Co-regulation and alcohol industry political strategy: A case study of the Public Health England-Drinkaware Drink Free Days Campaign

Youth behavioural responses to regulated alcohol advertising content: Results from a mixed-methods study in France

OBJECTIVES

The World Health Organization advocates measures regulating alcohol advertising content, as illustrated by the French Évin law. However, how people react to such regulation has been under-investigated. The research reported here has two objectives: to analyze how different advertising contents (regulated or not) affect the persuasion process from attention to behavioural responses, and whether young people are protected; to examine how alcohol warnings perform depending on their salience and the advertising content displayed (regulated or not).

MATERIALS AND METHODS

This study surveyed French people aged 15-30 using a mixed-methods design. In-depth interviews were conducted on 26 respondents to understand how non-regulated (NRA) and regulated (RA) alcohol advertising influence the persuasion process. An experiment on 696 people assessed the influence of RA vs. NRA on intentions to buy and drink alcohol, and whether less vs. more salient warnings displayed in the RA or NRA setting have differential effects on behavioural responses.

RESULTS

NRA (vs. RA) had a greater influence on young people's desire to buy and drink alcohol, which we explain by different psychological processes. NRA appeared to trigger a heuristic process that involves affective reactions (e.g. image, symbolism) and product-oriented responses (e.g. quality), whereas RA appeared to trigger a more systematic process that had less influence. The protective effect of content regulations was strong for the youngest participants but fades as age increases, reaching its limits at age 22 years. Salience of the warnings had no influence on desire to buy and drink alcohol, whatever the ad content.

CONCLUSION

Advertising content regulations need to be implemented to protect young people, particularly the youngest. Our results on alcohol health warnings highlighted that text-only labels similar to those adopted in many countries are ineffective at decreasing young people's intentions to buy and drink alcohol.

Alcohol industry-sponsored music festivals, alcohol marketing and drinking practices among young Nigerians: Implications for policy

INTRODUCTION

The global alcohol industry sponsors social/music events targeting young people; however, existing literature focuses on Westernised contexts. Given the decline in young people's drinking in many Western countries, it appears that multinational alcohol companies are importing the strategies they have used in high-income countries to the Global South countries like Nigeria to recoup profits. This study aims to examine the Guinness Show- a free one-month annual music festival, alcohol marketing at the festival and the extent to which the event encourages diverse drinking practices among its attendees.

METHODS

We observed the music festival before collecting data through 53 interviews and 3 focus groups (N = 26). Data were analysed to generate themes with the aid of NVivo 12 software.

FINDINGS

Over 6000 participants attend the Guinness Show daily, and participants gave detailed descriptions of the music festival, alcohol marketing activities that occur in it and the drinking practices of attendees, indicating that they were highly knowledgeable of the event. The Guinness Show attracts famous music artistes and other entertainers. Therefore, young people attend to see them perform free of charge. However, diverse alcohol promotions (e.g., quantity deals, low prices, giveaways) that happen daily, the strategic use of young women as 'beer promoters', and the pleasure the event induces by fusing music/entertainment into alcogenic environments, encourage drinking and drunkenness. All the attendees drank alcohol, and some engaged in impulse buying, while many consumed excessively due to promotions (e.g., buy-two-get-one free), which facilitated intoxication and the loss of control.

CONCLUSIONS

Guinness Nigeria organises the event for strategic brand communication, generating brand capital, and encouraging alcohol purchases and consumption among young people. Policymakers should reconsider self-regulation and implement national alcohol control policies and other public health interventions to restrain the alcohol industry from sponsoring such events.

Legal and regulatory instruments for NCD prevention: a scoping review and descriptive analysis of evaluations in OECD countries

CONTEXT

Public health law is an important tool in non-communicable disease (NCD) prevention. There are different approaches available for achieving policy objectives, including government, co-, quasi- and self-regulation. However, it is often unclear what legal design features drive successes or failures in particular contexts. This scoping review undertakes a descriptive analysis, exploring the design characteristics of legal instruments that have been used for NCD prevention and implemented and evaluated in OECD countries.

METHODS

A scoping review was conducted across four health and legal databases (Scopus, EMBASE, MEDLINE, HeinOnline), identifying study characteristics, legal characteristics and regulatory approaches, and reported outcomes. Included studies focused on regulation of tobacco, alcohol, unhealthy foods and beverages, and environmental pollutants.

FINDINGS

We identified 111 relevant studies evaluating 126 legal instruments. Evaluation measures most commonly assessed implementation, compliance and changes to the built and lived environment. Few studies evaluated health or economic outcomes. When examining the design and governance mechanisms of the included legal instruments, government regulation was most commonly evaluated (n = 90) and most likely to be reported effective (64%). Self-regulation (n = 27) and quasi-regulation (n = 5) were almost always reported to be ineffective (93% and 100% respectively). There were few co-regulated instruments evaluated (n = 4) with mixed effectiveness. When examining public health risks, food and beverages including alcohol were more likely to be self- or quasi-regulated and reported as ineffective more often. In comparison, tobacco and environmental pollutants were more likely to have government mandated regulation. Many evaluations lacked critical information on regulatory design. Monitoring and enforcement of regulations was inconsistently reported, making it difficult to draw linkages to outcomes and reported effectiveness.

