The extent and nature of alcohol advertising on Australian television

Patterns of alcohol and alcohol-flavoured non-alcoholic beverage advertisements over Japanese free-to-air television networks

Background

Alcohol use is a serious public health challenge worldwide. Japan has no government regulations or legal penalties against advertising alcoholic beverages on television (TV). Instead, advertisements depend on the Japanese alcohol industry’s self-regulation on airtime (no advertisements from 5 am to 6 pm) and the content of alcoholic beverages, which must not tempt minors. However, many adolescents (10 to 19 years old) watch TV from 6 pm to 11 pm. The aim of this study was to describe the pattern in the advertising of alcoholic beverages and alcohol-flavoured non-alcoholic beverages (AFNAB) in Japan during the popular TV viewing time for adolescents.

Methods

A secondary analysis of advertising airtime data from five free-to-air Japanese TV networks in the Greater Tokyo area that aired between 12 August and 3 November 2019, was performed.

Results

During the study period, 5215 advertisements for alcoholic beverages and AFNABs aired (1451.75 min). In total, 2303 advertisements (44.2%) were beer, low-malt beer, or beer-taste beverages, 277 (5.3%) were whisky, 2334 (44.8%) were local alcoholic beverages (shochu and seishu), and 301 (5.8%) were AFNAB. On average, more advertisements aired on weekends (67.6 advertisements) than on weekdays (59.3 advertisements) per day. Approximately 30% of advertisements for AFNABs were aired during the time restricted for alcohol advertising, although AFNABs are considered alcohol according to industry guidelines. During the popular television viewing time for young adolescents, about two to three times more advertisements were aired per hour than during the rest of the day, on both weekdays and weekends (p < 0.001).

Conclusion

The number of alcohol advertisements aired at times when adolescents often watch TV is 2 to 3.2 times higher than that at other times of the day. Furthermore, despite the industry’s self-imposed regulations, some alcoholic beverages are still advertised. Therefore, other methods to protect children and adolescents from exposure to advertisements for alcoholic beverages should be investigated and implemented.

Potential financial impact on television networks of a ban on alcohol advertising during sports broadcasts in Australia

OBJECTIVE

This study aimed to assess the potential financial impacts on Australian television networks of a ban on alcohol advertising during sports broadcasts.

METHODS

We analysed television advertising data from Nielsen, a commercial market research company. The data included details of all advertisements (ads) for the 10 highest-spending alcohol brands on free-to-air television networks in the five largest capital cities in Australia over a 12-month period (November 2018-October 2019). We estimated alcohol advertising spend during sports broadcasts. Financial value per network was estimated using ad duration and total spend per channel.

RESULTS

There were 10,660 alcohol ads (average of 75 minutes per week) shown during sports broadcasts, amounting to A$14.4 million in revenue to television networks. Forty-five per cent of these ads were at children's viewing times. Channel Seven received the largest amount of alcohol advertising revenue (A$20.8 million), of which A$10.8 million (52.0%) was during sports broadcasts (0.5% of its total advertising revenue).

CONCLUSIONS

Alcohol advertising during sports broadcasts is pervasive but contributes a relatively small proportion of revenue for television networks. Implications for public health: A ban on alcohol advertising during sport broadcasts is unlikely to have major financial impacts on broadcasters, whilst the health and social benefits are potentially substantial.

Commercial Advertising of Alcohol: Using Law to Challenge Public Health Regulation

In most countries, the alcohol industry enjoys considerable freedom to market its products. Where government regulation is proposed or enacted, the alcohol industry has often deployed legal arguments and used legal forums to challenge regulation. Governments considering marketing regulation must be cognizant of relevant legal constraints and be prepared to defend their policies against industry legal challenges.

An evaluation of the evidence submitted to Australian alcohol advertising policy consultations

BACKGROUND

Industry self-regulation is the dominant approach to managing alcohol advertising in Australia and many other countries. There is a need to explore the barriers to government adoption of more effective regulatory approaches. This study examined relevance and quality features of evidence cited by industry and non-industry actors in their submissions to Australian alcohol advertising policy consultations.

METHODS

Submissions to two public consultations with a primary focus on alcohol advertising policy were analysed. Submissions (n = 71) were classified into their actor type (industry or non-industry) and according to their expressed support for, or opposition to, increased regulation of alcohol advertising. Details of cited evidence were extracted and coded against a framework adapted from previous research (primary codes: subject matter relevance, type of publication, time since publication, and independence from industry). Evidence was also classified as featuring indicators of higher quality if it was either published in a peer-reviewed journal or academic source, published within 10 years of the consultation, and/or had no apparent industry connection.

RESULTS

Almost two-thirds of submissions were from industry actors (n = 45 submissions from alcohol, advertising, or sporting industries). With few exceptions, industry actor submissions opposed increased regulation of alcohol advertising and non-industry actor submissions supported increased regulation. Industry actors cited substantially less evidence than non-industry actors, both per submission and in total. Only 27% of evidence cited by industry actors was highly relevant and featured at least two indicators of higher quality compared to 58% of evidence cited by non-industry actors.

CONCLUSIONS

Evaluation of the value of the evidentiary contribution of industry actors to consultations on alcohol advertising policy appears to be limited. Modifications to consultation processes, such as exclusion of industry actors, quality requirements for submitted evidence, minimum standards for referencing evidence, and requirements to declare potential conflicts, may improve the public health outcomes of policy consultations.

A randomized controlled trial of the effectiveness of combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction communications

INTRODUCTION

Alcohol is a major source of harm worldwide. The aim of this study was to experimentally assess the effects of exposing Australian adult drinkers to combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction messages.

