In the same year, the Santé publique France Health Barometer, a national survey based on a representative sample of the French population, showed that the alcohol consumption level of nearly one-quarter of 18–75-year-olds exceeded the recommended limit1.
Within this context, Santé publique France launched ‘Ravages’, a national awareness campaign about the health effects of alcohol and the new consumption guidelines. This multimedia campaign included a TV spot, expert interviews on the radio, digital banners and posters, which were broadcast and distributed across the country with the objective of reducing alcohol consumption in France.
If some studies, including experimental ones, tend to show that mass media campaigns influence public knowledge and attitudes towards a decrease in alcohol consumptions, do we find these results in the real context of running a campaign in the general population?
The article that was just published in the international review Addiction answers this question. It presents results from the evaluation of the alcohol campaign ‘Ravages 2019’ and shows how useful information was brought to light in view of the next awareness campaigns.
3 questions for Guillemette Quatremère, Prevention and Health Promotion Department (DPPS), Santé publique France
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.
 Quatremère G., Guignard R., Cogordan C, Andler R, Gallopel-Morvan K, Nguyen-Thanh V. 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. Addiction. 2022. https://doi.org/10.1111/add.16107
Experts focus their attention on lower-risk drinking guidelines
A group of independent experts (epidemiologists, addictologists, health education specialists) was commissioned in 2017 by Santé publique France and the National Cancer Institute (INCa, Institut national du cancer) to change the public discourse on alcohol consumption in France. One of their missions was to develop lower-risk drinking guidelines based on the scientific literature, modelling work and a qualitative study.
The modelling was entrusted to two Canadian researchers from the Toronto Centre for Addiction and Mental Health. The mortality risk attributable to alcohol for the French population was modelled according to different scenarios of exposure to alcohol (ranging from 0 g to 100 g of pure alcohol per day), confirming that no level of alcohol consumption is risk free. They then compared the risk levels and associated consumption levels with the views and perceptions of the French people in a qualitative study. The study confirmed that "zero alcohol" was not an achievable goal and that it was necessary to establish benchmarks acceptable to the population. This is part of a harm reduction perspective.
The qualitative study showed the need to have a double reference point for consumption – day and week – without distinction of gender. This was possible because, at the consumption threshold used, the health risks are not very different between men and women.
The new lower-risk drinking guidelines thus have three dimensions and are aimed at all healthy adults: "if you drink alcohol, it is recommended that you consume no more than 10 standard drinks per week and no more than 2 standard drinks per day, and that you have days in the week when you do not drink", in order to limit the risks to your health over your lifetime.
These guidelines have been reworded to make them easier to remember and understand for the general public: "for your health, no more than 2 alcoholic drinks per day, and not every day".
For more information on the opinion: Expert opinion on the evolution of public discourse on alcohol consumption in France, organised by Santé publique France and INCa.
Find out more:
- Andler R, Richard JB, Cogordan C, Deschamps V, Escalon H, Nguyen-Thanh V, et al. New alcohol consumption guidelines and use in France: Results from the Santé publique France 2017 Health Barometer. Bull Epidémiol Hebd. 2019;(10-11):180-7.
- Andler R, Quatremère G, Gautier A, Soullier N, Lahaie E, Richard J-B, et al. Exceeding lower risk drinking guidelines in France: Results from the Santé publique France 2020 Health Barometer. Bull Epidemiol Hebd. 2021(17):304-12.
- Consumption monitoring indicators and prevention measures on alcohol consumption
- Prevention tools (videos, TV spots, radio spots) and documents made available to health professionals and the general public
Evaluations of social marketing schemes
- Amis aussi la Nuit : Ilaria Montagni, Maëlys Abraham, Christophe Tzourio, Amandine Luquiens, Viêt Nguyen-Thanh & Guillemette Quatremere (2022) Mixed-methods evaluation of a prevention campaign on binge drinking and cannabis use addressed to young people, Journal of Substance Use, DOI: 10.1080/14659891.2021.2022223
- Consommation d’alcool : évaluation de la 1re édition du Défi de janvier - Dry January en France en 2020 (Santé publique France)
Programmes for building life skills
- Les compétences psychosociales : état des connaissances scientifiques et théoriques. Saint-Maurice : Santé publique France, 2022. 135 p.
- Addictions : prévention et comportements de consommation. du Roscoät E, Spilka S, Lecrique J-M, Gillaizeau I, Quatremère G, Nguyen-Thanh V, et al. La Santé en action. 2019(449):11-3.
- Unplugged program: https://www.santepubliquefrance.fr/docs/resultats-de-l-evaluation-du-programme-unplugged-dans-le-loiret
- Gillaizeau I. Évaluation d’un programme de prévention des consommations de substances psychoactives auprès de jeunes apprentis du BTP.
Advocacy for regulatory measures
- Gallopel-Morvan K, Andler R, Nguyen Thanh V, Critchlow N. Does the French Évin Law on Alcohol Advertising Content Reduce the Attractiveness of Alcohol for Young People? An Online Experimental Survey. J Stud Alcohol Drugs. 2022;83(2):276-86.
- Quatremère G, Guignard R, Andler R, Avenel J, Gallopel-Morvan K, Nguyen-Thanh V, Quelle exposition des Français à la publicité des alcooliers ? Evaluation des investissements publicitaires réalisés entre 2018 et 2020. Journées SFA, 24-25 mars 2022, Lyon.
1. Andler R, Quatremère G, Gautier A, Soullier N, Lahaie E, Richard J-B, et al. Exceeding lower risk drinking guidelines in France: Results from the Santé publique France 2020 Health Barometer. Bull Epidemiol Hebd. 2021(17):304-12.
2. Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010;376(9748):1261-71
3. Young B, Lewis S, Katikireddi SV, Bauld L, Stead M, Angus K, et al. Effectiveness of Mass Media Campaigns to Reduce Alcohol Consumption and Harm: A Systematic Review. Alcohol Alcohol. 2018;53(3):302-16