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Low risk drinking guidelines in Europe:

results from RARHA survey E. Scafato ,

Istituto Superiore di Sanità, Italy

LOOKING HOW TO REDUCE ALCOHOL RELATED HARM

SHARING THE RESULTS RARHA - FINAL CONFERENCE

Work Package “Guidelines”

• Co-led by the National Institute for Health and Welfare, Finland, and Istituto Superiore di Sanità, Italy

• Nearly 50 partners from 26 expert organizations based in 20 countries

Surveys to update state of play and background papers to summarize science underpinnings regarding

▪ low risk drinking guidelines ▪ brief intervention practices ▪ standard drink concept ▪ guidance for young people

Seeking broader views by means of

Delphi surveys with ▪ public health and addiction experts ▪ experts on young people Online survey of consumer views Expert meetings ▪ Rome & Brussels 2014 ▪ Helsinki 2016 ▪ CNAPA 2014-2016

3 Low risk drinking guidelines in Europe: results from RARHA survey

The RARHA survey task 1 and 2

Low risk drinking guidelines in Europe: results from RARHA survey


Standard Drink



Standard Drink concept currently used

RARHA

RARHA survey

SD in grams of pure alcohol:

19

2 91

19

2 101

30

21

21 7

0

31Y

es

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated

Review WHO 2012 WHO 2013 OECD 2014

no

. o

f C

ou

ntr

ies


8

10

12

14

16

18

20

AU

STR

IA (

20

)

CR

OA

TIA

(10

; 1

4)

CZE

CH

REP

UB

LIC

(1

6)

DEN

MA

RK

(1

2)

ESTO

NIA

(1

0)

FIN

LAN

D (

12

)

FRA

NC

E (1

0)

GER

MA

NY

(10

; 1

2)

GR

EEC

E (1

0; 1

6)

HU

NG

AR

Y (1

2; 1

4)

ICEL

AN

D (

8 ;

12

)

IREL

AN

D (

10

)

ITA

LY (

12

)

LATV

IA (1

2)

LITH

UA

NIA

(1

0)

LUX

EMB

OU

RG

(1

2)

MA

LTA

(8; 1

0)

NET

HER

LAN

DS

(TH

E) (

10

)

NO

RW

AY

(12

; 15

)

PO

LAN

D (1

0)

PO

RTU

GA

L (1

0)

RO

MA

NIA

(1

2)

SLO

VEN

IA (

10

)

SPA

IN (

10

)

SWED

EN (

12

)

SWIT

ZER

LAN

D (

10

; 12

)

UN

ITED

KIN

GD

OM

(8

)

Mean= Median=

11


Standard Drink concept currently used in:



Low Risk Guidelines (GL)/Recommendations (R)



Low Risk GL/R issued

RARHA

Revision (yrs):

2010

0 112

8

107

2420

31 7

0

31Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated

Review WHO 2012 WHO 2013 OECD 2014

no

. o

f C

ou

ntr

ies


22

5

2

2

Yes No missing data Country not investigated

*

* Hungary and Lithuania have recommended limits


WEEK low risk GL/R (in g)



DAY low risk GL/R (in g)

Low risk drinking guidelines in Europe: results from RARHA survey E. SCAFATO 2014


RARHA Low risk GL or R

17

523

4

Guidelines (GL) Recommendations (R) Not investigated Countries Missing data No GL or R

105 2

Day D+W Week

Guidelines

14

Day D+W Week

Recommendations



RARHA Low risk GL or R A

vera

ge

alc

oh

ol i

nta

ke in

a d

ay

no

t to

be

ex

cee

de

d

(gra

ms

of

pu

re a

lco

ho

l)


05

101520253035404550

AU

STR

IA (2

4)

BE

LGIU

M

BU

LGA

RIA

CR

OA

TIA

(4

0)

CYPR

US

CZEC

H R

EPU

BLI

C (4

0)

DE

NM

AR

K (2

4)

ESTO

NIA

(40

)

FIN

LAN

D (

20

)

FRA

NC

E (3

0)

GER

MA

NY

(24

)

GR

EECE

(30

-48)

HU

NG

AR

Y (2

4-4

8)

ICE

LAN

D

IREL

AN

D

ITA

LY (2

4)

LAT

VIA

LITH

UA

NIA

(3

0-4

0)

LUXE

MB

OU

RG

(24)

MA

LTA

(36

)

NE

TH

ER

LAN

DS

(T

HE

) (2

0)

NO

RW

AY

POLA

ND

(40)