CONCLUSIONS

Food and alcohol regulation has tended to be less successful in part due to the strong reliance on self- and quasi-regulation. More work should be done in understanding how government regulation can be extended to these areas. Public health law evaluations are important for supporting government decision-making but must provide more detail of the design and implementation features of the instruments being evaluated - critical information for policy-makers.

Constructing public-private partnerships to undermine the public interest: critical discourse analysis of Working Together published by the International Alliance for Responsible Drinking

BACKGROUND

The global burden of alcohol harm has increased and is forecast to grow further without effective policy implementation. Public-private partnerships aiming to address global health, and other societal challenges, are a burgeoning feature of neoliberal governance. Rhetorically distancing themselves from tobacco, the major alcohol companies are committed to tackling 'harmful drinking' and have created a distinct type of public relations organization for this purpose. The activities of such organizations are increasingly recognized as an impediment to the implementation of policies to reduce alcohol harm, including in low- and middle-income countries where markets are expanding.

METHODS

The approach of critical discourse analysis is used to examine the discursive tactics and strategies used in Working Together; a 'toolkit' published by the key global level alcohol industry public relations organization, the International Alliance for Responsible Drinking (IARD). This study considers how it works discursively to set the terms of, and overcome skepticism about partnerships, to define aims and position various actors by constructing their roles. The construction of prospective partners provides insights into the alcohol industry itself.

RESULTS

The toolkit operates as an ideological resource for forming public-private partnerships across the world based on the accumulated know-how of the major companies through IARD. This allows the largest alcohol companies to exercise leadership of the industry, while remaining off-stage. The toolkit relies on a form of rhetorical work which creates distance from obvious corporate interests and the harms caused to population health and society. This is accomplished by working against evidence-informed population level approaches, and thus avoiding policies that will make any significant difference to overall alcohol harm. Unspecific "complexity" affords opportunity for preferred types of "actions", and "partnership" provides opportunity to gain credibility by association, further minimizing the likelihood of any material harm being reduced.

CONCLUSIONS

The toolkit is designed to not only legitimate the inclusion of alcohol industry actors as initiating 'partners', but also assigns them roles as managers of a set of carefully constructed relationships. This vision of public-private partnership reproduces the hegemonic narrative that has successfully blocked policy advances for decades and led to growing alcohol harm globally.

Influencing the global governance of alcohol: Alcohol industry views in submissions to the WHO consultation for the Alcohol Action Plan 2022-2030

BACKGROUND

In 2020, the Secretariat of the World Health Organization (WHO) conducted an open consultation, with public submissions, for the purpose of developing an Alcohol Action Plan to "strengthen implementation" of the WHO's 2010 Global Strategy to Reduce the Harmful Use of Alcohol. The consultation process and public submissions provided an opportunity to critically examine alcohol industry perspectives and arguments in relation to the global governance of alcohol.

METHODS

48 alcohol industry submissions to the WHO's 2020 consultation were included for analysis. Directed content analysis was used to examine the policy positions and arguments made by industry actors. Thematic analysis was employed to further explore the framing of industry arguments.

RESULTS

In framing their arguments, alcohol industry actors positioned themselves as important stakeholders in policy debates; differentiated "normal" drinking from consumption that merits intervention; argued that alcohol policy should be made at the national, rather than global, level; and supported industry self-regulation or co-regulation rather than cost-effective public health measures to prevent harms from alcohol.

CONCLUSION

The alcohol industry's submissions to the WHO's 2020 consultation could be seen as efforts to stymie improvements in the global governance of alcohol, and repeats several framing strategies that the industry has used in other forums, both national and global. However, their arguments appear to have had little traction in the creation of the Alcohol Action Plan. Changes from the Working Document to the adopted Action Plan show little acceptance by WHO of industry arguments.

Evolution of the major alcohol companies key global policy vehicle through the prism of tax records 2011-19

BACKGROUND

Important insights have been generated into the nature of the activities of the International Center for Alcohol Policies (ICAP). Its successor, the International Alliance for Responsible Drinking (IARD) is less well understood. This study aims to rectify evidence limitations on the political activities of the alcohol industry at the global level.

METHODS

Internal Revenue Service filings were examined for ICAP and IARD each year between 2011 and 2019. Data were triangulated with other sources to establish what could be gleaned on the internal workings of these organisations.

RESULTS

The stated purposes of ICAP and IARD are near identical. The main declared activities were similar for both organisations and comprised public affairs/policy, corporate social responsibility, science/research and communications. Both organisations work extensively with external actors and it has become possible more recently to identify the main contractors supplying services to IARD.

DISCUSSION

This study sheds light on the political activities of the alcohol industry at the global level. It suggests that the evolution of ICAP into IARD has not been accompanied by shifts in the organisation and activities of the collaborative efforts of the major alcohol companies.

CONCLUSION

Alcohol and global health research and policy agendas should give careful attention to the sophisticated nature of industry political activities.

