Perceptions influence why and how people drink

Michael Haines, another co-author of the study and the executive director of the National Social Norms Resource Center at Northern Illinois University, emphasized the need for students to learn that normal attitudes and behavior towards alcohol are much healthier than they realize. The survey also indicated that exposure to alcohol education that corrects misperceptions about drinking on college campuses reduces alcohol-related problems.

Some Georgetown students agreed that it is important to educate students on the realities of college drinking. But Restituyo also said that peer pressure seems to play a stronger role in affecting drinking behavior than misperception does. The perception of how much others drink has been the focus of various studies among students in the USA Borsari and Carey, , , ; Carey et al.

This research has demonstrated the high prevalence of overestimating i. This overestimation, or misperception, has been identified as a strong predictor of one's own drinking McAlaney and McMahon, ; Perkins and Wechsler, For example, the belief that others drink heavily will have considerable influence on the amount a person drinks Cunningham and Selby, Previous research among students has noted that misperceptions concerning overestimating the amount of drinking by others are associated with higher levels of alcohol consumption, and perceived social norms are a strong predictor of alcohol use by them Kypri and Langley, ; McAlaney and McMahon, ; Perkins et al.

Various interventions have been designed to address these misperceptions, and have had some success among college students Carey et al. Alcohol use interventions should aim at correcting misperceptions by providing normative feedback on prevailing drinking norms. One hypothesis is that individuals with heavy alcohol use should decrease their consumption by correcting the misperception. A Cochrane review listed evidence that normative feedback interventions for students have been effective in reducing the alcohol use Moreira et al.

Many of these interventions helped subjects narrow down the difference between perceived and actual behaviours of others i. The possibility that normative feedback may decrease misperceptions provides support for the theoretical rationale on which these interventions are based.

Berkowitz, ; Moreira et al. General population studies also showed promising results when normative feedback is used, especially when embedded within web-based brief interventions Cunningham et al. Estimating alcohol misperceptions in an entire population is of interest since factors such as living on campuses or being part of student activities may have an impact on perceptions.

In Switzerland, or in other countries where there is a mandatory army conscription process, there is a unique opportunity to assess the health behaviours of young men at the population level and to conduct population-based preventive interventions.

Understanding the factors influencing alcohol consumption in these settings is essential in developing targeted preventive interventions. The Swiss conscription process mandates that virtually all non-institutionalized young men attend a physical and psychological evaluation as part of the army recruitment, at least 6 months prior to actual enrolment.

Switzerland is divided into three main linguistic regions corresponding to the main national languages of French, German and Italian. All French-speaking males have to attend the same recruitment centre where the present study was conducted, offering an opportunity to study a census of these young Swiss men. In terms of drinking recommendations, Addiction Info Suisse published the following drinking guidelines: no more than 14 drinks per week and no more than 4 drinks per occasion AddictionInfoSuisse, We were, therefore, able to investigate the extent of misperceptions surrounding alcohol use in a random sub-sample of an entire population of year-old French-speaking men in Switzerland.

Factors associated with current drinking and misperceptions were assessed, with some focus on whether education or living environment influences differences in overestimating the amount of drinking by others. We conducted a survey among year-old males attending the mandatory medical assessment portion of the Swiss army recruitment process. Subjects were informed that the study was not connected to the army, and that the military could not receive any information regarding the responses of any individual.

Virtually all of the attendees were eligible to participate in the study, but only those giving their informed consent were accepted. Recruitment for the present study took place weekly during conscription between January and September During the above period, 12, young men attended the Lausanne recruitment centre; of these, left before meeting with the research staff, refused to participate in the study and 49 did not fully complete the questionnaire and were excluded.

A visual aid was provided to participants. Answers to these questions were combined to obtain weekly alcohol consumption. Data from the conscripts were used to compute the census norms. This sample was random because it contained those individuals who were previously randomized for participation in a controlled trial of brief motivational interventions BMI; no selection based on reported alcohol use and had completed additional assessment questionnaires containing the perception item.

The BMI was delivered after having filled out the questionnaire, ensuring that questionnaire data were not biased by the BMI. Informed consent was already on file for those in the BMI trial. Individuals reporting no alcohol use were averaged into the overall computation of the census-based alcohol use estimates. However, to study a more homogeneous group, subjects in the random sample that provided drinking perceptions but did not use alcohol in the past 6 months were dropped from further analyses.

