Effectiveness of a French mass-media campaign in raising knowledge of both long-term alcohol-related harms and low-risk drinking guidelines, and in lowering alcohol consumption

The ‘Ravages’ prevention campaign on the risks of alcohol was developed following the publication in 2017 of an expert opinion on the public discourse on alcohol (see box). This expert group produced a number of recommendations, highlighting the importance of informing the public that the health risks of alcohol consumption increase with the amount consumed, that there is no such thing as risk-free alcohol consumption, and that guidelines for lower-risk consumption exist. The 2019 campaign was the first by Santé publique France to address the long-term risks associated with alcohol and to raise awareness of the consumption guidelines.

It had therefore two main objectives:

• To improve the population’s knowledge of medium and long-term risks related to alcohol consumption. Three pathologies were emphasised during the campaign: cancer, hypertension, cerebral haemorrhage. 
• To publicise the new lower-risk drinking guidelines, formulated as "No more than two drinks a day, and not every day".

Ultimately, the objective was to reduce the proportion of drinkers who consume over the recommended limit in order to reduce alcohol-related morbidity and mortality further down the line.

The first broadcast of the campaign in March–April 2019 was evaluated by means of a longitudinal follow-up survey of 4,002 drinkers (sample constituted according to the quota method). They were surveyed via the internet before the campaign (22 February–18 March), just after the first broadcast (17 April–12 May), then approximately 6 months later (25 September–15 October): 2,538 people responded to all three survey waves.

The main indicators of the evaluation were: knowledge of the risks highlighted in the campaign (cancer, hypertension, cerebral haemorrhage), knowledge of the guidelines, and declared alcohol consumption in relation to the guidelines.

After the campaign was broadcast, a link between exposure to the campaign and a better knowledge of the "two drinks maximum a day" dimension of the guidelines, as well as of the risks of hypertension and cerebral haemorrhage, was observed among drinkers, including those who exceed the recommended limit and who therefore take more risks for their health. Another positive result was the association between exposure to the campaign and a decrease in the proportion of higher-risk drinkers across the sample. On the other hand, there was no association between exposure to the campaign and knowledge of the link between alcohol and cancers, or knowledge of the benchmark number of days without consumption.

Further analysis showed differences according to the profiles of the respondents: the link between exposure to the campaign and a reduced proportion of higher-risk drinkers was carried by women, and the link with improved perception of high blood pressure risks in relation to alcohol consumption was observed only among the more privileged social categories.

The positive results nevertheless diminished over time: all favourable effects observed were insignificant after six months. 

These results support the scientific literature, showing that mass media campaigns on alcohol risks can be effective in improving public knowledge about the subject and changing attitudes towards it². Evidence regarding the effect on reducing alcohol consumption is weaker³. However, recent experimental studies show that campaigns combining messages on long-term risks and consumption guidelines can potentially have an impact on drinking habits. The strength of our study is how it shows, in "real life" conditions, that a social marketing campaign on alcohol can have an impact on knowledge and behaviour.

The fact that the effects of the campaign are no longer perceptible after a few months is consistent with the scientific literature (including for campaigns on other subjects than alcohol) and argues for repeat broadcasts of large-scale campaigns. The 2019 campaign was thus successively improved (creation of new visuals and more educational messages on risks and guidelines, adaptation of the media plan to ensure good visibility by the target audiences) for six repeat broadcasts over four years.

Today, our studies show that alcohol still has a predominantly positive image in the population, that the guidelines for lower-risk consumption remain insufficiently known, and that the risks surrounding low quantities of alcohol are unknown or viewed with detachment from one's own consumption. It therefore seems necessary to continue de-normalising alcohol and to remind people that alcoholic products present health risks, even in small doses. Changes in perception take time... and changes in behaviour even more so.

To avoid the habituation effect with the ‘Ravages’ campaign, we are developing new communication tools. The "Good health has nothing to do with alcohol" campaign, set to launch in January 2023, reminds people about the long-term risks of alcohol and invites them to reflect on the place it takes in their lives by highlighting a widespread cultural absurdity: raising a toast to "good health"... with an alcoholic drink.

January, the month for New Year’s resolutions, is a good time to reflect on our drinking habits: hence the Dry January challenge, launched in France in 2020 by a group of associations, based on a model developed in the United Kingdom. It is a one-month alcohol-free challenge to test one's relationship with alcohol and observe the benefits on one's quality of life. The evaluation carried out by the agency in 2020 revealed the value of this scheme for taking a step back and reducing alcohol consumption.

The Alcool Info Service website (see box) offers support in this process of reflection and of reducing consumption. It also provides advice and assistance if necessary. Furthermore, it offers a digital tool, the "alcohol meter", which allows users to compare their consumption with the guidelines and to find out the risks they are taking for their health.

In addition to social marketing aimed at the general public and the remote assistance tools provided by Alcool Info Service, Santé publique France is carrying out other work on alcohol prevention: dissemination of measures aimed at specific groups, such as young people, with the objective of reinforcing protective behaviour in a festive context (campaign Amis aussi la nuit); evaluation and promotion of several schemes to reinforce life skills among adolescents; advocacy for regulatory measures that support reduced consumption (e.g., controlled advertising for alcoholic drinks). It is the combination of these efforts that may ultimately create a favourable environment for changing the image of alcoholic beverages and lead to a decrease in drinking in France.