Working to reduce alcohol harm

Children’s exposure to alcohol marketing in Ireland

A comment by marketing expert, Dr Pat Kenny, on research commissioned by Alcohol Action Ireland and carried out by the Health Promotion Research Centre at NUI Galway.

Alcohol_Action_graphic4

Introduction

Alcohol is not just an ordinary consumer product. While it can form part of a balanced social life, alcohol can also lead to a myriad of serious health and social problems.

Given the significant personal and societal costs of alcohol misuse, one key objective of public health policy is to reduce the per capita level of alcohol consumption and in particular to delay the age of initial alcohol consumption by adolescents.

Central to this core public health objective is the role of alcohol marketing in encouraging, normalising and glamourising alcohol consumption among young people.

The alcohol marketing debate

There is an understandable tendency in some quarters to assume that marketing and advertising are synonymous. But marketing is considerably more than just advertising. At its most basic level, marketers refer to the “4 Ps” of marketing – product, price, place and promotion. Each of these 4 Ps can be manipulated to bring about a change in sales and brand positioning. Advertising is one part of the 4th P – promotion – along with sponsorship, sales promotions, direct marketing, personal selling and public relations.

And in turn, advertising can be further sub-divided according to the communications channel used – television, newspapers, outdoor, online etc. These diverse elements of a marketing plan are not designed in isolation, but are created in an integrated and mutually reinforcing manner (1).

The advent of digital and social media marketing has created new and important communications channels within the marketing mix. Several alcohol brands have diverted significant marketing spend into the digital sphere (2,3). Digital marketing, and in particular social media networks, allow for more effective targeting of consumers, and the interactive nature of this communication makes it arguably more effective than traditional passive advertising methods (4).

In this regard it is worth noting that digital marketing operates largely “below the radar” of policy makers because they do not form part of the target audience, thus making digital marketing significantly harder to monitor or regulate. There is no longer any credible scientific debate about whether alcohol marketing influences consumption behaviour.

Some older studies, based on econometric modelling, have argued that there is little or no relationship between marketing and consumption. But econometric modelling is an inappropriate way to assess the real world impact of marketing on behaviour – the techniques involved are too blunt to capture the influence of marketing in real life (5).

Studies using consumer-level data provide a more realistic insight into human behaviour. A large number of longitudinal consumer studies from different countries have followed young people over time, tracking their exposure to marketing and their subsequent alcohol consumption. Longitudinal studies are important because they can establish if causal relationships exist.

A number of systematic reviews of these longitudinal studies clearly indicate a causal relationship between marketing and drinking behaviour, especially among young people (6,7,8,). There is some evidence that younger adolescents are especially susceptible to the influence of marketing due to their relative lack of life experience and their ongoing cognitive development (9). For this reason, alcohol marketing regulations are generally oriented towards protecting young people by reducing their exposure to commercial marketing messages.

Alcohol marketing regulation

There are a number of Irish self-regulatory and co-regulatory codes, the most important of which is the Alcohol Marketing, Communications and Sponsorship Code of Practice, agreed between the advertising and alcohol industries and the Government in 2005 and revised in 2008 (10). The primary aim of the code is to reduce young people’s exposure to alcohol marketing communications, and it places moderate limits on the timing of alcohol advertising and the amount that can be placed in any one medium.

While efforts to reduce exposure to alcohol marketing are laudable, it is worth noting that there does not appear to be any scientific basis for many elements of this co-regulatory code. To take just one example, the code prohibits outdoor advertising within 100m of schools. But why 100m rather than 50m or 150m? The contents of the code seem to be almost entirely arbitrary.

NUIG study: introduction

While there is much public debate about alcohol policy, marketing and consumption in Ireland, there is a relative lack of empirical data on Irish young people’s exposure to alcohol marketing. That is why the study conducted by the Health Promotion Research Centre in NUIG is important. It provides a snapshot illustrating how little protection is currently afforded to Irish children.

As with every study, there are a number of limitations that have to be borne in mind. The study is cross-sectional in nature, so it cannot establish cause and effect relationships. Research also involves inevitable trade-offs between data capture and a comprehensive coverage of the full range of confounding factors. Thus, when dealing with children the simplicity and shortness of the survey instrument is a key consideration that in this instance means not considering all possible confounding factors in the regression analysis.

Finally, it is also challenging to accurately measure exposure to advertising, and there is no foolproof way of doing so. The NUIG study utilised a memory-based approach where respondents provide self-reported levels of exposure and there are many precedents for this approach in the literature (11,12).

Notwithstanding these inevitable limitations, the study provides an important insight into the experience of a large sample of children with alcohol marketing and its findings are in broad agreement with much of the international literature.

NUIG study: key findings

  The study clearly illustrates the weakness of the current co-regulatory system. To take just some examples from the report:

  •   More than 90% of the children surveyed reported that they were exposed to traditional (offline) alcohol advertisements in the week prior to the study and more than half reported that they were exposed to 4 or more advertisements per day.
  •   More than  ¾ (77%) of the children reported exposure to alcohol marketing online and very large minorities seem to have been specifically invited to engage with alcohol marketers on social media, with 35% reporting that they were invited to “like” an alcohol brand, 29.7% invited to like an event sponsored by an alcohol brand and 21.4% invited to attend such an event.
  • 61% of children reported that they owned alcohol branded merchandise, and ownership was as high as 71.4% amongst boys.

These alarming figures indicate that the regulatory codes in their present form are not protecting children from exposure to alcohol marketing. The international literature is clear – the greater the level of exposure to, or engagement with, alcohol marketing, the more likely young people are to drink alcohol.

