Presentations from ESRC Seminar Three: Changing Alcohol, Drug and Smoking Behaviours

27th March 2015

The Royal Society, London

why disobedience is our best (only?) hope

ESRC Behaviour Change Seminar Three: Changing alcohol, drug and smoking behaviours

Gerard Hastings27th March 2015

ISM Institute for Social Marketing

structure

1. A problem

2. A solution

3. A gentle revolution

Commercial Determinants of Ill-health

‘Marmot’s focus on the social determinants of ill health needs to be matched with an equal concern for the

commercial determinants of ill health’ (2)

A problem

Industrial Epidemics‘The concept of an epidemic associated with the

commercialization of a dangerous product ….diseases of consumers, workers and community residents caused by

industrial promotion of consumable products …. public health oriented policies run the risk of being opposed by

industrial corporations in a health versus profit trade-off.’ (1)

Tobacco, alcohol, food – the bedrock of public health

A problem

Tobacco, alcohol, food – the bedrock of public health

But much bigger than this:

• Inequalities

• Materialism

• Passivity

• Sustainability

Wicked problems – we do not have solutions

A problem

structure

1. A problem

2. A solution

3. A gentle revolution

a) Containment of the pathogen (eg by regulation)

b) Counteracting its spread (eg by counter advertising)

c) Critical capacity building to boost population resilience (eg with media literacy)

Public health would suggest three logical responses:

A solution

ContainmentMarketing regulation in tobacco control shows that:• the key requirement is to reduce exposure. content

regulation, with one exception*, produces ineffective and resource wasting codes of conduct

• measures have to be comprehensive, taking in all forms of marketing communication as well as other elements of the marketing mix (inc product design, packaging, distribution and pricing)

• popular demand is a great driver of regulation• commercial operators have to obey these rules, but

otherwise must be excluded from the regulatory process

*the Loi Evin in France

A solution

Counteractionpro health counter-marketing has been shown to be effective. the Truth campaign in the US for example, significantly reduced teen smoking (3). in the UK CRUK’s ‘smoke this’ demonstrates how digital channels can perform a similar task (4)

counteraction can also involve a more direct attack on commercial marketing. in the 1980s a very successful campaign (BUGA UP) (5) was waged in Australia against tobacco advertising using irreverent graffiti. this tradition has also be used against energy dense food advertising…

A solution

Counteractionpro health counter-marketing has been shown to be effective. the Truth campaign in the US for example, significantly reduced teen smoking (3). in the UK CRUK’s ‘smoke this’ demonstrates how digital channels can perform a similar task (4)

counteraction can also involve a more direct attack on commercial marketing. in the 1980s a very successful campaign (BUGA UP) was waged in Australia against tobacco advertising using irreverent graffiti (5).

as with regulation, counteraction should address not just advertising, but the whole marketing mix

A solution

Critical capacityCitizens need to be engaged in the process of change that will bring about healthier societies. This means they need to know more about the methods of big business

This includes media literacy campaigns to explain the process of advertising and how to guard against them

But, as for containment and counteraction, should go further and explain the whole marketing mix (‘marketing literacy’):

• Why does Coke prioritise ubiquitous distribution? • How do pricing deals work? • Why are processed foods inevitably unhealthy?

A solution

Basic foods (eg milk)

Processing (eg into fruit

yoghurt)

Added value

Increased marketing spend

higher sales & margins

higher profits

Generic sales, low margins, little marketing (Often used as ‘loss leaders’ to support sales of

higher margin processed foods)

Why food marketing is unhealthy

Processing usually involves adding salt, sugar & fat and

maximising palatability

Critical capacityCitizens need to be engaged in the process of change that will bring about healthier societies. This means they need to know more about the methods of big business

This includes media literacy campaigns to explain the process of advertising and how to guard against them

But, as with containment and counteraction, it needs to go much further and explain the whole marketing mix

More widely still, people need to be taught abut the fiduciary imperative which requires corporations to put stockholder returns ahead of all other concerns (including public health) (6)

A solution

NB• these are not alternatives, but mutually reinforcing pillars of

a strategic response guided by clear targets and continuous monitoring

• each is a product of ongoing partnership working between citizens, public health professionals and civil society. The Coca Cola brand has been a century in the making; the public health response has to be equally long term

• each can take many forms and needs to be deployed strategically

• this thinking can be summarised in a diagram

A solution

Building the critical capacity of the population so they can respond effectively to marketing.

Includes media literacy, critical business training, self production, community co-ops etc

Regulation to constrain unhealthy marketing: the key

concern is to reduce exposure

counteraction

Pro-health counter marketing, including

media efforts like Truth Campaign and CRUK’s ‘Smoke This’ and direct action like

BUGA UP

cont

ainm

ent

critical capacity

unhealthymarketing

resist much, obey little(Walt Whitman)

a gentle revolution

references1) Jahiel RI, Babor TF. Industrial epidemics, public health

advocacy and the alcohol industry: lessons from other fields. Addiction 2007;102:1335-9.