POR

TUG

AL

(20)

RO

MA

NIA

SLO

VA

KIA

SLO

VE

NIA

(20

)

SPA

IN (4

0)

SWED

EN

SWIT

ZER

LAN

D (2

0 -

36)

UN

ITE

D K

ING

DO

M (

24-

32

)

Men

05

101520253035404550

AU

ST

RIA

(16

)

BEL

GIU

M

BU

LGA

RIA

CR

OA

TIA

(20

)

CY

PR

US

CZ

EC

H R

EP

UB

LIC

(2

0)

DEN

MA

RK

(12)

ESTO

NIA

(20)

FIN

LAN

D (

10

)

FRA

NCE

(20)

GER

MA

NY

(12)

GR

EECE

(20

-32

)

HU

NG

AR

Y (1

8-2

1)

ICEL

AN

D

IREL

AN

D

ITA

LY (

12)

LAT

VIA

LITH

UA

NIA

(20

-30

)

LUXE

MB

OU

RG

(12)

MA

LTA

(27)

NET

HER

LAN

DS

(TH

E) (1

0)

NO

RW

AY

POLA

ND

(20)

POR

TUG

AL

(10)

RO

MA

NIA

SLO

VA

KIA

SLO

VEN

IA (1

0)

SPA

IN (2

0 -

25)

SWED

EN

SWIT

ZER

LAN

D (1

0 -

24 )

UN

ITE

D K

ING

DO

M (1

6-2

4)

Women

E. SCAFATO 2014


Average alcohol intake in a day not to be exceeded (g pure alcohol)



Binge Drinking


11

9

9

2

Guideline Recommendation No GL/Rec Not investigated


RARHA Binge Drinking GL or R

4

1

64

2 3

By

gen

de

r

By

gen

de

r an

d A

ll

All

con

sum

ers



RARHA Binge Drinking Maximum intake per drinking occasion (g pure alcohol)

0102030405060708090

AU

STR

IA

BEL

GIU

M

BU

LGA

RIA

CRO

ATI

A

CYPR

US

CZE

CH

REP

UB

LIC

DEN

MA

RK

(60)

ESTO

NIA

FIN

LAN

D (8

4)

FRA

NCE

GER

MA

NY

GR

EE

CE

HU

NG

AR

Y

ICEL

AN

D

IRE

LAN

D

ITA

LY

LAT

VIA

(60

)

LITH

UA

NIA

(60

-80)

LUX

EM

BO

UR

G (

60

)

MA

LTA

NET

HER

LAN

DS

(TH

E)

NO

RW

AY

POLA

ND

(60)

POR

TUG

AL

(60)

RO

MA

NIA

SLO

VA

KIA

SLO

VEN

IA (

50)

SPA

IN (6

0)

SWED

EN

SWIT

ZER

LAN

D (4

0-4

8)

UN

ITED

KIN

GD

OM

(8 S

U)

Men

0102030405060708090

AU

STR

IA

BEL

GIU

M

BU

LGA

RIA

CR

OA

TIA

CYPR

US

CZEC

H R

EPU

BLI

C

DEN

MA

RK

(60)

ES

TO

NIA

FIN

LAN

D (6

0)

FRA

NCE

GER

MA

NY

GR

EECE

HU

NG

AR

Y

ICEL

AN

D

IREL

AN

D

ITA

LY

LATV

IA (

40)

LITH

UA

NIA

(40-

80

)

LUXE

MB

OU

RG

(60)

MA

LTA

NET

HER

LAN

DS

(TH

E)

NO

RW

AY

POLA

ND

(40)

POR

TUG

AL

(50)

RO

MA

NIA

SLO

VA

KIA

SLO

VE

NIA

(3

0)

SPA

IN (4

0)

SW

ED

EN

SWIT

ZER

LAN

D (3

0-3

6)

UN

ITED

KIN

GD

OM

(6 S

U)

Women

0

10

20

30

40

50

60

70

80

90

AU

STR

IA

BE

LGIU

M

BU

LGA

RIA

CRO

ATI

A

CYPR

US

CZ

EC

H R

EP

UB

LIC

(80

)

DEN

MA

RK

ESTO

NIA

FIN

LAN

D (

60-

72

)

FRA

NCE

(40)

GER

MA

NY

(50)

GR

EECE

(4 S

U)

HU

NG

AR

Y (

72-

84

)

ICEL

AN

D

IREL

AN

D (6

0)

ITA

LY (7

2)