When asked what percentage of people their age drink more than they do, non-drinkers judge the prevalence of drinking in the population without any reference to the amount of alcohol drunk by others.

One additional individual was excluded since he did not respond to the perception question. This left subjects with complete and usable data in the study sample. It is important to remember that this sample was indeed random and was not based on consumption reported in the screening questionnaire.

To determine for each person the proportion of persons in the census who drank more alcohol than that individual did, the weekly alcohol consumption in standard drinks of each of the subjects was compared with the weekly alcohol consumption of each of the conscripts.

The proportion of the sample that reported higher, lower or similar alcohol consumption was determined for each subject. The proportion of subjects in the census drinking more than a given subject in the sample was compared with the perceived proportion reported by each of the subjects of the sample. The prevalence of overestimation, underestimation and accurate estimation of the amount of drinking by others was computed in the total sample, and in subgroups defined by weekly drinking categories less than one, 1—2, 3—7, 8—14, 15—21 and 22 or more drinks.

Linear models Analysis of variance and covariance, SAS, Proc GLM were used to compare mean alcohol consumption between subjects who did or did not overestimate the amount of drinking by others. Potential confounders, such as socio-demographic environment and education level, were tested. Logistic regression models were used to assess the determinants of the overestimation of drinking by others.

A multivariable model, including all the aforementioned variables in the same logistic regression model, was also used. Analyses were performed using SAS software Version 9. Table 1 displays the characteristics of the subjects. The mean SD age was Among the subjects, when the differences between the perceived proportion of individuals who drink more than them and the actual proportion was calculated from the census data, The prevalence of over, under and accurate estimation of the amount of drinking by others by subgroups according to weekly alcohol use is presented in Fig.

Overestimation of the amount of drinking by others increased as the self-reported weekly alcohol use increased.

Proportion of subjects overestimating, underestimating and accurately estimating the amount of drinking by others by current weekly drinking in drinks per week. Note: subjects in the random sample were asked to estimate what proportion of people their age and sex drink more than them. This perception was then compared with the weekly consumption of the census.

Research in marketing theory confirms that price is a complex stimulus. At its simplest, increased price is expected to reduce the probability of a product being purchased, but it can also have the opposite effect if price is perceived to link to quality. Another tendency is 'sale proneness', defined as an increased propensity to respond to a purchase offer because of the sale form in which the price is presented.

Thus, an item becomes more attractive for purchase when the price is presented in the form of a sales offer, compared with presentation at the standard price [ 45 ]. We addressed what respondents thought would be the effect of low prices and discounts and increased alcohol prices on 'people's alcohol use', rather than their perceived impact on their own alcohol intake.

While this supports the intent to measure a population-level effect, responses varied by demographic, socioeconomic and drinking habit, making it seem likely that respondents projected views on other similar populations in a 'false consensus effect' [ 38 ].

We thus conjecture that the beliefs expressed relate to participants' own anticipated reactions to the two potential pricing strategies. We acknowledge that beliefs about these behaviours do not necessarily translate into actual behaviour. It might be expected that there would be a balance of agreement between both price statements, and insensitivity to increasing price would be incongruous. Some groups exhibited this disparity more than others: females were more likely to view alcohol as 'lower price elastic only', believing that low prices and discounts increased people's drinking but that price increases had no effect.

In contrast, males were more likely than females to be completely price elastic. Modelled UK data have suggested that because women purchase more alcohol from the off-licensed trade where strategies such as minimum pricing are more likely to have an impact and because women consume more expensive drinks, they are more likely to be affected by increased prices than men [ 46 ].

We hypothesise that women in our survey may have been more likely to believe that household budgets would be compromised in order to maintain consumption. The youngest age group were more likely to be completely price elastic, suggesting that age may have an effect on the degree to which the consumption of alcohol is an entrenched behaviour.

Trends over the last decade in alcohol consumption in this age group show fluctuating levels compared to more stable patterns in older ages,[ 47 ] suggesting that behaviour, as well as perceptions, may be more flexible in younger people. Sensitivity to price reductions has been strongly supported in the literature, particularly where tax reductions have facilitated cheaper alcohol, such as in Finland and Switzerland [ 11 , 48 , 49 ].

