Public acceptability of nudging and taxing to reduce consumption of alcohol, tobacco, and food: A population-based survey experiment

Abstract

There is growing evidence for the effectiveness of choice architecture or ‘nudge’ interventions to change a range of behaviours including the consumption of alcohol, tobacco and food. Public acceptability is key to implementing these and other interventions. However, few studies have assessed public acceptability of these interventions, including the extent to which acceptability varies with the type of intervention, the target behaviour and with evidence of intervention effectiveness. These were assessed in an online study using a between-participants full factorial design with three factors: Policy (availability vs size vs labelling vs tax) x Behaviour (alcohol consumption vs tobacco use vs high-calorie snack food consumption) x Evidence communication (no message vs assertion of policy effectiveness vs assertion and quantification of policy effectiveness [e.g., a 10% change in behaviour]). Participants ( N = 7058) were randomly allocated to one of the 36 groups. The primary outcome was acceptability of the policy. Acceptability differed across policy, behaviour and evidence communication (all p s < .001). Labelling was the most acceptable policy (supported by 78%) and Availability the least (47%). Tobacco use was the most acceptable behaviour to be targeted by policies (73%) compared with policies targeting Alcohol (55%) and Food (54%). Relative to the control group (60%), asserting evidence of effectiveness increased acceptability (63%); adding a quantification to this assertion did not significantly increase this further (65%). Public acceptability for nudges and taxes to improve population health varies with the behaviour targeted and the type of intervention but is generally favourable. Communicating that these policies are effective can increase support by a small but significant amount, suggesting that highlighting effectiveness could contribute to mobilising public demand for policies. While uncertainty remains about the strength of public support needed, this may help overcome political inertia and enable action on behaviours that damage population and planetary health.

Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability

“…Evidence is only one factor that determines the likelihood of policy changes, and so demonstrating effectiveness does not ensure any given intervention will be implemented [25]. A key barrier to implementation is public acceptability [25], which is increasingly recognised for its pivotal role in the extent to which evidence is implemented into policy [26]. As such, were there evidence for the effectiveness of these labels in reducing selection and consumption of alcohol and energy-dense snacks, their low public acceptability may justify generating evidence for other label types.…”

“…In addition to its effectiveness, the public acceptability of an intervention affects the likelihood that it is implemented [25]. Public attitudes can also change with evidence of an intervention's effectiveness [21,26,27]. Public support for tobacco control policies, such as taxation and image-and-text HWLs, is generally high [26,28].…”

“…Public attitudes can also change with evidence of an intervention's effectiveness [21,26,27]. Public support for tobacco control policies, such as taxation and image-and-text HWLs, is generally high [26,28]. This high acceptability reflects the low prevalence of smoking in the population, with people generally less supportive of policies that might affect their own behaviour [26].…”

“…Public support for tobacco control policies, such as taxation and image-and-text HWLs, is generally high [26,28]. This high acceptability reflects the low prevalence of smoking in the population, with people generally less supportive of policies that might affect their own behaviour [26]. It may also reflect a high awareness of tobacco harms [28] and exposure to image-and-text HWLs [10].…”

“…Research into the acceptability of HWLs in the context of alcohol and food is limited [25]. A recent study found high acceptability for the implementation of image-and-text HWLs for both alcohol and food [26], but respondents were not shown examples of the warnings. A small number of studies suggest that text-only HWLs are generally accepted for both alcohol [29] and SSBs [30] but image-and-text HWLs could plausibly be less acceptable due to their graphic nature.…”