LAT

VIA

(60

)

LITH

UA

NIA

LUX

EM

BO

UR

G (

60

)

MA

LTA

(36)

NET

HER

LAN

DS

(TH

E)

NO

RW

AY

PO

LAN

D

PO

RTU

GA

L

RO

MA

NIA

(72

)

SLO

VA

KIA

SLO

VEN

IA

SPA

IN

SWED

EN

SWIT

ZER

LAN

D

UN

ITE

D K

ING

DO

M

All consumers


10

12

14

16

18

20

22

24

AU

ST

RIA

BEL

GIU

M

BU

LGA

RIA

CR

OA

TIA

(18

)

CY

PR

US

CZ

EC

H R

EP

UB

LIC

DEN

MA

RK

(16)

ESTO

NIA

(18

)

FIN

LAN

D

FR

AN

CE

GER

MA

NY

GR

EECE

HU

NG

AR

Y

ICEL

AN

D

IREL

AN

D

ITA

LY (1

8)

LATV

IA

LITH

UA

NIA

LUX

EM

BO

UR

G (1

6-1

8)

MA

LTA

NET

HER

LAN

DS

(TH

E) (1

8)

NO

RW

AY

POLA

ND

(18)

POR

TUG

AL

(10

-24

)

RO

MA

NIA

SLO

VA

KIA

SLO

VEN

IA (

18)

SPA

IN (

16

)

SWED

EN (1

8-2

0 )

SWIT

ZER

LAN

D

UN

ITE

D K

ING

DO

M (

15

)

Age

(yrs

)


Young People GL or R

6

10

510 12

19

1513

12

0

31

Yes

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated Ye

s

No

mis

sing

dat

a

Coun

try

not

inve

stig

ated

WHO 2012 WHO 2013 RARHA

no

. o

f C

ou

ntr

ies

WHO 2012 WHO 2013 RARHA



Older People GL or R

6

21

22


RARHA

214

5

10


WHO 2012



Pregnancy/ Breastfeeding GL or R

8

0

22

1 7 7 710

7

0

24

0

31

Ye

s

No

mis

sin

g d

ata

Co

un

try

no

t in

vest

igat

ed

Ye

s

No

mis

sin

g d

ata

Co

un

try

no

t in

vest

igat

ed

Ye

s

No

mis

sin

g d

ata

Co

un

try

no

t in

vest

igat

ed

Review WHO 2012 WHO 2013

no

. of C

ou

ntr

ies

WHO 2012 WHO 2013REVIEW

25

4

2

Yes No Country not investigated

RARHA



Other guidelines:

www.rarha.eu

Consensus and differing views

in RARHA Delphi survey

on “low risk” drinking

www.rarha.eu

Joint Action RARHA – Work Package “Guidelines” 1

Starting Point

• Guidelines for limiting drinking in order to reduce risks of harm from alcohol are given in most EU countries.

• Lot of variation in the scope of guidelines, levels of drinking defined as low/high risk, and definitions of ”standard drink”.

• May confuse consumers when information is accessible across borders on the internet, on product labels ...

• May reduce the potential for effect of risk communication to reduce alcohol related harm.

Working methods

• Background papers to summarize the scientific basis as well as current definitions and practices to enable informed discussion.

• Two Delphi surveys to identify points of convergence and potential for consensus: • Issues around “low risk” drinking guidelines • Guidelines for reducing alcohol-relate harm for young people

• Meetings for exchange between experts and dialogue with decision-makers .

www.rarha.eu

Joint Action RARHA – Work Package “Guidelines” 2

Co-leaders

• National Institute for Health and Welfare THL (FI) • Istituto Superiore di Sanità ISS (IT)

Further Task leaders

• Landschaftsverband Westfalen-Lippe LWL (DE) • Health Service Executive HSE (IE) • Eurocare (EU)

Participants

• Actively involved or as followers 34 partners from 24 countries

Delphi survey around “low risk” drinking

• In all 22 partners involved in the planning process • Methodological support provided by two additional experts • Core planning group comprising

Marjatta Montonen & Pia Mäkelä / National Institute for Health and Welfare (FI) Emanuele Scafato & Claudia Gandin / Istituto Superiore di Sanità (IT) Sandra Coughlan /Health Service Executive (IE) Sandra Tricas-Sauras / Eurocare.

www.rarha.eu

RARHA Delphi survey on “low risk” drinking

The Delphi method

• Method developed for future forecasting and to provide material for decision making on complex issues.

