Behaviour Change

PROPAGANDA FOR CHANGE is a project created by the students of Behaviour Change (ps359) and Professor Thomas Hills @thomhills at the Psychology Department of the University of Warwick. This work was supported by funding from Warwick's Institute for Advanced Teaching and Learning.

Tuesday, May 1, 2018

Keep Track of Your Drinking!

Having studied at multiple universities now, we (Natalia and Lise) have noticed that drinking culture appears to be a big part of student life, no matter which country you study in. It is often forgotten that alcohol is a drug that affects both body and mind (National Institute on Alcohol Abuse and Alcoholism,, 2018).
Starting with the basics, alcohol puts a serious strain on your liver, causing various complications in the functioning of your liver such as steatosis, or fatty liver, alcoholic hepatitis, fibrosis or cirrhosis  (, 2018). It also affects your brain’s communication pathways, which in turn makes you behave differently  (, 2018). Long-term consumption leads to heart problems such as strokes, arrhythmia, high blood pressure and parts of your heart muscle giving out  (, 2018). Another problem for chronic drinkers is an increased risk for cancer and pancreatitis, and a weakened immune system resulting from drinking also leaves one more vulnerable to diseases (, 2018).

Drinking during adolescence is associated with brain damage and neurocognitive deficits (Zeigler et al., 2005). High-risk drinking, in other words consuming 4 drinks within about 2 hours for women and 5 drinks in the same period of time for men, also called binge drinking, is popular among young adults (Zeigler et al., 2005; Snyder, Kivlehan & Callopy, 2014) ).

Binge drinking is the main cause of alcohol poisoning (Snyder et al., 2014). Alcohol poisoning occurs when the liver can no longer metabolise the alcohol into non-intoxicating byproducts at the rate that it enters the bloodstream (Snyder et al., 2014) and its symptoms are recognised by about a mere one-thirds of university students (Haas & Flores, 2012). This is alarming, because unrecognised alcohol poisoning is left untreated, and this can lead to the death of the poisoned person (Voelker, 2015). This was the case for many people among the 8758 UK residents who died from alcohol-related causes in 2015 (Alcohol Concern, 2016). 

In an effort to raise awareness about alcohol poisoning, and get students to change their drinking behaviour, we have made a video we published online.

The goal was for students to keep track of their drinking, and our proposed way to do it is by tallying on your hand for every drink you consume. In order to appeal to Warwick students, the NHS statistics specific to this region were requested. The situation turned out to be subpar. The last four years, there have been 1316 young adults from 17 to 25 years old admitted to the hospital because of alcohol poisoning in South Warwickshire alone (University Hospitals Coventry & Warwickshire NHS Trust). The video specifically targets university students to help them drink responsibly. The video format helps get the message across because it’s the most common medium the target audience comes into contact with. For the same reason, the video starts with a Snapchat segment presenting a group of university students on a night out in a recognisable environment for Warwick students. The hospital filmed in the second part of the snapchat story is also tailored to Warwick students because that’s where they would be taken if they do get alcohol poisoning. The most informative part of the video comes after the snapchat segment and introduces the viewer to tactics they can apply when helping someone who has alcohol poisoning. This second segment utilizes behaviour change techniques to maximise the video’s impact.

