Alcohol Marketing, the Alcohol Industry and Their Impact on Binge Drinking by Adolescents Thomas F. Babor, PhD, MPH The University of Connecticut School of Medicine Department of Community Medicine and Health Care Farmington, Connecticut, USA NZ Situation • Above-average alcohol consumption compared with other countries • Binge drinking pattern, especially among young • Pacific Islanders and Maori drink more heavily NZ Situation: Harmful Effects • In 2007, there were 802 deaths attributable to alcohol, 5.4% of all deaths • Maori men had the highest rates of mortality and years of life lost • • • • Social life effects: 20% of population Home life effects: 14% Injuries: 12% Chronic disease: ??? • Injuries and trauma ??? What causes alcohol abuse? • Multiple genes may account for the observed genetic vulnerability to alcohol as a drug as well as more general traits (e.g., negative affectivity) • Parental alcoholism may increase risk through general deviance proneness and pharmacological vulnerability • Alcohol expectancies, drinking patterns, and "drinking to cope" are learned through observation of social models who are portrayed in reinforcing or positive situations. Alcohol Promotion • The marketing of alcohol is a global industry • Alcohol brands advertised through: – – – – – – – Television Radio Billboards Print media Point-of-sale promotions the Internet Product placements in movies and TV Snoop Dogg Promotes New caffeinated alcohol drink • Snoop Dogg is promoting a new caffeinated alcoholic beverage called Blast. • The product has a 12 percent alcohol content and comes in a variety of fruity flavors. • Blast is criticized for being nearly indistinguishable from soft drinks and encouraging binge drinking among young people. • In a video Snoop Dogg frolics with models at a photo shoot to promote the launch of Blast. Does marketing affect alcohol use and abuse by young people? • Studies in neuroscience, psychology and marketing conclude that adolescents may be especially attracted to risky branded products that, in their view, provide immediate gratification, thrills, and/or social status. • If an ad portrayal corresponds closely to personally relevant reference groups, children will be more likely to copy it. • If children admire models in an advertisement, they learn to expect that imitating the models’ behaviours will bring positive results. • Repeated exposure to visual modeling can make even marginal behaviour seem normal and desirable by desensitizing the observer to the possible risks Effects of Alcohol Marketing • Research shows that alcohol advertising reinforces perceptions of drinking as positive, glamorous, and relatively risk-free. • Exposure to repeated high-level alcohol promotion inculcates pro-drinking attitudes • More focused consumer studies, especially recent ones with sophisticated designs, show clear links between advertising and drinking behaviour Effects of Alcohol Marketing • Strong evidence of effect of exposure to alcohol marketing on younger people: – Lowers the age at which drinking starts – Increases the amounts drunk by young people • There is more evidence that increased exposure is associated with more drinking than decreased exposure is associated with reduced drinking • Plausible theoretical explanations based on vulnerability theory, social learning principles and developmental psychology Research on alcohol marketing • Smith & Foxcroft (2009) concluded: “The data from these studies suggest that exposure to alcohol advertising in young people influences their subsequent drinking behaviour.” • Meier (2008) concluded “exposure to …TV, music videos and billboards, which contain alcohol advertisements, predicts onset of youth drinking and increased drinking.” • Anderson et al. (2009) concluded: “alcohol advertising and promotion increases the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol.” Types of Regulation • Total bans (e.g., Norway, France) • Partial bans (e.g., daytime TV) • Industry self-regulation (voluntary codes of practice that restrict certain content and exposure markets) Assumptions Behind Alcohol Marketing Regulation POLICY Regulating alcohol advertising and other marketing Pan American Health Organization ASSUMPTION Reducing exposure to marketing that normalizes drinking and links it with social aspirations will slow recruitment of young drinkers and reduce heavier drinking Reducing exposure to social modeling of excessive drinking will reduce underage drinking problems Self-regulation codes • Guidelines developed by the alcohol industry that define responsible advertising practices • Exposure guidelines: specify markets that should not be exposed to alcohol promotions (e.g., children, adolescents, pregnant women) • Content guidelines: specify content that should not appear in advertising (e.g., cartoon characters, celebrities, young looking actors, excessive drinkers, drinking while driving) Industry Self-regulation Codes Vulnerability Assumption • Certain groups should not be exposed to irresponsible advertising content because of presumed vulnerability to alcohol’s effects or susceptibility to advertising • Examples: children, adolescents, pregnant women, alcoholics, children of alcoholics …should not present alcohol beverages as a means of removing social or sexual inhibitions, achieving sexual success, or making an individual more sexually attractive (Guiding Principles, ICAP) Santa’s Butt Beer ….alcohol marketing should not portray Santa Claus and other images that appeal to children …should not depict or be addressed to at-risk groups. …should not present alcohol beverages as a means of removing social or sexual inhibitions, achieving sexual success, or making an individual more sexually attractive …should avoid showing minors (or people likely to be perceived as minors) Compliance Review  Complaints against beer advertisements are made to the Code Compliance Review Board  The beer manufacturer responds to the complaint  3 members of the board make a decision  In USA, the Compliance Board responded to 8 complaints in 2006 and 2007  All were overturned Controls to reduce exposure • Exposure restrictions limit advertising to certain hours of the day, and forbid alcohol ads on programs likely to be watched by children. • Despite these voluntary guidelines, children and adolescents are exposed to large amounts of alcohol marketing in countries without total bans. Youth Exposure to Alcohol Ads  Between 2001 and 2007, more than 2 million alcohol advertisements were aired on U.S. television; in 2001, 39% of these ads were aired during sports