2) Hastings, G. 2012. Why corporate power is a public health priority, British Medical Journal, 345: e5124. doi:10.1136/bmj.e5124

3) Farrelly MC, Healton CG, Davis KC, Messeri P, Hersey JC, Haviland ML (2002). Getting to the truth: evaluating national tobacco countermarketing campaigns. American Journal of Public Health, 92(6): 901-907.

4) https://www.youtube.com/watch?v=a19KSaUueok

5) http://www.bugaup.org

6) Bakan, J. (2004) The Corporation: The Pathological Pursuit of Profit and Power. Toronto: The Penguin Group (Canada).

Alcohol marketing to young people via social media: Whose behaviour needs to change?

Professor Christine GriffinPsychology, University of Bath, UK

ESRC Seminar series onBehaviour Change

Royal Society27 March 2015

Young people and the culture of intoxication

Drinking to get (very) drunk Linked to alcohol availability,

price, targeted products, venues aimed at youth

More liberal alcohol policies, licensing regulation

Relationship between exposure to alcohol marketing & consumption

Public discourses: the policy context 2004: UK government

publishes ‘Alcohol Harm Reduction Strategy for England’

First cross-government statement on the harms caused by alcohol

2007: Follow up document ‘Safe. Sensible. Social’.

18-25 year old ‘binge drinkers’ a focus for concern in both documents.

The impact of alcohol marketing on young people’s alcohol consumption

Exposure to offline alcohol marketing and alcohol consumption

Exposure to online alcohol marketing and attitudes to drinking

Exposure to online alcohol marketing and alcohol consumption

…but what processes are involved?

Social networking and young people’s drinking

Rapid growth in use of social media & mobile technologies (smartphones) amongst young people

Facebook most popular - 1 billion users in October 2012 Drinking and getting drunk most common themes in

young people’s Facebook pages Sharing photos of self and others drinking (and drunk)

very common amongst young people

Marketing alcohol via social media

Digital marketing budgets increasing rapidly

Diageo: Social media marketing accounted for 21% of its marketing budget in 2010

In 2011 Diageo brands had collectively enjoyed a 20% increase in sales as a “direct result of Facebook activity”

Goal is “user engagement” (Socialbakers, 2013)

Young people’s drinking and online alcohol marketing:Key questions

1) What forms does alcohol marketing via social media take?

2) How does this engage with young people’s drinking practices & their social media use?

3) What do young people think about online alcohol marketing?

1) Forms of alcohol marketing via social media

a) Adverts on FB / twitter/ across social media >>>>

b) ‘Likes’, ‘comments’ and ‘shares’ on FB pages of drink brands, bars, clubs

c) Promotions, Events – ‘real world tie-ins’

d) Smartphone apps And much much more ….

b) Facebook pages of brands & venues

b) Snapstar Watching /being watched & being entertained

c) Events & ‘Real world tie-ins’:Carnage & the Smirnoff Nightlife Exchange project

d) ‘Let’s get wasted’ and other smartphone apps

Young people’s drinking and social media project

Aotearoa (New Zealand) Research Team Antonia Lyons, Ian Goodwin & Patricia Niland (Massey University, Wellington) Tim McCreanor, Helen Moewaka Barnes, Acushla Dee O’Carroll & Tuiloma

Lina Samu (Whariki Research Unit, Massey University, Auckland) Christine Griffin (University of Bath, UK) Fiona Hutton (Victoria University, Wellington, Aotearoa/NZ) Kerryellen Vroman (University of New Hampshire, USA) Supported by the Marsden Fund, administered by the Royal Society of New

Zealand (contract MAU0911).

New Zealand study: Research design

Stage 1: 37 friendship group discussions with 154 participants

Stage 2: 23 individual interviews with laptop/online access

Stage 3: Analysis of online representations of young people drinking, including advertising via social media

Dylan: I think the reason why we have the drinking photos is because it makes your life like more fun, so you're always doing something

Lo: It's memories as well and all your friends are out together on the piss and you do have fun. So you take photos and some of them

will be funny photos, and you'll just look at them and crack up and go oh my gosh, do you remember when you were that

wasted? [laughing]Extract 1 European/Pakeha Group 1; 4 females

Krystal: oh yeah, if you don’t really remember what happened the night before, like you will see a photo and it will trigger your memory and then you will remember what happened

Extract 2 Maori Group 24; 2 males 2 females

Trish: Do you see any alcohol advertising online?Alex: Yeah - no.Jack: There might be some somewhereMark: I don’t think - oh are they allowed to?Alex: I never see it online bro. Not on Facebook or anything. I always just see it on a

billboardTrish: Have you seen any Facebook profiles, like Tui or Cruiser or?Mark: Oh yeah [all nod].Alex: Yeah I have seen that. You can like them. And then oh it'll just be on Facebook

so often you'll come across a friend in the notification or the update his profile update it'll just say [name] likes XXX vodka and you click on it and it'll be like a description of what it's about. Stuff like that. What flavours. Where you can get it from.