METHODS

Three online surveys were administered over six weeks: Time 1 at baseline (n = 7,995), Time 2 at three weeks post-baseline (n = 4,588), and Time 3 at six weeks post-baseline (n = 2,687). Participants were randomly assigned to one of eight conditions: (1) a control condition; (2) a 'why to reduce' television advertisement; (3-5) one of three 'how to reduce' messages referring to the following protective behavioral strategies (PBSs): Keep count of your drinks, Decide how many drinks and stick to it, It's okay to say no; and (6-8) the television advertisement combined with each PBS message individually. Intention-to-treat analyses were conducted to determine effects of condition assignment on changes over time in attempts to reduce alcohol consumption and amount of alcohol consumed.

RESULTS

Participants assigned to the 'TV ad' and 'TV ad + Keep count of your drinks PBS' conditions reported significant increases in attempts to reduce alcohol consumption. Only participants assigned to the 'TV ad + Keep count of your drinks PBS' condition exhibited a significant reduction in alcohol consumed (-0.87 drinks per person per week).

CONCLUSIONS

Well-executed 'why to reduce' alcohol harm-reduction advertisements can encourage drinkers to attempt to reduce their alcohol consumption. These ads may be effectively supplemented by specific 'how to reduce' messages designed to encourage drinkers to monitor their intake.

Birds Drinking Alcohol: Species and Relationship with People. A Review of Information from Scientific Literature and Social Media

Ethanol is a natural by-product of the fermentation process of fruit sugars and is occasionally consumed by fruit-eating and tree sap drinking birds. Information on this form of alcohol consumption features in the scientific literature. However, as pets or as wild animals living close to humans in urban habitats, birds have increasing possibilities to consume alcohol from beverages, such as beer, wine or spirits. Some observations have been discussed in a light-hearted manner in mass media and social media, but without any generalization of why some bird species drink the beverages intentionally or unintentionally provided by humans. To check which species and in what circumstances birds drink alcohol and how this is evaluated by humans, we reviewed the scientific literature and analysed videos from YouTube. In total we found and analysed 8 scientific papers and 179 YouTube videos, from which we identified at least 55 species (in some cases not all birds were identified to species level), 11 in the scientific literature and 47 in videos. The distribution of these species over the avian phylogenetic tree suggests that the origin of this convergent behaviour is mainly by human influence. The two data sources differed in the species covered. Videos typically presented interactions of birds with human-provided alcoholic beverages, and were dominated by two groups of intelligent birds: parrots and corvids. The popularity of YouTube videos for a particular species was positively correlated with the general popularity of the species as measured by the number of hits (results listed) on Google. Human responses to the videos were generally very positive and we analysed how the responses were influenced by factors derived from viewing the videos. Moreover, YouTube videos also provide information on at least 47 new bird species not previously mentioned as using alcohol, and our results suggest that parrots in particular can be potentially good candidates for future restricted laboratory studies on the effect of ethanol on birds and their relationship with humans.

Alcohol and breast cancer risk: Middle-aged women's logic and recommendations for reducing consumption in Australia

BACKGROUND

We aimed to understand the factors shaping alcohol consumption patterns in middle-aged women (45-64), and to identify participant-driven population- and policy-level strategies that may be used to addresses alcohol consumption and reduce breast cancer risk.

METHODS

Semi-structured interviews (n = 35) were conducted with 'middle-aged' women conversant in English and living in South Australia with no history of breast cancer diagnosis. Data were deductively coded using a co-developed framework including variables relevant to our study objectives. Women were asked about their current level of awareness of the association between alcohol and breast cancer risk, and their personal recommendations for how to decrease consumption in middle-aged Australian women.

RESULTS

Women discussed their previous efforts to decrease consumption, which we drew on to identify preliminary recommendations for consumption reduction. We identified a low level of awareness of alcohol and breast cancer risk, and confusion related to alcohol as a risk for breast cancer, but not always causing breast cancer. Participants suggested that education and awareness, through various means, may help to reduce consumption.

CONCLUSIONS

Participants' description of strategies used to reduce their own consumption lead us to suggest that campaigns might focus on the more salient and immediate effects of alcohol (e.g. on physical appearance and mental health) rather than longer-term consequences. Critical considerations for messaging include addressing the personal, physical and social pleasures that alcohol provides, and how these may differ across socio-demographics.

Perceptions of Alcohol Advertising Vary Based on Psychological Characteristics

BACKGROUND

The alcohol industry recognizes children and pregnant women as population sub-groups vulnerable to the effects of alcohol marketing. Research indicates that heavy alcohol users are also potentially vulnerable to alcohol marketing. The purpose of the current study is to determine if sub-groups defined by psychological characteristics should be classified as potentially vulnerable as well.

METHODS

College students (n = 326) from two northeast schools were recruited to complete a survey containing questions on demographics, alcohol use, and psychological characteristics (alcohol expectancies, alcohol dependence, sensation seeking traits, and past delinquent behaviors). Additionally, after viewing each of five alcohol ads (4 television and 1 magazine), participants answered questions about their perceptions of alcohol consumption, responsible drinking, excessive drinking, and appeal of the ads. Main effects were assessed using hierarchical linear modeling, with adjustment for age, sex, race, ethnicity, and AUDIT score.