In the UK, consumers are regularly presented with alcohol at discounted prices, including those that encourage bulk purchase for example, volume discounting [ 14 ]. Thus, individuals make choices influenced by low prices, which may lead to greater awareness of their impact. Lack of perception that price increases would reduce drinking is an interesting observation that may relate to the UK drinking population having little experience of rises in alcohol prices--the price of alcohol in real terms having fallen consistently over the past three decades [ 13 ].

In fact the small incremental rises associated with annual government budget changes have been largely met by alcohol retailers who sell alcohol at below cost price, protecting the public against experience of higher costs [ 14 , 50 ]. However, prices in on licence setting have increased and people who listed pubs, bars and clubs as a main alcohol source were more likely to think price increases would decrease intake.

Sensitivity to price increases are reported in the international literature, indicating the likelihood that price rises do result in reduced drinking;[ 7 — 9 ] a minimum price for a unit of alcohol 10 ml or 8 g of alcohol , now under discussion in a number of countries, are thus still anticipated to be a major measure to curb alcohol consumption. An alternative interpretation, not widely evidenced in the literature, is that people consider relatively high levels of alcohol to be an essential component of daily life, such that they view people as willing to absorb the increased cost of alcohol rather than reduce their drinking.

One study in Sweden noted that where price increases were only attached to specific alcohol types, consumption of cheaper products rose [ 51 ]. In our survey, the heavier drinkers were least likely to report that low prices increased consumption, suggesting true price insensitivity. However, those in the highest drinking category appeared strongly influenced by income, with the low and medium income heavy drinkers being more likely to be price elastic. Further, those on low incomes and who drink least were more likely to believe increased prices will decrease consumption.

This is consistent with alcohol playing a less important role in their lives and the relative impact of increased prices being greater. Other studies counter this, suggesting harmful drinkers are more sensitive to price [ 48 , 52 , 53 ]. As a convenience sample, not selected randomly, it may not be fully representative and the findings from the inferential statistics should be interpreted with caution.

Large-scale convenience samples are useful when the random sampling is not possible e. Random sampling was not appropriate for the Big Drink Debate, which sought to give all residents the opportunity to participate and did this via widespread advertising and the use of a variety of methods to engage participants in different settings. This, coupled with the simplicity of the survey tool, provided wide recruitment and the final sample included a breadth of public involvement.

This was highlighted by the broad distribution of wealth and age in the categorised populations, and the full representation of poorer and less educated populations, who are often missed in such surveys. However, males, in particular, were underrepresented.

Those of Asian and Asian British backgrounds were also less likely to participate. Capture of information in the many different settings required a short simple questionnaire which reduced our ability to generate in-depth intelligence on both alcohol consumption and surrounding beliefs.

Surveys are subject to respondents' recall where alcohol consumption can interfere with memories held [ 58 ] as well as honesty, and have been shown to produce considerable under-estimates of total amounts consumed [ 59 ].

Although respondents were assured of their anonymity, we assume the reported quantities consumed are a low estimate. Much of the damage relating to the lack of control over alcohol pricing has already been done. The vast majority of persons surveyed believe that price reductions increase alcohol consumption; consistent with the real term reductions in price seen over recent decades and corresponding to the observed rise in consumption [ 12 , 13 ].

The continued focus of the alcohol industry in using special offers including 'buy one get one free' encourages greater consumption, as known from marketing theory [ 45 ] and confirmed by our respondents.

International evidence shows that price is an important way to impact on the drinking behaviour of the population,[ 4 , 12 , 52 ] with a minimum pricing policy thought to be most effective in order to ensure all retailers pass increased prices to the consumer [ 3 , 5 , 17 ].

Despite the fact that the population has not had experience of increasing alcohol prices on which to base opinions on the effect of increasing price on drinking behaviour, a significant minority of survey respondents do perceive higher prices will reduce drinking. However, the instigation of such a policy relies on strong action from government, and is unlikely to happen without more support from the public.

More work is required to enable the public to 'buy into' the belief that price increases would impact on the population's drinking behaviour and ultimately on alcohol related harms. However, those planning public health interventions also need to recognise that alcohol is an addictive drug, and that the UK population as a whole has become habituated to a high level of consumption: even if prices are increased, people may, to a certain extent, sacrifice other parts of their expenditure to maintain consumption at levels they now feel they need.

Our survey, which sought the views of over 20 people, supports this by suggesting the population may be reticent to reduce their drinking when prices increase.

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