Health Stream Literature Summary - Issue 56 - December 2009

Health beliefs about bottled water: A qualitative study.
Ward, L.A., Cain, O.L., Mullally, R.A., Holliday, K.S., Wernham, A.G., Baillie, P.D. and Greenfield, S.M. (2009) BMC Public Health, 9, Article No. 196.

Over the last decade there has been a consistent rise in bottled water consumption. In the UK bottled water consumption increased from 1415 to 2275 million litres between 2000 and 2006. Even though tap water quality has improved over the last 10 years and bottled water can cost on average 500-1000 times more per litre than tap water, the increase in bottled water consumption has continued. However, recent media reports suggest there is new found cynicism about bottled water with the environmental cost highlighted and a reticence to accept the rising cost of bottled water on the basis of health benefits.

The existing quantitative literature shows that consumers choose bottled water due to health, taste, odour and sight reasons. Health reasons seem to be an important reason for preferring bottled water and generally are based on beliefs concerning unfavourable properties of tap water. This study was conducted to discover more about individuals' beliefs associated with bottled water and the perceived health effects of bottled water in the UK. The study aimed to determine whether these beliefs were important motivating factors to drink bottled water and therefore contribute to the growth of the bottled water market.

All study participants were users of the Munrow Sports Centre on the University of Birmingham campus. Recruitment occurred in January and February 2008 at the entrance to the sports centre. A standard email was sent on two occasions to those who provisionally agreed to participate, to attend an individual interview. All email respondents were interviewed with no exclusions. Recruitment ended when researchers agreed that no new themes were emerging and that data saturation had been reached. Semi-structured interviews were conducted using some pre-determined, mainly open ended questions. Participants were prompted to discuss their habits of bottled water consumption, perceived differences between tap and bottled water, personal beliefs about bottled water and the beliefs that others hold about bottled water. Socio-demographic information about each of the participants was collected at the start of each interview.

There were a total of 23 interviews conducted and recorded between January and March 2008. There were 19 females and 4 males aged between 18 and 52 years who participated. Participants were classified into three groups based on their reported average bottled water consumption in litres per week. Most of the study participants (19) were 'limited consumers' of bottle water and drank 0.5 to 3.5 litres per week. Two participants were 'consumers' drinking more than 10 litres each per week and two participants were 'non-consumers' and never drank bottled water. There were two main themes which emerged encompassing participants' beliefs about bottled water; health beliefs and environmental concerns.

The study found that most people did hold health beliefs about bottled water however for most of the cases these health beliefs were not strong motivating factors for purchasing bottled water. Factors such as convenience, cost and taste emerged as far more important reasons for preferring bottled water. Also most participants felt there was not a substantial health benefit in drinking bottled water compared to tap water. Therefore, from these results it is unlikely that the recent surge in bottled water consumption is because of beliefs about the health benefits associated with bottled water. Convenience was a main motivating factor for buying bottled water when tap water was unavailable such as in a shopping centre or at the cinema. A main emerging health belief was that the majority of people were satisfied with the quality of their tap water supply and believed that it would not pose an adverse health risk. There was some confusion over the health benefits of bottled water with the majority of participants believing that bottled water had some health benefits and then these same participants also stating that the health benefits were negligible or non-existent. Participants often felt that bottled water had an increased mineral content compared to tap water and that this conferred a health benefit, however all of the brands the participants drank apart from one, had low mineral content classification. There was no supportive evidence found for any of the specific health benefits of bottled water the participants stated. Participants still felt that bottled water was safer and purer when compared to tap water.

A number of participants were concerned about a link between the plastic container of bottled water and cancer. Laboratories studies have not found harmful human health effects due to plastic containers. The environmental impact of bottled water was a concern to almost a third of participants. The British bottled water industry generates about 30,000 tones of carbon dioxide per year, which was estimated to equal the energy consumption of 6,000 homes per year. The environmental impact of the production and disposal of plastic bottles was also mentioned by some participants and this is a valid concern.

There are a number of issues that arise from this study that require further research. The link between marketing strategies for bottled water and their role in creating health beliefs in the general public requires further research. A future study could identify people who exclusively drink bottle water and discover their reasons for this and their health beliefs about bottled water, and then the results could be compared with the results of this study to determine whether people who drink only bottled water are motivated to buy it by the same factors as this study's participants. It also may be useful to further educate the public about the safety of tap water in view of the unfounded concerns arising.

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