AltN8

Background

AltN8 is a multi-faceted project aimed at reducing binge drinking and its negative impacts. The project pulls together WHO suggestions recommending safe practice, and is translated into a social marketing campaign for binge drinking.

What is the problem you are trying to solve?

We are aiming for a reduction in alcohol related crime and disorder in the near term and a reduction in alcohol related illness and death in the longer term.

What local organisations are involved?

AltN8 is a multi-agency project funded by the Health Improvement Fund. It is Primary Care Trust (PCT)-led in partnership with NightSafe, a Blackpool police initiative to reduce drink related violence, and BSafe, the Blackpool Community Safety Partnership.

How many people are running this project and who are they?

Ian Treasure, alcohol harm reduction policy officer, Blackpool PCT; Christopher Lewis, public protection officer, Blackpool Council; Inspector Tim Leeson, Blackpool Police; Jeff Holden, Fire Station Manager at Lancashire Fire and Rescue Service.

What local population are you targeting?

AltN8 targets teenagers to 44 year olds. There are 60 000 people in Blackpool within that age range and the UK alcohol needs assessment research project indicated that 25% of those people are binge drinking, or drinking harmfully. We also know that local people cause most of the alcohol related assaults and the situation is aggravated by overcrowding throughout the holiday season. Blackpool is still a top UK holiday destination. Blackpool has the third highest concentration of vertical drinking spaces in the UK.

How many people are you targeting?

All teenagers to 44 year olds in Blackpool (approximately 60 000 people)

Interventions

What interventions are you using to address the problem?

The project recommends drinkers alternate their alcohol drinks with non-alcoholic drinks (water or a soft drink) or alternate the days on which they drink to give their liver time to recover.

Run out of Blackpool PCT, the project includes research that has been conducted through local consultation and studying the evidence base, plus a high profile social marketing campaign in public spaces, bars and clubs.

We distributed T shirts to pubs and clubs along with washroom stickers, key rings, mobile phone charms, posters and tip cards. Pub companies were reluctant to introduce vending machines for soft drinks, so part of the campaign was to encourage patrons to acquire the free water that all licensed premises have to offer as a condition of their license.

Is the project design based on evidence? If so, please state reference.

An extensive trawl of the evidence base helped to shape the campaign.

Unsolicited distribution of leaflets is common practice. Randomised control trials of general health information reveal that even leaflets considered relevant as a stand alone have little effect on changing behaviour ¹ .

A wider approach of leaflets, supported by group education, one to one education and paying participants yielded a significant uplift of desired behaviour change in a study of low income groups in America ² (one criticism of this review is that no strands of the intervention can be identified as most effective).

Perhaps the most encouraging evidence on increasing knowledge and enhancing emotional responses ³ was facilitated by media campaigns, health education programmes, peer support, training health professionals, video support, and leaflets. Again unravelling the effectiveness of different strands of intervention is difficult.

Urberg et al ⁴ reveal that even in deprived areas, it is not parental alcohol consumption that influences adolescent drinking, but the supportive environment of the family home. Without this support, it is peer approval that is sought, often manifesting in alcohol consumption with peers ⁵ Most recently (still in print) UKATT ⁶ suggests that parental drinking does have an influence on adolescent drinking.

There is some evidence to suggest that leaflets targeted at those accessing or ready to access services is effective ⁷ .

Looking to alcohol advertising, the most remembered elements by 18-24 year olds were animals, music and storyline/humour ⁸ . This helped to inform the radio campaign where we used sheep with voiceovers to encourage people to lead and not follow.

Outcome

What outcomes or planned outcomes are you measuring?

The project will be evaluated in a number of ways. The cut-through of the branding and the level of awareness and understanding of the AltN8 messages such as the WHO safety recommended limits. The project will also be measured against alcohol related crime and disorder statistics and anecdotal evidence from licensors. We will be interviewing people from late autumn, prior to our continuation of the campaign. We did extensive pre-test surveys and we will be comparing the outcomes of the two surveys.

Do you have any outcomes or results yet? If so, what are they?

Results from the Population Based Survey (n=500) show:

• 19% of the total population recognised the AltN8 campaign;

• Of this cohort, 29% reported that they were drinking less;

• We surveyed people in on licensed premises, of which 51% recognised the AltN8 campaign, and 31% were drinking less;

• Posters and toilet room stickers were the most effective intervention with radio being the least effective; and

• Partnership work is needed to ensure that delivery is robust and widespread.

We have also seen a 65 % reduction in accidental house fires and a 44% reduction in assaults in licensed premises during the intervention period.

Is your project relevant to a government target or guideline?

The Alcohol Harm Reduction Strategy ⁹ ; the Respect Campaign ¹⁰ ; Section 17 of the 1998 Crime and Disorder Act ¹¹ ; and Choosing Health: Making healthy choices easier ¹² .

Feedback

What obstacles did you have to overcome to set up this project?

There was a lot of resistance from the licensing trade as the campaign poses a threat to sales of alcohol. The fact that water is more profitable than beer (although it does not return as high a turnover) has helped to reduce resistance.

What have you learned about the project so far?

We have learned that a multifaceted campaign which includes branding, interaction, and support is more likely to change behaviour. Our campaign messages were designed around research which showed humour and animals have a longer lasting impact on people when used in advertising.

What would you do differently?

Early research to test awareness could have been more specific to target the project’s intended demographic.

References:

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4. Uberg K, Goldstein MS, Toro PA. Supportive relationships as a moderator of the effects of parent and peer drinking on adolescent drinking. Journal of Adolescent Health. Wayne State University, Detroit. 2005.
5. Nash SG, McQueen A, Bray J. Pathways To Adolescent Alcohol Use: Family Environment, Peer Influence, and Parental Expectations. Journal of Adolescent Health. College of Medicine, Houston, Texas. 2005.
6. Heather N. UKATT. Department of Health. 2004.
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9. Cabinet Office. Alcohol Harm Reduction Strategy for England. 2004. http://www.cabinetoffice.gov.uk/strategy/downloads/su/alcohol/pdf/CabOffce%20AlcoholHar.pdf (accessed 17 April 2007).
10. Respect: Tackling anti-social behaviour and its causes. 2006. http://www.respect.gov.uk/ (accessed 17 April 2007).
11. Office of Public Sector Information. Crime and Disorder Act 1998. Prepared 1 November 2000. http://www.opsi.gov.uk/acts/acts1998/19980037.htm (accessed 17 April 2007).
12. Department of Health. Choosing Health: Making Healthy Choices Easier. 2004. www.dh.gov.uk (search for 4135, accessed April 17 2007).