programming  Between 2001 and 2006, almost 20,000 alcohol ads were placed in U.S. magazines  Youth are 22 times more likely to see an alcohol ad than a public service announcement  In 2006, 4.4 alcohol ads were aired per hour of programming for the 15 highest rated TV shows in the 12-20 age group Evaluating industry codes governing alcohol advertising • A research project to: • A) develop a new rating procedure to evaluate alcohol marketing according to the industry’s self regulation coes • B) apply the procedure to ads broadcast on the NCAA basketball tournament between 1997 and 2008 • Funded by the US National Institute on Alcohol Abuse and Alcoholism Initial Research with 300 college students who rated 6 ads considered to have possible code violations • College students perceive actors in some beer commercials to be excessive drinkers • These perceptions are related to individual differences in alcohol expectancies, family history of alcoholism, alcohol dependence severity, binge drinking and alcohol-related problems • Heavy drinkers perceive more drinking in alcohol ads but are less likely to call it excessive Measuring Code Violations • Questions measuring the viewers’ agreement or disagreement with statements of fact and opinion (e.g. “This ad depicts situations where beer is being consumed excessively”). • Viewers’ perception of the age group to which the ad primarily appealed (e.g. “The images in this ad are most appealing to which of the following age groups: below 21; between 21 and 30; etc.”). • Perception of the appeal of the ad (e.g. “How appealing are the images in the ad to you?”). Scale: “Very Unappealing” to “Very appealing”. • Perception of the amount of drinking taking place (e.g. “How many drinks do you estimate this person is likely to consume in the situation shown in the ad?”). Ad # 5 - Stamp of Approval – Smirnoff Ice malt beverage (print ad) This full page magazine ad shows an arm grasping a bottle of Smirnoff Ice malt beverage. There is no human face on this picture, just an arm. The bare skin of the arm shows six different nightclub stamps. One text superimposed on the picture reads “4:06 am. We get past our sixth doorman of the evening.” Another text reads: “See where it takes you.” Smirnoff Ice: Stamp of Approval 4:06 A.M. WE GET PAST OUR SIXTH DOORMAN OF THE EVENING SEE WHERE IT TAKES YOU Example of violation Stamp of Approval - Smirnoff Ice Description of item Score Avg. Freq. 7.4 72% 2.b How many drinks do you estimate this person is likely to consume in the situation shown in the ad? (# of drinks) 2.b This ad shows situations where people are drinking alcohol responsibly. (Reversed) 60% 2.c This ad suggests that being drunk is acceptable. 51% The NCAA Beer Ad Study • Funded by NIAAA • 290 beer advertisements shown during the men’s and/or women’s NCAA basketball tournament were rated by 15 professionals trained in psychology, public health, alcoholism, social work and other helping professions Aims of NCAA Beer Ad Study • Estimate the prevalence of content code violations in beer ads shown during the NCAA tournament games (1999-2008) – Determine which sections of the Code are violated most often – To determine if different producers use age targeting to different degrees – To determine if different products are intended to appeal to different age groups Percent ads with a violation by producer a An Producer % Ads with a violationa AnheuserBusch 39.9% SABMiller 31.9% All other producers 32.5% Total 36.9% advertisement was in violation of the advertising code when all expert raters agreed a violation existed for the ad Conclusions • Code violations of the US Beer Institute Guidelines are prevalent (35%) during NCAA sports events that appeal primarily to US college students. • Significant differences among the major US beer producers, with Anheuser-Busch ads having the highest prevalence of code violations. Findings • Most violations were found in content areas suggesting key public health concerns, such as content appealing primarily to young persons and the association of beer drinking with social success and sexual attractiveness. • Findings are consistent with evidence from other countries showing that alcohol industry selfregulation procedures are ineffective in preventing content violations. Conclusions • Self-regulation codes tend to be easily circumvented and largely ineffective. • The Precautionary Principle suggests that alcohol promotion communications should be limited in the interests of public health. • Industry compliance with self-regulation advertising codes should be evaluated regularly for both exposure and content guidelines. Model Policy: Loi Evin • Passed in 1985 but not defined and enforced until 1991 • Definition of alcoholics drinks (1.2%) • No advertising targeted at young people • No ads on TV or in movies • No sponsorship of cultural or sporting events Model Policy: Loi Evin • Advertising permitted only in the press (for adults), on billboards, on radio • Messages and images should refer only to the qualities of the product such as origin, composition, production, etc. • A health message must be included on each ad Global Dimensions • There has been a marked increase in alcohol marketing, especially in emerging markets. • There are unprecedented levels of exposure of young persons to sophisticated marketing worldwide. • Voluntary codes of content have been shown to be ineffective in a variety of countries. • Unlike tobacco, there is, as of yet, no international or regional agreement to restrict alcohol marketing. Implications • The protection of children and young adults from the effects of alcohol marketing requires more than industry self-regulation • Civil society, professional organizations and NGOs should support evidence-based policies to regulate alcohol marketing in ways similar to the regulation of tobacco marketing Conclusions • Alcohol problems can be minimized or prevented using a coordinated, systematic policy response. • Alcohol policies that limit access to alcoholic beverages, discourage driving under the influence of alcohol, reduce the legal purchasing age for alcoholic beverages, limit marketing exposure and increase the price of alcohol, are likely to reduce the harm linked to drinking • In most countries, regulation of affordability, physical availability, and alcohol promotions are the most costeffective strategies, but enforcement of drink driving laws and provision of treatment and early intervention are also needed • Effective interventions produce a favorable health return for cost incurred in policy implementation