RESULTS

Alcohol expectancies (p < .001), particularly the social and physical pleasure and social expressiveness sub-scales, and sensation seeking traits (p = .002) were positively associated with alcohol ad appeal. Alcohol dependence symptoms, specifically impaired control and tolerance, were positively associated with perceptions of responsible drinking (p = .035), even though mean perceived number of drinks consumed met the definition of binge drinking.

CONCLUSIONS

Individuals with positive alcohol expectancies, sensation seeking traits, and alcohol dependence may be vulnerable to alcohol advertising and marketing. Because alcohol advertising often contains content that can serve as a cue or reinforce to drink, specific regulations may be needed to prevent alcohol-related harm from occurring in these sub-populations.

The effect of chronic disease warning statements on alcohol-related health beliefs and consumption intentions among at-risk drinkers

Informing drinkers of the health risks associated with alcohol consumption via warning statements located on alcohol products can increase their capacity to make healthier choices. This study assessed whether exposing at-risk drinkers to warning statements relating to specific chronic diseases increases the extent to which alcohol is believed to be a risk factor for those diseases and influences consumption intentions. Australians drinking at levels associated with long-term risk of harm (n = 364; 72% male) completed an online survey assessing their drinking habits, beliefs in the link between alcohol and various diseases and drinking intentions. Respondents were then exposed to one of five statements advising of the potential risks associated with alcohol consumption (either cancer, liver damage, diabetes, mental illness or heart disease). Beliefs and drinking intentions were reassessed. Significant increases in the extent to which alcohol was believed to be a risk factor for diabetes, heart disease, mental illness and cancer were found. With the exception of the liver damage and heart disease statements, exposure to each statement was associated with a significant reduction in consumption intentions. Warning statements advising of the specific chronic diseases associated with alcohol consumption can produce favourable changes in drinking intentions among at-risk drinkers.

Behind Closed Doors: The Priorities of the Alcohol Industry as Communicated in a Trade Magazine

Background: Efforts to reduce alcohol-related harm face strong resistance from the alcohol industry. It is important to monitor industry actions over time to assist in developing appropriate responses to this resistance. Monitoring can enable public health to identify industry positions on alcohol policy issues, stay abreast of current and emerging marketing tactics, and inform the development of possible counter-actions. One form of monitoring is the examination of industry trade publications where the industry converses with itself. The aim of this study was to assess industry strategic approaches as communicated in articles published in a leading Australian alcohol trade magazine to provide insights for policy makers and advocacy groups. Methods: Thematic analysis of 362 articles published in a trade magazine over a one-year period. Results: Three primary themes were evident in the articles: (1) the legitimization of alcohol as an important social and economic product, (2) the portrayal of the industry as trustworthy and benign, and (3) the strategic embedding of alcohol in various facets of everyday life. Conclusions: There was a general failure to acknowledge the substantial burden of disease caused by alcohol products, and instead much effort was expended on legitimizing the product and the companies responsible for its production, distribution, and promotion. The level of denial exhibited shows that additional regulation of the industry and its tactics will need to proceed without industry acceptance. Clear resistance to increasing consumer protections also points to the futility of inviting industry members to the policy table.

Assessing Youth-Appealing Content in Alcohol Advertisements: Application of a Content Appealing to Youth (CAY) Index

Underage drinking is a serious public health problem in the United States, and youth exposure to alcohol advertising has been indicated as a possible contributing factor. Although a number of studies have identified advertising content features that youth find appealing, a key limitation of this research is the absence of a broader tool to examine those features, especially those used by alcohol brands that are popular with underage drinkers. We created an index of content elements found in the research literature to be appealing to youth, and then used this index in a content analysis to identify the degree to which youth-appealing content appeared in a sample of alcohol ads that aired on television shows popular among youth. Finally, using bivariate analysis, we tested the relationship between alcohol brands' use of this content and the popularity of those brands among youth. We found that many of the ads featured youth-appealing content, and that the ads for the alcohol brands most popular among youth had more youth-appealing content than the less popular brands.

Do betting advertisements contain attention strategies that may appeal to children? An interpretative content analysis

ISSUE ADDRESSED

Concerns have been raised about the expansion of sports betting marketing and the impact it may have on children's gambling attitudes and behaviours. This study aimed to investigate the content of Australian betting advertisements to identify if they contained specific attention strategies that have been identified by tobacco, alcohol and gambling researchers as having particular appeal to children.

METHODS

An interpretative content analysis of 91 advertisements from 11 corporate bookmakers was conducted. A search of specific attention strategies that may appeal to adults, but also have been demonstrated in the public health literature as having particular appeal for children was used to develop a coding framework. This framework was then applied to analyse the advertisements. Descriptive statistics were used to generate quantitative data and qualitative illustrations were used to provide examples of the strategies found within the advertisements.

RESULTS

On average there were 7.6 attention strategies found per advertisement. The most common attention strategies were music (n = 80), voiceovers (n = 79) and catchy slogans (n = 78). There were some attention strategies that related specifically to betting, such as technology, and risk-reducing promotions.

CONCLUSION

This research has demonstrated that the content of betting advertisements contains attention strategies that, based on the research findings from other areas of public health, may have particular appeal for children. SO WHAT?: This research provides important evidence which could encourage researchers, regulators and policy makers to consider changes to current advertising regulations, to ensure children are protected from the potentially engaging and harmful attention strategies present in betting advertisements.

Population Level Effects of a Mass Media Alcohol and Breast Cancer Campaign: A Cross-Sectional Pre-Intervention and Post-Intervention Evaluation

AIMS

To examine the relationship between a TV-led breast cancer mass-media campaign in the North East of England (conducted in two waves: Jul/2015 and Nov/2015), awareness of the link between alcohol and cancer, intention to reduce alcohol consumption and support for alcohol related policies.

