Welcome to the Real World

Dave Troy 

Taking laboratory studies into the ‘real world’ is every scientist’s nightmare. We love the lab – it’s where we feel safe, where we can control our world, our variables, our environment, and our interventions. However, lab studies can only tell us so much; eventually we need to know whether the findings from our lab studies apply in the real world. This is what the Tobacco and Alcohol Research Group (TARG) has endeavored to do. Findings in our lab suggest that individuals drink beer slower from a straight-sided glass compared to a curved glass. As a first step towards testing this effect in the real world, we carried out a small feasibility study to investigate whether a large-scale study might be possible. We needed to find out what outcome measure we could use to measure alcohol consumption, whether pubs and customers would be willing to take part, and what the logistical challenges of running a study of this nature might be. With this in mind, we contacted the owner of Dawkin’s Ales. He was open to the prospect of stocking three of his pubs (The Portcullis, Clifton Village; The Victoria, Clifton; and the Green Man, Kingsdown) with differently shaped pint glasses over a couple of weekends, using monetary takings as a proxy measure of the amount of alcohol consumed. He was extremely supportive of the endeavor and we would like to thank him for all his help. He seemed to be genuinely interested in the outcome of the study and in science in general. The feasibility study was a success: we showed that this type of drinking rate study can be carried out in a pub environment. However, there were some teething problems. Variables such as the size of a dishwasher caused unforeseen complications. Only when you get into the real world, do you realise how unstandardised it is.

Green Man Pub, Kingsdown
Green Man Pub, Kingsdown

What we learned on our adventures in the real world is that communication is key. Cultivating good relationships with pub landlords and staff was vital to the success of the feasibility study. Naturalistic studies are unpredictable – nothing goes to plan. Good communication and rapport with stakeholders is vital and can assist in acquiring high quality data. Pub staff are also a great source of industry knowledge. We were educated on the extent of research by the drinks industry into the effect of different glass shapes on drinking behavior, which is extensive in their opinion. They were also full of ideas regarding what other experiments could be carried out. One of the landlords mentioned that people “drink with their eyes”, which piqued an interest in me about how our other senses may play a role in our drinking behaviour. Another comment was that people tend to drink more quickly when they are standing up. This hadn’t occurred to me before, but I was told that it has grabbed the attention of policy makers, who want to discourage ‘vertical drinking’ by demanding pub license holders supply more seating. Another topic that came up again and again is the use of “nucleated” beer glasses. These have marking at the bottom of beer glasses to promote the formation of bubbles, maintaining the head for longer. The importance attached to it by pub staff and customers suggests it might be an important factor in people’s drinking. All of these are ideas that we may take forward in our lab studies. Pub staff also made valuable suggestions on how to improve future pub studies. One landlady said that we should do it over a whole week to get a better picture of the cadence of an average drinking week.

Nucleation vs Non-nucleation
Nucleation vs Non-nucleation

On a personal level, I learned more as an experimenter helping with this study than in all my previous lab studies. Perhaps surprisingly, the attention to detail and organisation required is above the requirements of a lab study. The logistics involved are greater and an ability to think on your feet is essential. The real world is a challenging place to do research but the advantages are clear. The data collected reflects more natural behavior of participants and therefore your findings have greater relevance. Activity that would have otherwise have gone unnoticed can be observed. Qualitative data collected can inform future research. Another advantage is that you can interact with professionals who have their ear to the ground, which can lead to ideas for new studies. There are also some challenges. There is a greater probability that an external variable, not controlled for in your study, has influenced your findings. Natural environments lack the control of lab studies. It may be difficult to replicate a study when there are so many variables at play. Nevertheless, lab and naturalistic studies complement each other and there is a need for both in science. Advances in technology, such as tablet computers and smartphones, have made acquiring vast amounts of data in the ‘real world’ much easier. Researchers in TARG will continue to engage with the public in natural settings in the future and hopefully capture data that will inform people’s lifestyles and public health policy.