The first technique is used throughout the video. Ellen Holmes, the Welfare and Campaigns Officer of the Student Union at the University of Warwick, recorded the voice-over. This augments the video’s impact because her position is well known among students. The fact that she is part of the university community and has the same experiences contributes to the effective message. According to Social Learning Theory (e.g. Bandura & Walters, 1977) and the Health Belief Model (Rosenstock, Strecher & Becker, 1998) role models may act as reinforcers, but only when the consequences are well understood by the audience. Thus, at the beginning of the video Ellen introduces the viewer to the topic, showing basic statistics and explaining what binge drinking is. Then, she introduces a threat by highlighting the negatives of being poisoned by alcohol. Finally, she concludes the video with a short exclamation: “Keep track of your drinking!” noting her full name and position later on.
In the beginning of the video, Ellen mentions “drinking is an integral part of university experience”. This calls on pre-existing beliefs and experiences of university students, who have been involved in this themselves. Doing this makes the video’s message more convincing to students who believe this to be true (Cacciopo, Petty & Sidera, 1982). This is our target audience, because people who don’t think alcohol is part of the university experience, may be less inclined to drink irresponsibly. Next, she encourages viewers to “think of how much they drink when they’re out circling”, which is not only referencing to pre-existing beliefs but also making the viewer visualise an amount of drinks that they usually have. They can compare this amount to the definition of binge drinking, which is given afterward.
A section laying out the statistics concerning the Warwick Uni area then serves as a fear appeal, which is later on followed by a high efficacy message. A high efficacy message is a recommended response to the threat that people perceive as effective and feasible (Witte & Allen, 2000). A fear appeal is a fear-arousing persuasive message (Peters, Ruiter & Kok, 2013) such as “in YOUR AREA, X amount of people YOUR AGE have ended up in the hospital for doing something YOU DO as well”. The combination of a fear appeal and a high efficacy message has been shown to result in the highest probability of behaviour change (Witte & Allen, 2000). The fear appeal serves to increase the belief that one is susceptible to a threat, and the proposed solution will determine whether one will try to control the threat or control their fear (Witte & Allen, 2000). A high efficacy message will motivate people to control the threat and not their fear of the threat (Witte & Allen, 2000). If there’s doubt about the efficacy of the response, or perceived low self-efficacy, people will do the latter through denial, avoidance or other coping mechanisms (Witte & Allen, 2000). The high efficacy message used in the video is an entire segment explaining what to do when someone you know has alcohol poisoning, and how to prevent it from happening in the first place. This should at the very least motivate people to look up the video or other aids in case they need to help someone with alcohol poisoning.
At the very end of the video, viewers are encouraged not to be irresponsible drinkers. It was deliberately worded this way because drinking irresponsibly is presented as a defining characteristic. Viewers don’t want to include “irresponsible drinker” their self-concept, and are therefore more inclined to change their drinking behaviour than if it were worded “don’t drink irresponsibly”. The latter seems very circumstantial and less consequential.

Unfortunately, one of the limitations of this project is that there is no way to keep track of the impact of our video. Whether people start tallying the amount of drinks they’ve had on their hand, is in their hands now. Moreover, there are various other factors in real life situations that will influence people’s drinking behaviour and that may cancel out our video’s message. A good example of this is social pressure or personal struggles. In the future, a more hands-on campaign may have a more visible impact. Campaigns that are held at parties, maybe involving the bartenders, could keep students’ drinking behaviour under control and may help them develop responsible drinking habits. More complex solutions that involve the participation of multiple institutions might have a bigger impact.

Lise Peeters & Natalia Bogacz

Alcohol Concern. (2016). Alcohol statistics. [online] Available at: [Accessed 11 Mar. 2018].

Alcohol Poisoning Deaths Hit Middle-Aged Men Hardest. JAMA. 2015;313(9):886. doi:10.1001/jama.2015.0700

Bandura, A., & Walters, R. H. (1977). Social learning theory (Vol. 1). Englewood Cliffs, NJ: Prentice-hall.

Haas, A., Flores, S. (2012). College student awareness of signs of alcohol poisoning. Journal of Alcohol and Drug Education, 56, 59-76.
Snyder, S. R., Kivlehan, S. M. & Callopy, K. T. (2014). Acute alcohol poisoning. EMS world, Malvern, 43, 36-42. (2018). Alcohol poisoning. [online] Available at: [Accessed 2 Mar. 2018]. (2018). Alcohol's Effects on the Body | National Institute on Alcohol Abuse and Alcoholism (NIAAA). [online] Available at: [Accessed 7 Mar. 2018].

Peters, G. J. Y., Ruiter, R. A., & Kok, G. (2013). Threatening communication: a critical re-analysis and a revised meta-analytic test of fear appeal theory. Health psychology review, 7(sup1), S8-S31.

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the health belief model. Health education quarterly, 15(2), 175-183.

Witte, K., &d Allen, M. (2000). A meta-analysis of fear appeals: Implications for effective public health campaigns. Health education & behavior, 27(5), 591-615.

Zeigler, D. W., Wang, C. C., Yoast, R. A., Dickinson, B. D., McCaffree, M. A., Robinowitz, C. B., & Sterling, M. L. (2005). The neurocognitive effects of alcohol on adolescents and college students. Preventive medicine, 40(1), 23-32.

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