This is also borne out in this study. The majority of children were exposed to more than 4 types of marketing within the past week. This level of exposure was associated with an almost threefold increase in the likelihood of drinking and an almost four fold increase in the self-reported intention to drink within the next year.

The average child was exposed to 7 types of alcohol marketing, and this level of exposure was associated with heightened risks of dangerous drinking behaviours, including a more than 400% increase in the risk of binge drinking and drunkenness.

The international scientific literature shows a strong association between ownership of alcohol merchandise and drinking behaviour (13). This is also reflected in the NUIG study – those who owned such items were 91% more likely to drink and more than twice as likely to binge drink or to get drunk or intend to start drinking within the next year.

The bottom line is that the current regulatory system does not protect children from exposure to alcohol marketing, and this failure is associated with increased alcohol consumption. In a very real sense, these children are victims of society’s failure to protect them.

Implications

It is extremely difficult to protect young people in the absence of a complete ban on alcohol advertising. However, the following modest interim steps suggest a starting point.

  • Outdoor advertising is indiscriminate because all age groups are exposed to it. Merely prohibiting it within 100m of schools provides no protection for children. A society that is serious about protecting children from exposure to alcohol advertising would prohibit outdoor alcohol advertising.
  • Audience profile thresholds for radio and television advertising need radical change. Currently alcohol advertising is allowed around programmes if up to 25% of the audience are underage. This needs to be reduced to less than 10% if children are to be protected from disproportionate levels of exposure. 10-17-year-olds account for approximately 10% of the population. This is the age group largely represented in the NUIG study and it is the cohort that are at greatest risk of experimenting with alcohol. Current audience profile thresholds allow young people to be disproportionately exposed to alcohol marketing.
  • Digital alcohol marketing, and in particular social media marketing, is now a central element of the marketing communications mix and needs to be regulated. This is obviously challenging, but the pioneering steps recently taken in Finland (14) suggest a model for action, including a prohibition on the use of games and user-generated material in branded social media sites. Independent age verification systems are also an important tool to protect children from alcohol branded sites.

Children who drink alcohol before the age of 15 are at significantly increased risk of alcohol dependence in later life compared to those who delay drinking initiation (15). Creating an environment where children are free from alcohol marketing is a children’s rights issue that requires immediate action.

References

1. Kliatchko, J. (2005) ’Towards a new definition of integrated marketing communications’, Internatiuonal Journal of Advertising, 24(1): 7-34.

2. Mosher, J.F. (2012) ’Joe Camel in a bottle: Diageo, the Smirnoff brand, and the transformation of the youth alcohol market’, American Journal of Public Health, 102(1): 56-63.

3. Jernigan, D.H. and Rushman, A.E. (2014) ’Measuring youth exposure to alcohol marketing on social networking sites: Challenges and prospects’, Journal of Public Health Policy, 35(1): 91-104.

4. Lin, E.Y., Caswell, S., You, R.Q. and Juckle, T. (2012) ’Engagement with alcohol marketing and early brand allegiance in relation to early years of drinking’, Addiction Research and Theory, 20(4): 329-38.

5. Kenny P. and Hastings, G. (2010) ’Alcohol Advertising in Ireland: The Challenge of Responsibility and Regulation’ in J. Hogan, P.F. Donnelly and B.K. O’Rourke (eds) Irish Business and Society: Governing, Participating and Transforming in the 21st Century, Dublin: Gill & McMillan

6. Anderson, P., de Bruijn, A., Angus, K., Gordon, R. and Hastings, G. (2009) ’Impact of alcohol advertising and media exposure on adolescent alcohol use: A systematic review of longitudinal studies’, Alcohol and Alcoholism 44(3): 229-43.

7. Meier, P. (2008) Independent Review of the Effects of Alcohol Pricing and Promotion. Part A: Systematic Reviews [Online]. Available: http://www.dh.gov.uk/en/Publichealth/Healthimprovement/Alcoholmisuse/DH_4001740

8. Science Group of the European Alcohol and Health Forum. (2009). Does Marketing Communication Impact on the Volume and Patterns of Consumption of Alcoholic Beverages, Especially by Young People? – A Review of Longitudinal Studies [Online]. Available: http://ec.europa.eu/health/ph_determinants/life_style/alcohol/Forum/docs/science_o01_en.pdf

9. Collins, R., Ellickson, P., McCaffrey, D. and Hambarsoomians, K. (2007) ’Early adolescent exposure to alcohol advertising and its relationship to underage drinking’, Journal of Adolescent Health 40(6): 527-34.

10. http://health.gov.ie/wp-content/uploads/2014/03/alcohol_codes_practice.pdf

11. Fleming, K., Thorson, E. and Atkin, C.K. (2004) ’Alcohol advertising exposure and perceptions: Links with alcohol expectancies and intentions to drink or drinking in underaged youth and young adults’, Journal of Health Communication, 9(1): 3-29.

12. Lin, E.Y., Caswell, S., You, R.Q. and Juckle, T. (2012) ’Engagement with alcohol marketing and early brand allegiance in relation to early years of drinking’, Addiction research and Theory, 20(4): 329-38.

13. McClure, A.C., Dal Cin, S., Gibson, J. and Sargent, J.D. (2006) ’Ownership of alcohol-branded merchandise and initiation of teen drinking’, American Journal of Preventive Medicine 30(4): 277-83.
14. http://bit.ly/1ODCW5i

15. Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset, duration, and severity. Pediatrics 2006; 160:739–746.