METHODS

Three cross-sectional surveys were conducted; one over the 2 weeks pre-campaign (n = 572); one immediately following campaign wave 1 (n = 576); and another immediately following campaign wave 2 (n = 552). Survey questions assessed; campaign exposure; awareness of the links between alcohol and related cancers; intention to change alcohol consumption; and support for alcohol related policies.

RESULTS

The proportion of respondents indicating awareness of alcohol as a cancer risk factor was larger post-campaign compared to pre-campaign. The largest increase was seen for breast cancer with 45% aware of the links post-campaign wave 2 compared to 33% pre-campaign. The proportion of respondents indicating 'strong support' of the seven alcohol related policies significantly increased between surveys. The proportion of respondents both aware of alcohol as a cancer risk factor and supportive of the seven alcohol related policies significantly increased between surveys. There was no significant change in self-reported intention to reduce alcohol consumption amongst increasing/higher risk drinkers.

CONCLUSION

These findings indicate that a mass-media campaign raising awareness of the links between alcohol and breast cancer is associated with increased awareness and alcohol related policy support at a population level. However, there was no association found with a change in short-term drinking intentions.

SHORT SUMMARY

A mass-media campaign raising awareness of the links between alcohol and breast cancer is associated with increased awareness and alcohol policy support at a population level but does not appear to be associated with a change in short term drinking intentions.

Exploring adolescent-parent interaction strategies for accessing alcohol at home

Purpose

The purpose of this paper is to determine the extent to which youth have ready access to alcohol and the extent to which immediate family influence affects consumption.

Design/methodology/approach

This qualitative descriptive exploratory study undertook semi-structured peer-group interviews with 20 participants from four New Zealand high schools. The interviews centred on exploring the “general” experiences of youth related to alcohol access – but with a focus on alcohol access “at home” and the parental role.

Findings

The study confirmed that the home unit was the main source of alcohol for most youth and parents were the most common source of provision. Parents provided financial access to alcohol by giving their child money to purchase it themselves through older family members or friends. It was also found that youth used negotiation strategies with their parents to influence their consumer purchases of alcohol.

Research limitations/implications

Youth frequently used strategies such as pressure tactics, exchange tactics, ingratiating tactics and consultation tactics to influence their family’s decision-making process and to pressure their parents into supplying them with alcohol.

Practical implications

It is important to recognise the role that family play as “gatekeepers” for readily allowing access and supplying youth with alcohol – and the reasons for doing so.

Social implications

Alcohol plays an important part in many societies. It is important to understand how young people consume and access alcohol – particularly when the family plays a major role in access and consumption.

Originality/value

Many studies have been conducted in relation to youth and alcohol consumption. Very few, as far as we can tell, explore the role of the family from the young consumers’ perspective and especially from a qualitative narrative perspective.

Alcohol harm reduction advertisements: a content analysis of topic, objective, emotional tone, execution and target audience

BACKGROUND

Public health mass media campaigns may contribute to reducing the health and social burden attributed to alcohol consumption, but little is known about which advertising characteristics have been used, or have been effective, in alcohol harm reduction campaigns to date. As a first step towards encouraging further research to identify the impact of various advertising characteristics, this study aimed to systematically identify and examine the content of alcohol harm reduction advertisements (ads).

METHOD

Ads were identified through an exhaustive internet search of Google, YouTube, Vimeo, and relevant government and health agency websites. Eligible ads were: English language, produced between 2006 and 2014, not primarily focused on drink-driving or alcohol in pregnancy, and not alcohol industry funded. Systematic content analysis of all ads was performed; each ad was double-coded.

RESULTS

In total, 110 individual ads from 72 different alcohol harm reduction campaigns were identified, with the main source countries being Australia (40%) and the United Kingdom (26%). The dominant topic for 52% of ads was short-term harms, while 10% addressed long-term harms, 18% addressed underage drinking, 17% communicated a how-to-change message, and 3% advocated for policy change. The behavioural objective of most ads was to motivate audiences to reduce their alcohol consumption (38%) or to behave responsibly and/or not get drunk when drinking (33%). Only 10% of all ads mentioned low-risk drinking guidelines. Eighty-seven percent of ads used a dramatisation execution style and 74% had a negative emotional tone. Ninety percent of ads contained messages or content that appeared to target adults, and 36% specifically targeted young adults.

CONCLUSIONS

Some message attributes have been employed more frequently than others, suggesting several promising avenues for future audience or population-based research to compare the relative effectiveness of different characteristics of alcohol harm reduction ads. Given most alcohol-attributable harm is due to long-term disease, these findings suggest future campaigns may fill a potentially important gap if they were to focus on long-term harms. There is scope for such long-term harm campaigns to place greater emphasis on encouraging reduced personal consumption of alcohol, potentially through more frequent communication of low-risk drinking guidelines.

Factors that influence children's gambling attitudes and consumption intentions: lessons for gambling harm prevention research, policies and advocacy strategies

BACKGROUND

Harmful gambling is a public health issue that affects not only adults but also children. With the development of a range of new gambling products, and the marketing for these products, children are potentially exposed to gambling more than ever before. While there have been many calls to develop strategies which protect children from harmful gambling products, very little is known about the factors that may influence children's attitudes towards these products. This study aimed to explore children's gambling attitudes and consumption intentions and the range of consumer socialisation factors that may influence these attitudes and behaviours.

