Big alcohol: Universities and schools urged to throw out industry-funded public health advice

Drinkaware materials distributed at universities

The tide may be turning in Ireland, but in the UK the alcohol industry is active in schools and universities. Universities continue to welcome initiatives funded by Drinkaware intended to educate students about “responsible” drinking skills.

According to Students Organising for Sustainability UK (SOS UK), a partner organisation of the National Union of Students (NUS), eight universities in England and Wales were part of a poster campaign advertising free materials to students, including a Drinkaware plastic half pint cup measuring the number of units in spirits, wine, beer, and cider; a cardboard wheel with the number of units and calories in popular drinks; and a QR code to Drinkaware’s online resources. SOS UK distributes the poster on behalf of Drinkaware. Drinkaware told The BMJ that the number of universities given is “incorrect and a substantial miscalculation” and that the poster was given to more universities.

SOS UK told The BMJ that it promotes responsible alcohol use as well as inclusive campuses for students who choose not to drink. “We utilise a range of resources, like unit measurement cups, to engage students in discussing risks resulting from alcohol consumption and actions to reduce harm,” the statement said.

Drinkaware has produced a “freshers’ week survival guide,” which advises students on ostensibly safe drinking practices, including eating carbohydrates or protein before going out and drinking plenty of water.3

These materials teach students “responsible drinking” skills and downplay the long term health risks of alcohol, which include an increased risk of cancer and cardiovascular disease, says May van Schalkwyk, public health doctor and honorary research fellow at the London School of Hygiene and Tropical Medicine.

She says the material selectively quotes from the chief medical officer’s advice. Drinkaware’s freshers’ guide says it is “safest” not to drink more than 14 units of alcohol a week, and to have at least three drink-free days each week. But it omits the part of the guideline which says there is no level of regular drinking that can be considered completely safe in relation to some cancers.

“The guidelines are for low risk drinking, but drinking at any level is still associated with risk of harm,” she tells The BMJ.

Drinkaware told The BMJ that “the cup and wheel help people understand how much they are drinking.” It added that it had quoted directly from the chief medical officer’s guidelines and that the stated aim of the guidelines is to inform people but not to stop them drinking alcohol, “as it is considered a normal activity.”

It added that the guide begins with the statement, “drinking doesn’t have to be a way of life at university” and that one in five young people choose not to drink. The guide also advises students to eat and drink plenty of water to go out to “help you not get too drunk.” “Food helps slow the absorption of alcohol, stopping it going to your head too quickly.”

Mark Petticrew, professor of public health evaluation at the London School of Hygiene and Tropical Medicine, said this focuses on the short term effects of getting drunk. “Food has no relevance to the longer term harms of alcohol, including cardiovascular disease, cancers and fetal alcohol spectrum disorders,” he adds.

“This advice is an example of assuming the drinking of alcohol, akin to teaching students how to pre-load ‘safely,’ rather than helping them question whether they should be pre-loading at all,” says Richard Piper, chief executive of Alcohol Change UK.

A Drinkaware scheme also trained staff working in student bars to “reduce drunken anti-social behaviour and help keep people safe.”4 This included being able to “identify and support” drunk students. “Nightlife Crew teams circulate in the venues, reuniting customers with their friends, or possessions, or helping them to get home safely. They also proactively promote a positive atmosphere, by talking to customers queuing to enter the venue, and engaging with them during the evening,” reads its website. Drinkaware says this initiative and its in-person presence was scaled back in 2021.

There were nightlife crews in Cardiff University’s student union and also in Swansea University’s nightclub until it closed for refurbishment in 2020.5

Jim McCambridge, professor and chair of addictive behaviours and public health at the University of York, called the nightlife crew initiative “curiously narrow” and “industry friendly” as it is focused on protecting people after they have bought and consumed alcohol. “This type of initiative is interesting in that it is not about helping students to avoid getting drunk in the first place. It is after having consumed and therefore also having purchased large volumes of alcohol, trying to minimise the worst effects of those excesses.”

Universities have been too slow to take action on the “fresher’s week of oblivion,” says Ian Gilmore, chair of Alcohol Health Alliance UK. “The most influential thing I’ve ever done to influence public policy on alcohol was to resign from co-chairing the alcohol strategy group for Public Health England when they decided to partner with Drinkaware.”

The Department for Education said that universities are private institutions and the government has no remit to review materials distributed to students in England. In Wales, universities were given a toolkit to assess whether they are keeping students safe from alcohol created by the Welsh government, NUS Wales, and Drinkaware.6

Mark Petticrew criticised the toolkit as “misinformation” given it omits any information about the risks of cancer, cardiovascular disease, injury, and death associated with alcohol. It also focuses on actions individual students and staff can take, rather than universities could take, such as restricting sales of alcohol, restricting alcohol marketing, and creating alcohol-free spaces in the university.

“The framing of the entire document is to preserve the industry reputation and not about protecting young people at universities from harm,” says Petticrew.

The document was created 13 years ago and “is not something we have been involved in since then”, said a Drinkaware spokesperson. “We are very clear that alcohol can cause cancer and other health risks.”

The toolkit was available on Public Health Wales’ website in 2023, but the Welsh government has since removed it after inquiries from The BMJ and said that it has not funded Drinkaware in the past five years.