• The Delphi process: survey of expert views in two or more rounds, with results fed back to respondents in between.

• Respondent anonymity to minimize the effect of speaker status and group dynamics. • The process leads to some degree of consensus and helps identify topics on which

positions differ.

The expert panel

• First round: 51 experts based in 27 countries • Second round: 41 experts based in 23 countries • 4/5 participating in both rounds

• strong expertise in the alcohol field considerable input from broader public health

Prevention primary secondary tertiary /universal /targeted /indicated

www.rarha.eu

Topics of the “low risk” Delphi survey

Drinking guidelines as a public health measure

• Conceptual clarification: purposes of drinking guidelines; “low” versus ”high” risk; drinking over longer terms versus on single occasion

• Need for gender-specific and age-specific guidelines

Methodological issues

• Scientific basis: use of mortality data; how to factor in morbidity and harms to others

Communication aspects

• How to prevent unwanted effects; groups and situations where general guidelines do not apply; particular harms to highlight in risk communication

Possibility to move towards common guidelines

• Desirability of a common definition of “low risk” drinking; how to set the threshold for “low risk”

Practical aspects related to the labelling of alcoholic beverages

• Usefulness of a common definition of “standard drink”; what health related information should be given on alcoholic beverage labels

www.rarha.eu

Delphi results: Drinking guidelines as a public health measure 1

Would you be supportive or against providing the general population with "low risk" drinking guidelines?

0

5

10

15

20

25

Totallysupportive

Somewhatsupportive

Undecided Somewhatagainst

Totally against

Round 1 (N=40)

Round 2 (N=39)

www.rarha.eu

Delphi results: Drinking guidelines as a public health measure 2

Rationale for communicating “low risk” drinking guidelines

• Consumers have the right to be informed about risks related to lcohol consumption

• It is the responsibility for governments to provide such information.

• The core message is about risk rather than safety.

Guidelines are needed separately concerning

• drinking over longer periods of time

• drinking on a single occasion.

Realistic expectations regarding effects

• “Low risk” drinking guidelines may help correct misconceptions

• Communication about “low risk”, “high risk” and single occasion drinking guidelines may contribute in the longer term to influencing attitudes and drinking patterns in the whole population.

• Drinking guidelines are just one tool in the portfolio of measures to curb alcohol-related harm.

www.rarha.eu

Delphi results: Drinking guidelines – to whom and for what purpose

Encourage ”at risk” drinkers reduce the amounts they are consuming

Inform alcohol consumers and others about alcohol related risks

Draw all alcohol consumers’ attention to the risks that may be involved in their drinking habits

”Low risk” drinking guidelines ”High risk” drinking guidelines

Single occasion drinking guidelines

The primary purpose of ”low risk” guidelines is to inform rather than immediately change drinking patterns.

Injuries and social harms

www.rarha.eu

Delphi results: Need for gender-specific drinking guidelines

Should the guideline on what consitutes a "low risk" level of drinking be different for women and for men

0

5

10

15

20

25

30

Yes, the specification forlow risk level should be

different for women andmen.

Undecided No, the same specificationof low risk level can beapplied to women and

men

Round 1 (N=40) Round 2 (N=39)

• Physical differences (BAC levels) • Biological differences (mortality) • Specific risks (breast cancer) • Risk fo harm to the foetus • Broad acceptance of gender difference

• Alcohol is harmful for humans • Gender differences in risk are small • Women are less prone to risky behaviour • People adjust drinking according to effects • Easier to communicate a single guideline

Why different Why not the same

www.rarha.eu

Delphi results: Need for age-specific drinking guidelines: young people

Young people: Which age group/s, if any, should be covered by separate guideline/s?

0 2 4 6 8 10 12 14 16 18 20

15 year olds

16 year olds

17 year olds

18 year olds

19 year olds

20 year olds

21 year olds

22 year olds

23 year olds

24 year olds

25 year olds

No separate "low risk" guidelines for young people

• 18year olds • No ”low risk”

guidelines for young people

www.rarha.eu

Delphi results: Need for age-specific drinking guidelines: older people

• For the age group 65 years and over • Clear statement on the level of alcohol intake not to be exceeded • General statement about greater vulnerability due to biological changes • Specific risks to be highlighted

• Interference or interaction of alcohol with medication, in particular with central nervous system depressants.

• Comorbidities with alcohol use disorders or diseases that may increase the risk of alcohol related harm.

• Risk of injuries and accidents, including when driving.