METHODS

Children aged 8 to 16 years old (n = 48) were interviewed in Melbourne, Australia. A semi-structured interview format included activities with children and open-ended questions. We explored children's perceptions of the popularity of different gambling products, their current engagement with gambling, and their future gambling consumption intentions. We used thematic analysis to explore children's narratives with a focus on the range of socialising factors that may shape children's gambling attitudes and perceptions.

RESULTS

Three key themes emerged from the data. First, children's perceptions of the popularity of different products were shaped by what they had seen or heard about these products, whether through family activities, the media (and in particular marketing) of gambling products, and/or the alignment of gambling products with sport. Second, children's gambling behaviours were influenced by family members and culturally valued events. Third, many children indicated consumption intentions towards sports betting. This was due to four key factors: (1) the alignment of gambling with culturally valued activities; (2) their perceived knowledge about sport; (3) the marketing and advertising of gambling products (and in particular sports betting); and (4) the influence of friends and family.

CONCLUSIONS

This study indicates that there is a range of socialisation factors, particularly family and the media (predominantly via marketing), which may be positively shaping children's gambling attitudes, behaviours and consumption intentions. There is a need for governments to develop effective policies and regulations to reduce children's exposure to gambling products and ensure they are protected from the harms associated with gambling.

Qualitative process evaluation of an Australian alcohol media literacy study: recommendations for designing culturally responsive school-based programs

Background

Alcohol media literacy programs seek to mitigate the potentially harmful effects of alcohol advertising on children’s drinking intentions and behaviours through equipping them with skills to challenge media messages. In order for such programs to be effective, the teaching and learning experiences must be tailored to their specific cultural context. Media in the Spotlight is an alcohol media literacy program aimed at 9 to 12 year old Australian children. This study evaluates the process and implementation of the program, outlining the factors that facilitated and inhibited implementation. From this evaluation, a pedagogical framework has been developed for health professionals implementing culturally responsive programs in school settings.

Methods

Process measures included: semi-structured interviews with teachers before and after the program was implemented (n = 11 interviews), program evaluation questionnaires completed by children (n = 166), lesson observations completed by teachers (n = 35 observations), and reflective journal entries completed by the researcher (n = 44 entries). A thematic analysis approach was used to analyse all of the data sets using NVivo. Inductive coding was used, whereby the findings were derived from the research objectives and multiple readings and interpretations of the data.

Results

Five key pedagogical considerations were identified that facilitated implementation. These were: connecting to the students’ life worlds to achieve cultural significance; empowering students with real-world skills to ensure relevance; ensuring programs are well structured with strong connections to the school curriculum; creating developmentally appropriate activities while providing a range of assessment opportunities; and including hands-on and interactive activities to promote student engagement. Three potential inhibitors to implementing the alcohol media literacy program in upper-elementary school classrooms were identified. These included topic sensitivities, classroom management challenges, and fitting new programs into already busy school schedules.

Conclusion

Overall, the program content and individual lessons were well received by the teachers and students. The lessons learned from the development, implementation and evaluation of this program can provide health professionals with key pedagogical strategies for designing culturally responsive educational programs. Culturally responsive programs are critical for ensuring interventions are effective for their specific context.

Industry self-regulation of alcohol marketing: a systematic review of content and exposure research

BACKGROUND AND AIMS

With governments relying increasingly upon the alcohol industry's self-regulated marketing codes to restrict alcohol marketing activity, there is a need to summarize the findings of research relevant to alcohol marketing controls. This paper provides a systematic review of studies investigating the content of, and exposure to, alcohol marketing in relation to self-regulated guidelines.

METHODS

Peer-reviewed papers were identified through four literature search engines: SCOPUS, Web of Science, PubMed and PsychINFO. Non-peer-reviewed reports produced by public health agencies, alcohol research centers, non-governmental organizations and government research centers were also identified. Ninety-six publications met the inclusion criteria.

RESULTS

Of the 19 studies evaluating a specific marketing code and 25 content analysis studies reviewed, all detected content that could be considered potentially harmful to children and adolescents, including themes that appeal strongly to young men. Of the 57 studies of alcohol advertising exposure, high levels of youth exposure and high awareness of alcohol advertising were found for television, radio, print, digital and outdoor advertisements. Youth exposure to alcohol advertising has increased over time, even as greater compliance with exposure thresholds has been documented.

CONCLUSIONS

Violations of the content guidelines within self-regulated alcohol marketing codes are highly prevalent in certain media. Exposure to alcohol marketing, particularly among youth, is also prevalent. Taken together, the findings suggest that the current self-regulatory systems that govern alcohol marketing practices are not meeting their intended goal of protecting vulnerable populations.

Investigating Single- Versus Multiple-Source Approaches to Communicating Health Messages Via an Online Simulation

Purpose:

To assess whether exposing drinkers to information about the alcohol–cancer link via multiple and diverse sources in an online simulation produces larger improvements in attitudes and intentions relative to exposure to a single source of information.

Design:

Experimental; unequal randomization with respondents allocated to either the single-source (20%) or multiple-source condition (80%). Alcohol-related behavioral intentions were assessed preexposure and postexposure.

Setting:

Australia.

Participants:

A total of 2087 drinkers consuming alcohol at least twice per month.

Measures:

Scales were used to assess attitudes toward the messages (believability, convincingness, and personal relevance) and behavioral intentions (extent to which participants believed that they should and would reduce their alcohol consumption and their intention to consume 5 or more drinks in a single session).

Analysis:

Hierarchical linear regression.