Karen Tyrell, chief executive of Drinkaware, described its work in UK universities as “a pragmatic and worthwhile contribution to reducing alcohol related harm across the UK.” She said: “We work with the grain of public opinion and treat people like adults capable of making informed choices. While some may not like it, alcohol is a part of our society and there is currently no public desire to change that. We make no apologies for delivering a range of activities which support our charitable objectives and organisational purpose.”

Drinkaware materials in schools

In the absence of a specific ban, as in Ireland, industry related alcohol education charities have also been active in schools, providing information to pupils as young as 9. The BMJ asked theEnglish, Scottish, and Welsh governments if they planned to ban alcohol industry tied programmes from schools but none said they did.

Initiatives by the Talk About Trust (formerly the Alcohol Education Trust), which has received alcohol industry funding, and Smashed, a theatre group funded by Diageo, one of the world’s biggest alcoholic beverage companies, continue to run in British schools.

In 2022, Petticrew and van Schalkwyk published an analysis of teaching materials from the Talk About Trust, Smashed, and Drinkaware, which concluded that they are “misleading” and “serve to reproduce hegemonic industry-favourable discourses of personal responsibility, moderate consumption, and individualised problem definitions and interventions, linked to a concealing of the role of industry practices as drivers of harm and inequities.”7

Drinkaware targets adults, not schoolchildren, and its education programme wound down in 2019, before the analysis was published, a spokesperson said. Smashed is independently owned and developed by the educational company Collingwood Learning, and its content was established before it had a business relationship with Diageo, the director of Smashed Global, Andy Summers, told The BMJ. It has been updated in response to work with “multiple ministries of education around the world, schools, and teenagers themselves,” Summers added.

“This article reflects the view of two individuals,” said Talk About Trust’s chief executive, Helena Conibear. “The assertions … about promoting moderate consumption are unsupported by any evidence.” The authors ignore studies showing that the programme has positive effects on the age at which teenagers begin drinking whole drinks, she said. The organisation is currently not “accepting any funding from the alcohol industry” directly, and support by alcohol industry tied charities was not identified as a conflict of interest, she said.

Drinkaware has withdrawn its materials from schools, but recent materials from the Talk About Trust and Smashed indicate that little has changed, says Petticrew.

A 2021 manual produced by the trust for teachers of 11-18 year olds, for example, mentions cancer, cardiovascular risk, and addiction, but only in relation to “long term” and “prolonged” excessive alcohol intake.

“Just 5% of all men over 16 drink more than 50 units a week and 3% of women drink more than 35 units a week in England. Drinking at this level increases the risk of cancers (colon, breast, upper digestive tract), of heart disease and alcoholic liver diseases long-term. That’s why in the UK in 2019, 7565 people died from an alcohol-related illness, mainly from alcoholic liver disease,” it says.

“Prolonged abuse of alcohol can lead to addiction and causes many life threatening conditions including heart disease, haemorrhagic stroke, cancers of the liver, breast, mouth and throat, as well as cirrhosis of the liver and addiction,” it says.

“This contradicts the chief medical officer’s guidance and is a misrepresentation of the epidemiological evidence,” says Mark Petticrew. “It is false that only heavy drinking harbours risk of cancer, and similar to the alcohol industry misinformation, which presents risk as being only a consequence of ‘heavy’ drinking, alcohol ‘abuse,’ and ‘too much’ alcohol and so on.” This amounts to “very concerning misinformation,” Petticrew says.

A recent Talk About Trust brochure for students also contained “misinformation about alcohol and cancer,” Petticrew says. He gives a “misleading infographic” as an example, “which selectively omits breast cancer and colorectal cancer” from types of cancers caused by alcohol. “It is unacceptable and unethical to mislead the public and schoolchildren about the health harms of alcohol consumption, including cancers,” he says. Teaching students about adult guidance on alcohol units and drink-free days is also “concerning,” van Schalkwyk adds.

“[The trust] follows the science and evidence base at all times,” Conibear told The BMJ. “At no stage do we promote or normalise alcohol consumption.” She added that its “guidance and materials focus on the health harms that young people are most likely to face as they mature.”

The “guide for older teenagers takes a harm reduction approach,” which when taken together with lessons on alcohol and the law and its social and physical effects “equips young people with the knowledge … to make safer choices around alcohol,” she added.

The Smashed project, a theatre based educational programme including teaching materials for schools, was also criticised by van Schalkwyk and Petticrew’s analysis. Smashed claims on its website that it is “a firm fixture in over 23 countries around the world.” In 2020, Smashed announced an online teaching resource modelled on its theatre programme.

The programme is “consistent with other industry materials,” Petticrew says, “blame it on peer pressure, basically.” In a quiz that asked why a person might want to drink alcohol, industry marketing was left out as a reason, he pointed out. “So again, the alcohol industry is conveniently left out of the frame,” he says.

“The Smashed project seeks to present a nuanced reflection of teenage life and the competing pressures and influences that our research has shown were contributing factors to the decision making by young people on consuming alcohol underage,” Summers told The BMJ. “Peer pressure is not blamed for anything in the programme,” he said. “Our research, which involved numerous focus group sessions in UK high schools, did not show that ‘alcohol industry marketing’ was mentioned as a contributing factor to why a young person might want to drink alcohol,” he said.

There is a concern in the public health community that these industry backed programmes are poorly evaluated, says John Holmes, professor of alcohol policy at the University of Sheffield. Well designed and effective programmes have a role to play.

“Alongside that, we need other measures such as reducing the affordability of alcohol, reducing its availability, and better restriction of alcohol marketing,” he says.