Systematic review of health promotion policies or regulations with CCAT theory

One of the five Ottawa Charter's means of action is the concept of "healthy public policy," which is an approach to health promotion that is integrated with public policy. This concept can be used as an approach/method in solving health problems at the broader policy level and involving all sectors comprehensively, not just health promotion at the community level and the partial health sector, so that public health problems can be resolved properly. We conducted a systematic review of health promotion policies or regulations using CCAT theory. The purpose of this study is to find the state of the art of research related to stakeholder synergy in online game addiction prevention policies in adolescents. References and literature for this systematic review were collected from the Proquest, ScienceDirect, Pubmed, and Google Scholar databases. The search uses the boolean phrases "OR" and "AND." Keywords: policy or regulation, health promotion, and community coalition action theory. The results of the systematic review conducted by the researchers showed that of the twenty selected articles, three articles used the coalition/partnership dimension from the CCAT theory, four articles used the stakeholder dimension, two articles used the collaboration dimension, five articles discussed school health policies, policies related to gaming disorders. One article on the analysis of the juvenile contraceptive law, one article on the prevention of mental health disorders, one article on health promotion interventions, and two articles on risk factors and self-regulation focus on online gaming addiction in adolescents. This study concludes that in the future, further research is needed regarding health promotion policies to prevent online game addiction in adolescents to develop specific policy recommendations related to preventing online game addiction in adolescents.

Would the Brazilian population support the alcohol policies recommended by the World Health Organization?

OBJECTIVE

To evaluate the support of the Brazilian population to the alcohol-policies proposed by the World Health Organization to decrease alcohol harm (specifically: to decrease alcohol availability and advertising, and to increase pricing). In addition, we evaluated the factors associated with being against those policies.

METHODS

Data from 16,273 Brazilians, aged 12-65 years, interviewed in the 3rd Brazilian Household Survey on Substance Use (BHSU-3) were analyzed. The BHSU-3 is a nationwide, probability survey conducted in 2015. Individuals were asked if they would be against, neutral, or in favor of seven alcohol policies grouped as: 1) Strengthen restrictions on alcohol availability; 2) Enforce bans or restrictions on alcohol advertising, sponsorship, and promotion; and 3) Raise prices on alcohol through excise taxes and pricing. Generalized linear models were fitted to evaluate factors associated with being against each one of those policies and against all of policies.

RESULTS

Overall, 28% of the Brazilians supported all the above mentioned policies, whereas 16% were against them. The highest rate of approval refers to restricting advertising (53%), the lowest refers to increasing prices (40%). Factors associated with being against all policies were: being male (AOR = 1.1; 95%CI: 1.0-1.3), not having a religion (AOR = 1.4; 95%CI: 1.1-1.8), being catholic (AOR = 1.3; 95%CI: 1.1-1.5), and alcohol dependence (AOR = 1.6; 95%CI: 1.1-2.4).

CONCLUSIONS

The Brazilian government could count on the support of most of the population to restrict alcohol advertising. This information is essential to tackle the lobby of the alcohol industry and its clever marketing strategy.

The Alcohol Industry and Social Responsibility: Links to FASD

Fetal Alcohol Spectrum Disorder is directly linked to the consumption of alcohol during pregnancy. Prevention programs have been targeted at women of childbearing age and vulnerable populations. The beverage alcohol industry (manufacture, marketing, distribution, and retail) is often seen as playing a role in prevention strategies such as health warning labels. In this paper we explore the nature of the relationship between the industry and prevention programming. We consider the place of alcohol in society; the prevalence, social and economic costs of FASD; the ethical notion of alcohol-related harm and then move onto the question of public health partnerships with the industry including the potential conflicts of interests and ethical challenges in such partnerships.

Gamblers' perceptions of responsibility for gambling harm: a critical qualitative inquiry

Background

Gambling has traditionally been conceptualised as an issue of addiction and personal responsibility. While there are now clear public health models that recognise that gambling harm is caused by a range of socio-cultural, environmental, commercial and political determinants, government and industry messages about gambling are still largely personal responsibility focused. Given the well-recognised issues associated with personal responsibility paradigms, this study sought to understand how gamblers themselves conceptualised responsibility for gambling harm.

Methods

A qualitatively led online panel survey was conducted with 363 adult gamblers in New South Wales and Victoria, Australia. Participants were asked to respond to what they thought were the causes of gambling harm, and what could be done to prevent harm. A reflexive thematic analysis was conducted.

Results

Six common tropes were constructed from gamblers’ responses: (1) Gambling in moderation; (2) Personal responsibility for rational behaviour; (3) Character flaws; (4) Personal responsibility to seek help; (5) More education is needed; and (6) Governments are responsible for action – but motivation and efficacy are questioned. Gamblers primarily understood gambling harm as being a matter of personal responsibility, and government responsibility was generally seen as limited to providing information to facilitate informed gambling choices.

Conclusions

This study demonstrates that gamblers’ perceptions of gambling harm are similar to the personal responsibility framings and tropes present in industry and government messaging strategies. Refocusing public communication strategies away from ‘responsible gambling’ messaging, and towards evidence-based approaches, will be an important part of addressing the harms associated with gambling.