Is there a need for specific drinking guidelines for older people?

www.rarha.eu

Delphi results: Methodological issues

• There is consistent evidence of a causal impact of the volume of alcohol consumption on a number of diseases.

Knowledge of causality and risks relating to alcohol needs strengthening.

Reliability and validity of self-reports of alcohol consumption deserves further attention.

Further reserch on heavy drinking patterns and the risk of alcohol related mortality and morbidity.

• At the moment, mortality data is the most usable measure of alcohol related health harm available for epidemiological analysis of risks.

• Morbidity data (e.g. DALYs) would bring added value but at the moment does not allow robust estimation of risk curves.

Further research on dose-response relationship between alcohol consumption and morbidity.

• Quantifying harms to others would be useful background for formulating “low risk” guidelines.

• Further research may increase understanding of confounders and the relationship between alcohol consumption and health conditions but the main body of science in this area is likely to remain valid.

www.rarha.eu

Delphi results: Communication aspects

Points to highlight to prevent unwanted effects

• “Low risk” drinking does not mean “no risk”.

• The maximum for a single occasion does not mean that drinking up to that level is safe or that it is OK to drink that much every day.

• Occasional heavy drinking and daily drinking are both potentially harmful drinking patterns.

At-risk groups or high-risk situations that call for caution

• Use of medications

• Mental health problems / other addictions / family history of alcohol dependence

Situations where the safest option is not to drink at all

• During pregnancy / when driving / at work / in tasks that require concentration

Particular harms to highlight

• Increased risk of cancer

• Risk of adverse effects on the family

Positive effects of alcohol

• No messages or messages to correct misconceptions

www.rarha.eu

Messages reharding alcohol and pregnancy – Examples

Avoid alcohol if pregnant or trying to conceive

• UK Chief Medical Officers’ guideline, January 2016:

• “If you are pregnant or planning a pregnancy, the safest approach is not to drink alcohol at all.”

• “Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.”

• US Centers for Disease Control and Prevention’s Vital Signs report, February 2016

• “About half of all US pregnancies are unplanned and, even if planned, most women do not know they are pregnant until they are 4-6 weeks into the pregnancy. - - - It is recommended that women who are pregnant or might be pregnant not drink alcohol at all.

USA 1989 France 2007 UK 2007

www.rarha.eu

Delphi results: Health related information on alcoholic beverage labels 1

Consumers should obtain full information on alcoholic beverages

• The calorie content

• percentage of daily intake

• All ingredients

• additives, preservatives, colouring substances

• All allergens

• Other nutrients

Consumers should be alerted to specific risks:

• alcohol consumption during pregnancy

• drink driving

• mixing alcohol with medications

• vulnerability of minors

• effects on the brain

• loss of self-control

• violence

• decreased perception of risk

• addictive nature of alcohol

www.rarha.eu

Delphi results: Health related information on alcoholic beverage labels 2

0

5

10

15

20

25

30

35

40

Packages YES NO Adverts YES NO


YES • Consumer’s right • Coherent policy • Information gaps • Risks for others

NO • Risks are known • Too much info • Too small font • Campaigns better

Would it be useful from a public health perspective if warning messages about health or safety risks were required across the EU on alcoholic beverage packages

and/or on alcohol advertisements?

www.rarha.eu

Delphi results: Definiton of “standard drink”

• A common definition would widen the reach of consumer information campaigns while decreasing the possibility of misunderstanding

Alternative approaches

• Give up scientific precision in public communication: ”limit your consumption to X drinks a day”

• Display in grams pure alcohol the alcohol content of the bottle/can/box or of the serving on the price list.

0

5

10

15

20

25

30

35

Totally infavour

Somewhat infavour


Totally against

Would you be for or against agreeing on a common definition of standard drink


0

5

10

15

20

25

30

35

40

Totally infavour

Somewhat infavour


Totally against

Would you be for or against requiring alcoholic beverage labels to indicate – in addition to the % abv – the grams pure alcohol

contained in the package


www.rarha.eu

Delphi results: Moving towards common guidelines 1

0

5

10

15

20

25

30

35

Yes, a common concept wouldbe desirable

Undecided No, it would not be desirable

Round 1 (N=42)

Round 2 (N=39)

Would you consider it desirable for European public health bodies to agree on a common concept of "low risk" drinking?


SHARING THE RESULTS

RARHA - FINAL CONFERENCE


SHARING THE RESULTS

Lisbon . 13/14 October . 2016

Good practice principles for the use of low risk drinking guidelines as a public health tool

CONCLUSIONS



Towards a common concept

• More authority and credibility, clearer and stronger.

