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.

Reduction of Alcoholic Strength: Does It Matter for Public Health?

“…Finally, while—against some predictions to the contrary—the introduction of no- and low- alcohol beverages has led to general substitution effects [ 5 ], the uptake of such products by the general population has not been large enough to produce sizable public health effects. It would, therefore, be up to the industry to demonstrate that there could be conditions under which a public-health relevant substitution would take place.…”

“…Kantar Worldpanel’s (KWP) household shopping panels, previously described [ 5 , 12 , 39 , 40 ], were used for Great Britain and Spain: 5.02 million separate alcohol purchases were recorded by 79,415 British households, over six years (2015–2020); and 1.29 million separate alcohol purchases were recorded by 18,954 Spanish households, over five years (from the second quarter of 2017 to the end of the first quarter of 2022).…”

“…The second and third pathways, which are addressed in detail in this contribution, concern the reformulation of products with lower alcoholic strength, and the introduction of products with low or no alcohol content. To date, reformulation has mainly been done for beer (e.g., a beer with 4.8% alcoholic strength reduced to 4.5% [ 5 ]). The brand name has also occasionally been changed, i.e., the new beer has been given a different name.…”

Representations of Low(er) Alcohol (Craft) Beer in the United States

“…Due to increasing social interest in health and wellness, particularly vis-à-vis alcohol consumption, rising cultural trends toward sobriety and moderating alcohol intake, and improvements in brewing technology [ 1 , 2 ], “low-gravity” beer is on the rise among both craft and larger-scale producers [ 3 ]. As this particular style serves to distinguish breweries from their competition, in this paper, we assess the representation of “NoLo” [ 2 ] (no/low-alcohol) beer among craft brewers in the United States.…”

“…Globally, the definitions for, classifications of, and regulatory guidelines surrounding no- and low-alcohol products are extremely variable, despite widespread agreement among public health professionals that monitoring and potentially reducing alcohol’s impacts on society is a wise policy choice [ 2 ]. Thus, at the global scale at least, the debate is ongoing regarding how to best incentivize the production of no- and low-alcohol products [ 1 ]. In the United States, the same ambiguities and disincentives prevail.…”