A new study exploring Twitter reactions to the revised recommended drinking guidelines announced in 2016 has been published in the BMJ. The responses though may be seen to reflect previous indications of the public's response, generally showing a mixture of reactions including a significant sense of 'disagreement'.
As such, the findings may be more of interest in considering the value of Twitter as a potential barometer of public mood, and possible policy and intervention responses. Twitter, a 'microblogging' site which notably restricts 'tweets' to no more than 140 characters, reports having over 313 million monthly active users, including the some of highest profile politicians, celebrities and even... academics. As some Twitter users noted though, the extent to which the sample reflects the general public's views, or to what extent certain types of drinkers may have responded, is unknown.
A key function of Twitter is the use of the hashtag [#], allowing users to 'tag' or search tweets relevant to a certain topic. The research analysed tweets including #alcoholguidelines which was initiated by the TV show Good Morning Britain. Interestingly the Department of Health had tried to instigate coverage via a different #alcoholupdate although it failed to catch on.
Overall, 49% of tweets were deemed to be unsupportive, versus 44% supportive. Eleven themes were identified, three of which were rated as broadly supportive of the guidelines and seven of which were broadly unsupportive, while the 9% of humour based responses were rated as neutral (e.g 'Drink responsibly—don’t spill your drink!'). The most common theme overall was information sharing (30%), mainly shared by health related accounts. Other supportive themes included those expressing a general agreement with the guidelines (11%), and an intention to heed them (3%).
Tweets classed as broadly unsupportive includes themes of encouraging others to drink (12%), general disagreement (11%), an intention to ignore them (10%), libertarianism such as expressing dissatisfaction with 'nanny statism' (6%), confusion (4%), fatalism such as 'death comes to us all anyway' (3%), or belief that the guidelines 'won't work' (3%).
OK so people (on Twitter) don't like the guidelines...
Whilst some will be interested in the findings, others may return to key point of what policymakers should seek to communicate regarding the risks associated with alcohol. For instance should raising awareness of the guidelines be sought via seeking mandatory labelling on all drinks, or via wider public health campaigns.
Whilst most libertarians would presumably argue against the need to communicate a guideline at all, a more widely accepted question may relate the value of whether promoting a 'no safe level' message. Further evidence that risk of certain cancers begins at any level of alcohol use, albeit minimal at low levels, sparked controversy after the Chief Medical Officer suggested women should consider their risk of breast cancer with each glass of wine.
However concerns over the value of a 'no safe level' message have been expressed by those within the public health arena; John Holmes cautioned that such a message 'fails to distinguish between the presence of risk and the scale of risk', amongst other concerns. Last year CAMRA, whose commissioned YouGov poll said '51 per cent disagreed with the Chief Medical Officers' decision that alcohol guidelines should be the same for men and women', claimed to be most aggrieved by the guidelines overlooking the claimed health benefits of moderate drinking, itself an area of contention. Another point of note is that disagreement with the guidelines tends to be skewed towards those who regularly drink above them, partly attributed to 'normative misperception'.
Last year though the Department of Health (DoH) released a response to the consultation on communicating the revised guidelines. Indeed few people had seemed to be expecting such significant reaction when they were announced; in one of our expert reactions last year Chris Hackley, a Professor of Marketing, argued the guidelines had become a 'dramatic media performance of policy, rather than an actual policy'. The DoH though reconvened the guidelines development group, but found 'nothing raised through the process of consultation that they had not already seen and considered', and still believed the report provided a 'good balance of all the available evidence'. An addendum [pdf] to the original report was produced addressing the 'common criticisms and misunderstandings from the consultation'.
The CMO though has acknowledged that the guidelines alone 'may not reduce consumption directly', but for many there are obvious reasons why an official health guideline should at least exist for such a widely used drug, as explored in detail here by Prof. Nick Heather. However a BMJ study released last year showed even just awareness of the revised guidelines was only raised for a short period after the announcement, and with significant socio-demographic variations. What future emphasis Public Health England place on communication of the guidelines in the context of wider approaches to reducing alcohol harms remains to be seen. But at least based on the Twittersphere, there may be some way to go to convince much of the public that the guidelines are reasonable.