An on-product self-affirmation intervention to promote alcohol consumption within government recommended guidelines: A pilot study

Alcohol Insight Number 89

Small Grant

Background

Thirty-seven percent of men and twenty-nine percent of women in England drank more than the government recommended amount (2-3 units a day for women and 3-4 units a day for men) at least one day per week in 2009 (ONS, 2011). Given the known health risks associated with higher levels of alcohol consumption the UK Government recommends that alcohol products include information labels that warn of the risks. However, there is little evidence that such labels influence drinking behaviour (Stockwell, 2006; Wilkinson & Room, 2009).

Health warning labels present potentially threatening information that arouse unpleasant emotional states. Threatening messages can be detrimental to people’s sense of self (Steele, 1988) and lead individuals to process the information in a way that is consistent with their existing beliefs and thus unlikely to result in behaviour change. However, when participants are given a self-affirming manipulation, they process warning labels as more threatening and personally relevant, perceive higher levels of self-efficacy and have higher levels of intention for behaviour change (Harris, Mayle, Mabbott & Napper, 2007).

One of the difficulties of self-affirmation manipulations is that they are often time-consuming and impractical in the field.  However, drawing on the work of Harris, Napper, Griffin, Schuez, and Stride (2011), Armitage, Harris & Arden (2011) presented participants with the stem, “If I feel threatened or anxious, then I will…” (see Harris et al., 2011) and combined it with a self-affirming statement (e.g. “I will think about things that are important to me”, see Harris et al., 2011) to create a brief (one sentence long) but effective self-affirmation intervention that reduced alcohol intake by more than 1 unit per day. This kind of brief self-affirmation intervention could be used within an ecologically valid on-product health warning label. Thus this pilot study aimed to investigate the efficacy of an on-product self-affirmation intervention to promote alcohol consumption within recommended guidelines.  It was predicted that the intervention would result in more accurate judgements of the message and safe alcohol volume and result in changes in alcohol consumption in the following month.

Methods and Findings

The study took the form of a small-scale experiment in which participants were randomly allocated to one of two conditions. All participants completed baseline questionnaires (Alcohol Use Disorders Identification Test; Babor et al., 2001, Alcohol diary for the previous week; Sobell & Sobell, 1992;  and Protection Motivation Theory (PMT) measures; Rogers, 1983), and were exposed to one of two types of alcohol information labels positioned on a wine bottle: UK Government recommended information or UK Government recommended information + the self-affirmation statement: If I feel threatened or anxious, then I will think about things that are important to me.

They then undertook a wine pouring task in which they were asked to pour an amount of wine ‘that you think would be safe to drink on a single occasion’.  The number of units poured was then calculated. They also completed post-task questionnaires (Thought-listing procedure; Cacioppo & Petty, 1981, Perceived message strength; Zhao et al., 2011, Message derogation; Witte, 1994 and PMT measures).  113 participants (70 females and 41 males) completed this part of the study.

All participants were contacted 1 month later by letter or email (according to their stated preference) and completed time 2 questionnaires (Alcohol diary for the previous week; PMT measures). 107 participants completed this part of the study.

The results showed:

  • There were no differences in the amounts of wine poured between those exposed to the self-affirmation message and those not exposed.
  • Both males and females poured significantly more wine than the higher recommended limits.
  • There were no differences in the message perception measures by condition.
  • The information labels lead to a range of different thoughts including surprise, disagreement and reflecting on drinking behaviour
  • For participants classified as hazardous and harmful drinkers (AUDIT categories), exposure to the self-affirmation message resulted in significantly lower levels of alcohol consumption at time 2.
  • There were some effects of time but not condition on PMT variables.

Implications

The findings of this study indicated that a short self-affirmation message on an alcohol information label could reduce alcohol consumption for harmful and hazardous drinkers.  Further research should investigate the robustness of this effect, through which variables it acts, and test whether it is effective in the field.

The findings also indicated that the current recommended alcohol information is insufficient to enable people to make accurate judgements of ‘safe’ alcohol volumes. Further research should be conducted to establish what information should be provided to enable individuals to accurately make this judgement.

Research Team

Dr Madelynne Arden, Department of Psychology, Sociology & Politics, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, S10 2BP

Tel: 0114 2255623

Dr Christopher Armitage, Department of Psychology, University of Sheffield.

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References

Armitage, C. J., Harris, P. R., & Arden, M. A. (2011). Evidence that self-affirmation reduces alcohol consumption: Randomized exploratory trial with a new, brief means of self-affirming. Health Psychology, 30, 633-641.

Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., and Monteiro, M.G. (2001). The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. 2nd ed. World Health Organization, Department of Mental Health and Substance Dependence: Geneva, Switzerland.

Cacioppo, J.T., & Petty, R.E. (1981). Social Psychological Procedures for Cognitive Response Assessment: The Thought -Listing Technique. In T.V. Merluzzi, CR.Glass & M. Genest (Eds.) Cognitive Assessment pp. 309-392. New York: Guilford Press.

Harris, P.R., Mayle, K., Mabbott, L., & Napper, L., (2007). Self-affirmation reduces smokers’ defensiveness to graphic on-pack cigarette warning labels. Health Psychology, 26, 437-446.

Harris, P. R., Napper, L., Griffin, D. W., Schuez, B., & Stride, C. (2011). Developing a measure of spontaneous self-affirmation. Manuscript in preparation.

Rogers, R.W. (1983). Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation. In J. Cacioppo & R. Petty (Eds.) Social psychophysiology. New York: Guilford, pp. 153-176.

Sobell, L.C., & Sobell, M.B. (1992). Timeline follow-back: a technique for assessing self-reported alcohol consumption. In J.P. Allen & R.Z. Litten (Eds.), Measuring Alcohol Consumption: Psychosocial and Biochemical Methods, pp. 41-72. Totowa, NJ : Human Press.

Steele, C.M. (1988). The psychology of self-affirmation: Sustaining the integrity of the self. In L. Berkowitz (Ed.) Advances in experimental social psychology, Vol. 21, pp. 261-302. New York: Academic Press.

Stockwell, T. (2006) A Review of Research Into The Impacts of Alcohol Warning Labels On Attitudes and Behaviour. Centre for Addiction Research of British Columbia, Canada.

Wilkinson, C. & Room, R. (2009) Warnings on alcohol containers and advertisements: International experience and evidence on effects. Drug & Alcohol Review, 28, 426-435.

Witte, K. (1994). Fear control and danger control: A test of the extended parallel process model (EPPM). Communication Monographs, 61, 113–134.

Zhao, X., Strasser, A., Cappella, J.N., Lerman, C., & Fishbein, M. (2011). A Measure of Perceived Argument Strength: Reliability & Validity. Communication Methods and Measures, 5, 1-28