who drink very seldom is less of a worry than communicating with those who do drink to excess. However, although it is encouraging that those who are drinking more often show more awareness of unit content, the question remains whether this knowledge has any corresponding effect on behaviour consumption patterns.
Figure 4.8 Percentage correctly identifying the number of units in beer, spirits and wine, by frequency of drinking (%)
Base: All respondents
Sample size: 3/4 days a week or more = 323, 1/2 times a week = 445, 1/2 times a month or less/never = 724
Factors associated with correctly identifying daily limits
Sex and age
4.18 Initial bivariate analysis appeared to suggest that sex was a significant factor in knowledge of daily limits, with men more aware of both the male and female recommended limit than women. However, further regression analysis shows that once frequency of drinking is taken into account differences between men and women are not statistically significant. Women generally tend to drink less than men and as discussed below, frequency of drinking is a stronger indicator of knowledge of daily limits.
4.19 The pattern with respect to age is U shaped, with those in the middle two age categories more likely to get the answer right than those in both the youngest (18-29) category and the oldest (65+) category (Figure 4.9). Those aged 65+ are least likely to identify the correct daily limit for men and women, at 21% and 28% respectively. Given concerns about alcohol consumption levels among both these age groups, their particularly low levels of knowledge of sensible drinking guidance may cause some concern. As discussed earlier (para 1.5), younger people are much more likely than older people to report binge drinking, while health professionals and policy makers are also becoming increasingly concerned about alcohol consumption among pensioners (see para 4.14).
Figure 4.9 Percentage correctly identifying the daily limits for women and men, by age (%)
Base: All respondents
Sample size: 18-29 = 155, 30-39 = 214, 40-64 = 634, 65+ = 306
Income, class and education
4.20 Income is not significantly associated with correctly identifying the recommended daily units. However, class and education are still significant. Awareness of both male and female recommended limits is lower among those in routine and semi routine occupations compared with other socioeconomic groups, reflecting similar findings on awareness of units in drinks.
4.21 Forty-three per cent of those with either a degree or higher education, and 43% of those with Highers or A levels, correctly identify the recommended daily limit for men, compared with only 18% of those with no qualifications (Figure 4.10). A similar pattern is apparent for knowledge of the recommended units for women. However, the fact that well under 6 in 10 of even the most educated Scots are able to correctly identify safe drinking limits is evidence that public information and education drives surrounding alcohol awareness still have some way to go.
Figure 4.10 Percentage correctly identifying recommended daily limits for men and women, by education (%)
Base: All respondents
Sample size: None = 367, Standard Grade/ GCSE = 402, Higher/A Level = 238, Degree/Higher Education =487
Frequency of drinking
4.22 Once again the frequency with which respondents drink is significantly related to their awareness of the current recommended maximum units per day for both men and women. Those who drink the least are least likely to give the correct answer (Figure 4.11).
Figure 4.11 Percentage correctly identifying the daily limits for women and men, by frequency of drinking, 2007
Base: All respondents
Sample size: 3/4 days a week or more = 323, 1/2 times a week = 445, 1/2 times a month or less/never = 724
Key points
- Awareness of the term 'unit' in relation to the alcohol content of drinks is high in Scotland, with 95% having heard of measuring alcohol in this way.
- The same can be said for awareness of government advice not to drink more than a certain number of units of alcohol a day - only 7% have not heard of this advice.
- However, despite this level of awareness many people are simply unable to identify the number of units they are drinking.
- This is particularly the case for wine, with 4 in 10 underestimating the alcohol content of a normal bottle, and only 15% able to answer correctly.
- Knowledge of the recommended daily limits for men and women is also patchy - only 41% of respondents correctly identify the recommended daily limit for women, falling to 34% for the male limit.
- Knowledge of units in different drinks varies between men and women. Sixty per cent of men could identify the units in a pint of beer compared to 44% of women. However, women are slightly more likely to know the units in a bottle of wine. This may reflect different patterns of consumption between men and women.
- Age is significantly related to both knowledge of units in drinks and knowledge of daily drinking limits, with those in the youngest (16-29) and oldest (65+) age categories the least likely to identify the correct answers. This is particularly true of units in drinks - only 24% of those aged 65 and over could correctly identify the number of units in a pint of beer as 2 or 3, compared to 55% of those aged 40-64.
- Knowledge of unit content and recommended limits is higher in higher income groups. For example, 76% of those earning £38k+ correctly identify the number of units in a pint of beer, compared to only 34% of those earning £9,999 or less.
- Those in routine and semi-routine occupations and those with lower levels of education are less likely than managers and professionals to identify the correct answer for both the numbers of units in different drinks and the daily limits for men and women.
- The frequency with which respondents drink is significantly related to awareness of both the number of units in specific drinks and the daily limits for men and women, with those who drink the least the least likely to give the correct answer.
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