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.
|Publication status||Published - Sept 2022|
Bibliographical noteFunding Information:
P.A., D.K. and E.J.L. received funds from the European Health and Digital Executive Agency under a service contract. D.W.L. declares no conflicts of interest. R.B has completed paid consultancy for the World Health Organization. No other competing interests declared.
This work was partly supported by the European Health and Digital Executive Agency (HaDEA) (previously Consumers, Health, Agriculture and Food Executive Agency (CHAFEA)) acting under the mandate from the European Commission (EC) specifically by the project ALHAMBRA (EU Health Programme 2014–2020 under service contract 2019 71 05). The views expressed in this article are those of the authors only and do not necessarily reflect the views of the EC or HaDEA.
© 2022 by the authors.
- household purchase data
- lower strength alcohol products
- realist review