One for the road? The hidden risks of roadside alcohol availability

As JD Wetherspoon looks set to open its first motorway service station pub, it may be time to ask where to draw the line in the sale of alcohol, says Sally Adams

In the UK, you can purchase and drink alcohol in bars, restaurants, cafes, at the cinema, at the theatre and on planes and trains. However, how often have you had the urge for a pint while driving along the M40 and not had the opportunity?

Well fear not, this week sees popular pub chain JD Wetherspoon take to the motorways of Great Britain. In explaining the move, the company draws focus towards the franchise’s successful soft drink and food sales. However, what appears to be unspoken is the fact that this move will see alcohol served roadside. The successful application to a Buckinghamshire local council is alleged to include a licence to serve alcohol between 8am and 1am. The application is timely, given that the government is currently reviewing its alcohol strategy, including the sale of alcohol at motorway services.

One of the key aims of the government’s strategy is to regard “health as a new alcohol licensing objective … so that licensing authorities can consider alcohol-related health harms when managing the problems relating to the number of premises in their area”. In a UK where 17% of females and 26% of males drink above the weekly government recommendation for alcohol, increasing its availability at motorway service stations seems counterintuitive to this goal.

Firstly, let’s consider the proposed location of the first roadside JD Wetherspoon pub. This is a location that is only accessible by road. Therefore, for every group of customers there will be at least one designated driver. While it’s legal to drive after a drink, evidence has clearly demonstrated that even a small amount of alcohol is detrimental to driving performance.

One review concludes that there is no known threshold of blood alcohol concentration (BAC) at which impairment does not occur and no sufficient evidence that a certain category of driver will not be affected by alcohol. Alcohol-related impairments in driving are not consequence free. In 2010 it was estimated that 14% of road fatalities involved drink-driving. Figures from the same Department for Transport report indicated that almost 10,000 road traffic casualties occurred when the driver was over the legal alcohol limit.

These figures have the potential to be sobering if drivers are aware of their alcohol intake and the drink-driving limit. However, it is well documented that knowledge of alcohol units is weak. Moreover, awareness of the legal limit and penalties for drink driving are poorly understood.

Regardless of whether drivers are armed with this knowledge, the decision to drink alcohol, or of how much to consume, may be impaired as soon as you see that bar sign from the motorway. Cue reactivity is the principle that mere exposure to cues associated with alcohol use (eg a bar setting, or seeing others drinking) can trigger physiological and psychological responses indicative of arousal such as increased heart rate, sweating and alcohol craving. Importantly, these responses are often automatic, occurring without any conscious thought.

So imagine the scene: you stop at the services after a stint of driving and have to decide where to eat/drink. You are a regular drinker and recognise a familiar chain-pub brand, alcohol-related cue #1. You decide to go and refuel at this well-known chain and walk into a bar alcohol-related cue #2, with multiple drinks on display alcohol-related cue #3 and numerous other customers drinking alcohol alcohol-related cue #4. Before you have even made the decision whether to consume alcohol or not, you have been confronted with several alcohol-related cues.

Studies of alcohol cue exposure suggest that cues previously and repeatedly presented with drinking can become powerful cues in their own right, leading to cognitive and physical responses that can trigger alcohol seeking and consumption. Interestingly, the association between alcohol-related cues and reward can be especially powerful for heavier, more regular drinkers, meaning these drinkers are more vulnerable to environmental alcohol cues.

For social drinkers, cues can range from environmental context (being in a bar) and time of day (after work), to the external properties of alcohol (sight/smell of wine). These cues alone can be so strongly associated with alcohol-related reward that they promote alcohol use. A potential problem of roadside alcohol cue exposure is therefore the risk of drinking alcohol without any real intention to drink. This is particularly potent when you think of the potential damage alcohol consumption may cause in this context – namely, getting back in a vehicle and driving at high speeds.

Considering that the dawn of the new government alcohol strategy is upon us, increasing the presence of alcohol-related cues and availability of alcohol in a roadside location does not signal a step in the right direction. Is it time to call time on the availability of alcohol in seemingly hazardous and unnecessary places?

Sally Adams is a postdoctoral researcher in Experimental Psychology at the University of Bristol

This article first appeared on the Guardian science blog website on 5th June 2013 and is posted by Sally Adams