Results:

Source condition was significantly associated with all 3 attitudinal variables ( P < .001). Those exposed to an alcohol warning statement from multiple sources found the message more believable, convincing, and personally relevant compared to those exposed to a warning statement via a single source. They also reported significantly greater change preexposure to postexposure on the 2 behavioral beliefs that they should (Δ M = 0.25 vs Δ M = 0.09) and would (Δ M = 0.23 vs Δ M = 0.00) reduce their current alcohol consumption ( P < .001). Further, those in the multiple-source condition reported reduced intentions to consume 5 or more standard drinks in a single sitting (Δ M = 0.21 vs Δ M = 0.14; P < .001).

Conclusion:

Findings from the online simulation provide support for the suggestion that integrated approaches involving the combination of multiple sources to deliver a message produce superior outcomes compared to relying on a single source (eg, warning labels on alcoholic beverages).

A Systematic Review of the Impact of Exposure to Internet-Based Alcohol-Related Content on Young People's Alcohol Use Behaviours

AIMS

To conduct a systematic review of studies exploring the relationship between exposure to Internet-based alcohol-related content and alcohol use among young people.

METHODS

Searches of electronic databases and reference lists of relevant articles were conducted to retrieve studies of relevance up until December 2015. Full texts of the studies that met the inclusion criteria were read, appraised for quality using the Kmet forms and guidelines, and included in this review.

RESULTS

Fifteen relevant studies were identified. The included studies were a mix of cross-sectional, longitudinal, experimental and qualitative studies conducted in the USA, the UK, Australia and New Zealand. The age range of the participants involved in these studies was 12-25 years. Included studies employed a variety of study designs and a range of different exposure variables and outcome measures. Studies demonstrated significant associations between exposure to Internet-based alcohol-related content and intentions to drink and positive attitudes towards alcohol drinking among young people.

CONCLUSION

Exposure to alcohol-related content on the Internet might predispose young people to patterns of alcohol use by promoting alcohol as a natural and vital part of life. However, the research exploring the influence of this novel form of advertising on young people's alcohol use is emergent, and comprised primarily of cross-sectional studies. To evaluate the direction of the association between exposure to online alcohol-related content and alcohol use, we call for further research based on longitudinal designs.

SHORT SUMMARY

From 15 relevant studies identified, this review reports significant associations between exposure to Internet-based alcohol-related content and intentions to drink and positive attitudes towards alcohol drinking among young people, with different influences found at different stages of alcohol use.

Are schools and alcohol a good mix? A qualitative study of school principals' experiences of adults' alcohol use in Australian secondary schools

OBJECTIVE

Parents, schools and the broader community influence children's socialisation to alcohol. In Australia, the UK and the USA, there have been media reports of adults consuming alcohol at family-focused school events such as fairs and graduations. The aim of this qualitative study was to describe school principals' experiences of adults' use of alcohol at school events, when children are present.

DESIGN/SETTING/PARTICIPANTS

A qualitative study was undertaken. Publicly available lists were used to invite 60 principals from government and Catholic secondary schools in Victoria, Australia. In-depth interviews were conducted and analysed thematically and reported using the Consolidated Criteria for Reporting Qualitative Research guidelines.

RESULTS

14 principals (5 female, 9 male) participated. Most (10) of the participating principals reported adults' use of alcohol at events when students were present. Regarding these events, most principals reported concerns regarding potential harms and responsibility for decision-making about alcohol availability in schools. Some (4) principals believed alcohol should not be present at such events and this was their practice. Half of the participating schools had recently made changes to reduce the availability or management of alcohol at school functions.

CONCLUSIONS

The findings confirm the common use of alcohol by adults at school events, the challenges this poses for school principals and suggests consideration needs to be given to identifying strategies for supporting schools and school principals in decision-making regarding the conduct of such events.

Addressing inequities in alcohol consumption and related harms

Social determinants, or the conditions in which individuals are born, grow, live, work and age, can result in inequities in health and well-being. However, to-date little research has examined alcohol use and alcohol-related problems from an inequities and social determinants perspective. This study reviewed the evidence base regarding inequities in alcohol consumption and alcohol-related health outcomes in Australia and identified promising approaches for promoting health equity. Fair Foundations: the VicHealth framework for health equity was used as an organizing schema. The review found that social determinants can strongly influence inequities in alcohol consumption and related harms. In general, lower socioeconomic groups experience more harm than wealthier groups with the same level of alcohol consumption. While Australia has implemented numerous alcohol-related interventions and policies, most do not explicitly aim to reduce inequities, and some may inadvertently exacerbate existing inequities. Interventions with the greatest potential to decrease inequities in alcohol consumption and alcohol-related harms include town planning, zoning and licensing to prevent disproportionate clustering of outlets in disadvantaged areas; interventions targeting licensed venues; and interventions targeting vulnerable populations. Interventions that may worsen inequities include national guidelines, technological interventions and public drinking bans. There is a need for further research into the best methods for reducing inequities in alcohol consumption and related harms.

Reverse engineering a 'responsible drinking' campaign to assess strategic intent

BACKGROUND AND AIMS

The alcohol industry produces 'responsible drinking' advertising campaigns. There is concern that these may promote drinking while persuading governments and the general public that the industry is acting responsibly. This paper examined young people's thoughts and feelings in response to one of these campaigns in Australia.

DESIGN

A qualitative analysis of introspection data provided by young drinkers after exposure to a responsible drinking advertisement produced by DrinkWise called 'How to Drink Properly'.

SETTING

Perth, Western Australia.

PARTICIPANTS

Forty-eight 18-21-year-old drinkers.

