In a recent article published in the journal Addiction Science & Clinical Practice, researchers identify measures that improve alcohol health literacy (AHL) and lower alcohol consumption in Germany.
Study: Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany. Image Credit: Oleksandra Naumenko / Shutterstock.com
According to the World Health Organization (WHO), two primary determinants of alcohol use are the availability and affordability of alcoholic products. Theoretically, these appear easy to manage by modulating policy; however, practically, these factors require public and political support.
A sustainable reduction of alcohol consumption requires changing an individual's risk perception and social norms, alongside reducing their availability and affordability. For example, increasing awareness that alcohol use is a risk factor for cancer could help increase support for alcohol control policies.
Except for a few countries, most countries have not made significant progress in reducing alcohol consumption and, as a result, often report a high prevalence of alcohol users. Notably, alcohol consumption is highly prevalent in most middle- and high-income countries.
The core AHL attributes, which include the capacity to process and understand knowledge about alcohol content, strengths, units, and harm, could become a vehicle for the sustainable reduction of alcohol use. These characteristics are embedded in social and systemic environments called antecedents, which facilitate or limit the establishment of low-risk alcohol use patterns or abstinence.
About the study
In the current study, the authors searched PubMed using keywords like ‘affordability’ to derive recommendations for improving AHL. For education, health care, and policy, the researchers invited five experts to review the derived recommendations.
The reviewers rated the recommendations based on their likely impact on AHL and reducing alcohol consumption. Inter-rater agreement was assessed using a two-way intra-class correlation coefficient (ICC).
The researchers chose Germany as a target for the measures to improve AHL for several reasons. While other European countries have implemented strict alcohol control policies to reduce alcohol consumption, Germany has not.
In fact, the per capita alcohol consumption in Germany is above the global and European averages, thereby resulting in substantial alcohol-attributable morbidity. Despite its high financial burden on the German population, general health literacy, including AHL, remains low in Germany, especially among vulnerable groups.
A total of 11 recommendations were found to strengthen AHL and reduce alcohol consumption in Germany. Four of these recommendations were related to education and information measures.
'Unplugged', for example, is a school-based alcohol prevention program in Europe that provides knowledge and skills related to AHL in a series of 12 sessions delivered over one year. Another intervention example is “Klar bleiben,” which translates to “stay clear” in German, which involves students committing to not engaging in heavy drinking, even occasionally, for nine weeks and discussing alcohol-related topics among themselves.
While such programs critically reflected on alcohol advertising, they must be tailored to formulate appropriate goals, such as delaying the onset of alcohol use for younger people. Furthermore, although these education-based measures effectively raised individual competencies concerning alcohol consumption, they did not have an effect on alcohol consumption.
Alcohol control policy measures, such as alcohol taxes, were found to be most effective in reducing actual alcohol consumption; however, they had a low impact on AHL. The reviewers made study recommendations for Germany; however, these could also apply to other nations, such as Central-Western European countries with similar cultures and economies.
The current study highlighted AHL as a separate entity from alcohol consumption. To this end, programs targeting the enhancement of AHL focus on psychological concepts, like awareness, whereas the assessment of alcohol control policies focuses on alcohol sales and population-level health outcomes. Because these two areas of action operate in solitude, their efficacy is limited.
One reviewed study proposed the importance of increasing public awareness that alcohol is associated with various social and health risks. This educational approach could facilitate the learning of risk awareness skills that could help achieve adherence to stricter alcohol control policies.
Unfortunately, the authors could not find empirical evidence of how these policies interact with education-based awareness measures or whether to combine these two areas of research.
The study findings emphasize the importance of integrating alcohol strategies to sustainably improve AHL and reduce alcohol consumption. Importantly, any measure targeted to reduce the societal alcohol burden should not stigmatize people who consume alcohol or have alcohol use disorders.
- Manthey, J., Kokole, D., Riedel-Heller, S. et al. (2023). Improving alcohol health literacy and reducing alcohol consumption: recommendations for Germany. Addiction, Science, and Clinical Practice 18(28). doi:10.1186/s13722-023-00383-0