Trish: Do you think that could be advertising? Jack: Yeah it's gotta be. Mark: Oh not necessarily. Alex: Not necessarily. Someone has to make it. They don't have to make it. We could

make one about vodka. Alex: Isn't advertising selling the product? Trying to get the public to see it's not

selling the product. It's not really selling the product. It's just saying what it is. It's not really saying this much here. It's this much there. Specials are here

Extract 3 European /Pakeha group Group 7; 3 males

Key research findings Young people exposed to a great deal of

alcohol-related marketing online Not just exposure –interactive

engagement Online alcohol marketing infiltrates

young people’s social lives and drinking practices

Young people do not necessarily view online alcohol marketing as advertising

Current regulatory & health promotion strategies outmoded

Behavioural change approaches too individualised

Regulation of alcohol marketing should include social media & digital / mobile technologies

Monitoring & ‘transparency reports’ on industry activities

Implications for public health

The sobriety test puts users through a series of “coordination and cognition” tests such as “drag your mouse in a straight line,” “type the alphabet backwards,” or “follow the finger.” A low score results in a friendly admonition to avoid sending that tweet or whatever the case may be and a recommendation for a taxi company based on your phone’s geo-location.The app allows users to customize which sites they wish to block and at what time of the day they are most likely to commit regrettable acts.

New Zealand study at: http://drinkingcultures.info/Follow on twitter: @drinkculturesUK Centre for Tobacco & Alcohol Studies at: www.ukctas.ac.uk Follow on twitter: @chris_griffin55 or @jemlennoxEmail: c.griffin@bath.ac.uk or j.lennox@bath.ac.uk

ReferencesGoodwin, I., Lyons, A., Griffin, C. & McCreanor, T. (2014). Ending up online:

Interrogating mediated youth drinking cultures. In: A. Bennett and B. Robards (eds.) Mediated Youth Cultures: The Internet, Belonging and New Cultural Configurations. London: Palgrave.

Griffin, C., Szmigin, I., Bengry-Howell, A., Hackley, C. & Mistral, W. (2013). Inhabiting the contradictions: Hypersexual femininity and the culture of intoxication among young women in the UK. Feminism and Psychology. 23(2): 184-206.

Griffin, C., Szmigin, I.T., Hackley, C., Mistral, W. & Bengry Howell, A. (2009). “Every time I do it I absolutely annihilate myself”: Loss of (self)-consciousness and loss of memory in young people’s drinking narratives. Sociology, 43 (3), 457-476.

Lyons, A., McCreanor, T., Goodwin, I. & Griffin, C. (in press). Social networking and young adults’ drinking practices: Innovative qualitative methods for health behavior research. Health Psychology. DOI: 10/1037/hea0000168.

McCreanor, T., Lyons, A., Goodwin, I., Moewaka Barnes, H., Griffin, C. & Hutton, F. (2013). Youth drinking cultures, social networking and alcohol marketing: Implications for public health. Critical Public Health. 23(1): 110-120.

The challenges involved in changing addictive behaviours

Prof. Jim McCambridge

WHO, Global status report on alcohol and health 2014

• Hastings & Sheron…public health, AHA and a broader approach

• Nicholls & Griffin…stronger evidence

• Farrell…a different approach

Addiction industry studies approach

Adams, AJPH 2013

Adams et al. Addiction 2010

“A new scientific discipline that investigates industrial diseases and the transnational corporations that drive them, should be developed”

Moodie et al. Lancet NCD Action Group, 2013

Farrell position statement

• “Greater stakeholder engagement is needed to boost trust and better self-regulation”

• “Formal codes of practice, rules and regulation are not effective in changing bad corporate behaviour”

• Managerial control in US-UK model

• Pursuit of shareholder value key goal

• New corporate elite post 1997 in UK

• Political science under-developed

CSR

• Who should define corporate social responsibility?

• CSR used by companies to further economic interests

• Do corporations have responsibilities to society for license to operate with limited liability?

Addiction industries

• Largest and most successful companies in addiction industries deliberately engineer addiction

• Fundamental to business models

• Vested interests in opposing policies that better manage addictive behaviours

“Special Brew was originally brewed by the Danes for Winston Churchill. His visit to Copenhagen in 1950 was commemorated with a 'special' brew produced in his honour…Churchill's favourite drink was cognac, so in brewing him a commemorative beer, the brewers at Carlsberg created a stronger lager with cognac flavours among its tasting notes” 

Portman Group response

“This is another poorly evidenced piece of work produced by researchers with a track record of campaigning against public-private partnerships…We have to start questioning the motives of those….”