MEASUREMENTS

The qualitative data were imported into NVivo10 and coded according to the various stages of advertising effects frameworks. A thematic analysis approach was used to identify patterns in the data relating to (i) perceptions of the source and purpose of the advertisement and (ii) any resulting attitudinal or behavioural outcomes.

FINDINGS

Despite the sample comprising mainly high-risk drinkers, participants were generally unable to relate to the heavy drinkers depicted in the DrinkWise advertisement. This disassociation resulted in a perceived lack of need to modify their own drinking behaviours. Instead, the study participants found the advertisement to be entertaining and supportive of existing social norms relating to heavy drinking among members of this age group.

CONCLUSIONS

The 'How to Drink Properly' advertisement by Drinkwise in Australia may reinforce existing drinking attitudes and behaviours among young drinkers.

The Cognitive and Behavioural Impact of Alcohol Promoting and Alcohol Warning Advertisements: An Experimental Study

AIMS

To assess the immediate effect of alcohol promoting and alcohol warning advertisements on implicit and explicit attitudes towards alcohol and on alcohol seeking behaviour.

METHODS

We conducted a between-participants online experiment in which participants were randomly assigned to view one of three sets of advertisements: (a) alcohol promoting, (b) alcohol warning, or (c) unrelated to alcohol. A total of 373 participants (59.5% female) aged 18-40 (M = 28.03) living in the UK were recruited online through a research agency. Positive and negative implicit attitudes and explicit attitudes towards alcohol were assessed before and after advertisements were viewed. Alcohol seeking behaviour was measured by participants' choice of either an alcohol-related or non-alcohol-related voucher offered ostensibly as a reward for participation. Self-reported past week alcohol consumption was also recorded.

RESULTS

There were no main effects on any of the outcome measures. In heavier drinkers, viewing alcohol promoting advertisements increased positive implicit attitudes (standardized beta = 0.15, P = 0.04) and decreased negative implicit attitudes (standardized beta = -0.17, P = 0.02). In heavier drinkers, viewing alcohol warning advertisements decreased negative implicit attitudes (standardized beta = -0.19, P = 0.01).

CONCLUSIONS

Viewing alcohol promoting advertisements has a cognitive impact on heavier drinkers, increasing positive and reducing negative implicit attitudes towards alcohol. Viewing alcohol warning advertisements reduces negative implicit attitudes towards alcohol in heavier drinkers, suggestive of a reactance effect.

Creating symbolic cultures of consumption: an analysis of the content of sports wagering advertisements in Australia

BACKGROUND

Since 2008, Australia has seen the rapid emergence of marketing for online and mobile sports wagering. Previous research from other areas of public health, such as tobacco and alcohol, has identified the range of appeal strategies these industries used to align their products with culturally valued symbols. However, there is very limited research that has investigated the tactics the sports wagering industry uses within marketing to influence the consumption of its products and services.

METHOD

This study consisted of a mixed method interpretive content analysis of 85 sports wagering advertisements from 11 Australian and multinational wagering companies. Advertisements were identified via internet searches and industry websites. A coding framework was applied to investigate the extent and nature of symbolic appeal strategies within advertisements.

RESULTS

Ten major appeal strategies emerged from this analysis. These included sports fan rituals and behaviours; mateship; gender stereotypes; winning; social status; adventure, thrill and risk; happiness; sexualised imagery; power and control; and patriotism. Symbols relating to sports fan rituals and behaviours, and mateship, were the most common strategies used within the advertisements.

DISCUSSION/CONCLUSIONS

This research suggests that the appeal strategies used by the sports wagering industry are similar to those strategies adopted by other unhealthy commodity industries. With respect to gambling, analysis revealed that strategies are clearly targeted to young male sports fans. Researchers and public health practitioners should seek to better understand the impact of marketing on the normalisation of sports wagering for this audience segment, and implement strategies to prevent gambling harm.

Alcohol Advertising in Sport and Non-Sport TV in Australia, during Children's Viewing Times

Estimate the amount of alcohol advertising in sport vs. non-sport programming in Australian free-to-air TV and identify children's viewing audience composition at different times of the day. Alcohol advertising and TV viewing audience data were purchased for free-to-air sport and non-sport TV in Australia for 2012. We counted alcohol advertisements in sport and non-sport TV in daytime (6 am-8.29 pm) and evening periods (8.30 pm-11.59 pm) and estimated viewing audiences for children and young adults (0-4 years, 5-13 years, 14-17 years, 18-29 years). During the daytime, most of the alcohol advertising (87%) was on sport TV. In the evening, most alcohol advertising (86%) was in non-sport TV. There was little difference in the mean number of children (0-17 years) viewing TV in the evening (N = 273,989), compared with the daytime (N = 235,233). In programs containing alcohol advertising, sport TV had a greater mean number of alcohol adverts per hour (mean 1.74, SD = 1.1) than non-sport TV (mean 1.35, SD = .94). Alcohol advertising during the daytime, when large numbers of children are watching TV, is predominantly in free-to-air sport TV. By permitting day-time advertising in sport programs and in any programs from 8.30 pm when many children are still watching TV, current regulations are not protecting children from exposure to alcohol advertising.

Content Themes of Alcohol Advertising in U.S. Television-Latent Class Analysis

BACKGROUND

There is little alcohol research that reports on the thematic contents of contemporary alcohol advertisements in U.S. television. Studies of alcohol ads from 2 decades ago did not identify "Partying" as a social theme. Aim of this study was to describe and classify alcohol advertisements aired in national television in terms of contents, airing times, and channel placements and to identify different marketing strategies of alcohol brands.