• A co-ordinated effort by European countries to promote low risk guidelines using the same definition

would have a better chance of being accepted by the population.

However,

• National drinking guidelines have been introduced without coordination or international guidance.

• The WHO does not set limits for alcohol consumption ̶ “the ideal for health is not to drink at all.”

• Drinking guidelines in some countries have a long history.

• Public health bodies in some countries have chosen not to issue guidelines on low risk drinking.

• To effectively communicate low risk drinking guidelines to the population, pre-existing information

needs and perceptions need to be taken into account.

Nevertheless, a move towards a more aligned approach is possible

• Adopting the cumulative lifetime risk of death due to alcohol as a common metric for assessing the

risks from alcohol.

• Applying the good practice principles suggested by Joint Action RARHA.



Good practice principles for drinking guidelines

Principles

• Drinking guidelines are not normative but informative.

• The core message is about risk, not safety.

• Guidelines should convey

evidence-based information on risks at different levels of alcohol consumption,

correct misconceptions about the likelihood of positive or negative health effects of alcohol,

and help alcohol consumers to keep the risk of adverse outcomes low.

Agreeing on a “European code on alcohol”

• Set of core messages applicable across diverse populations.

• To amplify the core message to alcohol consumers and the society at large.

• To provide a common reference and support for national action.




Components

• Daily drinking and occasional heavy drinking should both be highlighted as potentially harmful

drinking patterns.

Advice to limit average consumption over a longer period of time.

Advice to limit the amount drunk on any single occasion.

• Advising equally low consumption levels for men and women, while highlighting gender-

specific factors in verbal communication, should be considered.

• Guidance for healthy adults should be accompanied by guidance for various age groups, in

particular for older people.

• Advice should be provided concerning alcohol consumption in high-risk situations and at-risk

groups.

• While the focus in drinking guidelines is on health risks, it should be communicated that

limiting alcohol consumption and avoiding drunkenness also reduces the risk of social harms to

the drinker and to others.




Key messages

• Not drinking at all is the safest option

in pregnancy, childhood and adolescence

when driving, at work or engaged in tasks that require concentration.

• High-risk situations include

taking a medication that may interact with alcohol.

• At-risk groups include people with

other addictions, mental health problems or family history of alcohol dependence.

• Advice for older people should highlight risk of

adverse interactions with medications, co-morbidities and injuries.

• Specific harms to highlight include

increased risk of cancer, high blood pressure, addiction, depression, adverse effects on the brain,

overweight and adverse effects on the family.

• As low risk drinking guidelines are based on averages across populations, any individual should also

take into account their own characteristics and particular situation.



Support measures at European and national level

Legislating for health relevant information on alcoholic beverage labels.

Ingredients and nutrition values

The amount of calories in the bottle or can

The amount of pure alcohol in the bottle or can, in grams of ethanol

Message/s on the health and safety risks related to alcohol consumption

Requiring information on health and safety risks on alcoholic beverage

packages and alcohol advertisements.

Alcohol consumption during pregnancy; Vulnerability of minors

Drink driving; Mixing alcohol with medications

Effects on the brain; Addictive nature of alcohol

Loss of self-control; Violence; Decreased perception of risk

For effectiveness, health and safety messages should be:

Rotating – designed to fill in gaps in information

Clear and powerful

Highly visible, of sufficient size, placed on the front of containers



Support measures at European and national level

• Applying and enforcing an age limit of minimum 18 years for the sale and serving

of any alcoholic beverages.

Organized and regular enforcement

Training for servers and retailers

Efforts to enhance public awareness and support for compliance with age limits

Effective use of sanctions ̶ suspension of alcohol license, closure order.

• For promoting awareness and enforcement, an integrated alcohol policy with a combination of

structural and individual prevention measures is needed rather than isolated actions.

• Supporting in particular primary health services to identify at-risk drinkers and offer advice to

reduce high-risk drinking.



Experts would welcome a common concept of low risk drinking

Would you consider it desirable for European public health bodies to agree

on a common concept of "low risk" drinking?

0

5

10

15

20

25

30

35

Yes, a commonconcept would be

desirable

Undecided No, it would not bedesirable

Round 1 (N=42)

Round 2 (N=39)

Low risk drinking guidelines in Europe:

results from RARHA survey

Thank you for your attention

low risk drinking guidelines in europe: results from rarha ... · low risk drinking guidelines in...

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