“The Portman Group is funded by the eight major UK drinks companies. Their motive is to protect the industry's long-term commercial interests”

Founding Director, Dr. John Rae, Addiction 1993

“I don’t think it’s appropriate that the drinks industry should be actively involved in campaigns around public health for the obvious reason”

Minister for Health Leo Varadkar commenting on Diageo CE resignation from campaign in Ireland this week

“The Public Health (Alcohol) Bill aims to reduce alcohol consumption in Ireland to 9.1 litres per person per annum (the OECD average) by 2020, and to reduce the harms associated with alcohol.”

• How do we manage addiction industry activities in the public interest?

• Some suggestions from an addiction industry studies perspective (looking at evidence across industries)

Some modest proposals

1. Start with the principle that regulation of all aspects of production and supply is necessary (as for gambling, alcohol & drugs)

2. Develop new provisions in company law for addiction industries (as for other industries)

Some modest proposals

3. Require all R & D data on product design and marketing to be available to regulators (as for dangerous commodities)

4. Require the licensing of all existing and new drugs and other addictive commodities (ditto)

Some modest proposals

5. Contribute windfall taxes (10% of profits?) to meet the social costs (as proposed for tobacco)

6. Preserve public health policies from interference by vested interests (a la FCTC)

….a new form of partnership working, in the public interest

Alcohol: Know (y)our limits?James Nicholls

Alcohol Research UKCentre for History in Public Health, LSHTM

What is this image actually saying..?!

“Alcohol: know your limits”

“You wouldn’t start a night like this, so why would you end it that way?”

‘Recognition of DH advertising was 66% … higher among 25-34 age group, at 85%, C1s C2s and harmful drinkers.

74% rating website as excellent or very good’

Department of Health (2010) Supplementary memorandum to Health Select Committee – Alcohol (AL 01B)http://www.publications.parliament.uk/pa/cm200910/cmselect/cmhealth/151/151we03.htm

‘Those adverts make me laugh … the one where they guy does some, he’s in a right state, and they say “You wouldn’t start a night off like this, so don’t end one like this”. And that makes you just think loads of people would just say “Oh, I would – yeah!”’ ‘I know one of my friends, she comes up to me and she goes, “I can see myself ending up like the girl in the adverts tonight!”’ Nicholls, J. (2009) ‘Young people, alcohol and the news – preliminary findings’. AERC Final Reporthttp://alcoholresearchuk.org/alcohol-insights/young-people-alcohol-and-the-news-preliminary-findings/

Demand-side

information

Supply-side

controls

Source: British Beer and Pub Association (2014) Statistical Handbook, 2014.

‘As well as becoming less likely to drink alcohol at all and less likely to drink frequently, young adults also became less likely to binge when they did drink’Office for National Statistics (2014) Adult Drinking Habits in Great Britain, 2013, 9.http://www.ons.gov.uk/ons/rel/ghs/opinions-and-lifestyle-survey/adult-drinking-habits-in-great-britain--2013/stb-drinking-2013.html

Trends in adolescent weekly alcohol use by region and demographic group

De Looze, M et al. (2015) Decreases in weekly adolescent alcohol use in Europe and North America: evidence from 28 countries from 2002 to 2010. European Journal of Public Health 25 Supp 2, 69-72. http://eurpub.oxfordjournals.org/content/25/suppl_2/69

‘Declines in youth drinking are unrelated to alcohol policies that are associated with reduced drinking such as changes in pricing, availability or advertising … they also appear unrelated to economic, cultural or geographical factors.’

Pennay, A., Livingston, M. and Maclean, S. (2015) Young people are drinking less: it’s time we found out why. Drug and Alcohol Review 34, 115-8. http://onlinelibrary.wiley.com/doi/10.1111/dar.12255/abstract

House of Commons Health Committee (2010) Alcohol HC151-I, 14 [data from Wilson, G (1940) Alcohol and

the Nation]

http://www.publications.parliament.uk/pa/cm200910/cmselect/cmhealth/151/15102.htm

House of Commons Health Committee (2012). DH Written Evidence (GAS 01)

http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/132/132we02.htm

Robin Room on changing drinking cultures

Change is typically about number of drinking occasions, not the style of drinking

Change occurs differently in different population subgroups (not collectively across whole populations)

Change often led by birth cohorts (‘wet’ and ‘dry’ generations)

How might policy enhance or attenuate trends?

Challenge: to develop and test more nuanced theories of sociocultural change in drinking

Room, R. (2014) Wet and dry generations: what happens with social change in drinking?. Presentation to Alcohol Research UK conference, 2014. http://alcoholresearchuk.org/further-resources/conference-2014/