METHODS

Content analysis of all ads from the top 20 U.S. beer and spirit brands aired between July 2009 and June 2011. These were 581 unique alcohol ads accounting for 272,828 (78%) national television airings. Ads were coded according to predefined definitions of 13 content areas. A latent class analysis (LCA) was conducted to define content cluster themes and determine alcoholic brands that were more likely to exploit these themes.

RESULTS

About half of the advertisements (46%) were aired between 3 am and 8 pm, and the majority were placed either in Entertainment (40%) and Sports (38%) channels. Beer ads comprised 64% of the sample, with significant variation in airing times and channels between types of products and brands. LCA revealed 5 content classes that exploited the "Partying," "Quality," "Sports," "Manly," and "Relax" themes. The partying class, indicative of ad messages surrounding partying, love, and sex, was the dominant theme comprising 42% of all advertisements. Ads for alcopops, flavored spirits, and liqueur were more likely to belong to the party class, but there were also some beer brands (Corona, Heineken) where more than 67% of ads exploited this theme.

CONCLUSIONS

This is the first analysis to identify a partying theme to contemporary alcohol advertising. Future analyses can now determine whether exposure to that or other themes predicts alcohol misuse among youth audiences.

How has alcohol advertising in traditional and online media in Australia changed? Trends in advertising expenditure 1997-2011

INTRODUCTION AND AIMS

The aim of this study was to determine changes in advertising expenditures across eight media channels for the four main alcohol beverage types and alcohol retailers in Australia.

DESIGN AND METHODS

Yearly advertising expenditures between January 1997 and December 2011 obtained from a leading media-monitoring company. Media channels assessed were: free-to-air television, newspapers, magazines, radio, outdoors (billboards), cinema, direct mail (from 2005) and online (from 2008). Data were categorised into alcohol retailers (e.g. supermarkets, off-licences) or four alcoholic beverage types (beer, wine, spirits, premixed spirits/cider). Regression analyses examined associations between year and expenditure.

RESULTS

Total alcohol advertising expenditure peaked in 2007, then declined to 2011 (P = 0.02). Television advertising expenditure declined between 2000 and 2011 (P < 0.001), while outdoor advertising expenditure increased between 1997 and 2007. Alcohol retailers' advertising expenditure increased over time (P < 0.001), and from the mid-2000s exceeded expenditure for any single beverage category. For both beer and spirits, television advertising expenditure declined over time (beer: P < 0.001; spirits: P < 0.001) while outdoor advertising expenditure increased (beer: P < 0.001; spirits: P = 0.02). However, the number of advertised beer (P < 0.001), spirits (P < 0.001) and wine (P = 0.01) products increased over time.

DISCUSSION AND CONCLUSIONS

Retailers are playing an increasing role in advertising alcohol. As our study excluded non-traditional advertising media (e.g. sponsorships, in-store) we cannot determine whether declines in television advertising have been offset by increases in advertising in newer media channels. However, our findings that media channels used for alcohol advertising have changed over time highlights the need for adequate controls on alcohol advertising in all media channels. [White V, Faulkner A, Coomber K, Azar D, Room R, Livingston M, Chikritzhs T, Wakefield M. How has alcohol advertising in traditional and online media in Australia changed? Trends in advertising expenditure 1997-2011. Drug Alcohol Rev 2015]2015;34:521-530.

Using a mass media campaign to raise women's awareness of the link between alcohol and cancer: cross-sectional pre-intervention and post-intervention evaluation surveys

OBJECTIVES

To evaluate the effectiveness of a population-based, statewide public health intervention designed to improve women's awareness and knowledge of the link between alcohol and cancer.

DESIGN

Cross-sectional tracking surveys conducted pre-intervention and post-intervention (waves I and III of campaign).

SETTING

Western Australia.

PARTICIPANTS

Cross-sectional samples of Western Australian women aged 25-54 years before the campaign (n=136) and immediately after wave I (n=206) and wave III (n=155) of the campaign.

INTERVENTION

The 'Alcohol and Cancer' mass media campaign ran from May 2010 to May 2011 and consisted of three waves of paid television advertising with supporting print advertisements.

MAIN OUTCOME MEASURES

Campaign awareness; knowledge of drinking guidelines and the link between alcohol and cancer; intentions towards drinking.

RESULTS

Prompted recognition of the campaign increased from 67% following wave I to 81% following wave III (adjusted OR (adj OR)=2.31, 95% CI 1.33 to 4.00, p=0.003). Improvements in women's knowledge that drinking alcohol on a regular basis increases cancer risk were found following wave I (adj OR=2.60, 95% CI 1.57 to 4.30, p<0.001) and wave III (adj OR=4.88, 95% CI 2.55 to 9.36, p<0.001) compared with baseline. Knowledge of the recommended number of standard drinks for low risk in the long term increased between baseline and wave I (adj OR=1.68, 95% CI 1.02 to 2.76, p=0.041), but not baseline and wave III (adj OR=1.42, 95% CI 0.84 to 2.39, p=0.191). Among women who drink alcohol, the proportion expressing intentions to reduce alcohol consumption increased significantly between baseline and wave III (adj OR=2.38, 95% CI 1.11 to 5.12, p=0.026). However, no significant reductions in recent drinking behaviour were found following the campaign.

CONCLUSIONS

Results indicate a population-based mass media campaign can reach the target audience and raise awareness of links between alcohol and cancer, and knowledge of drinking guidelines. However, a single campaign may be insufficient to measurably curb drinking behaviour in a culture where pro-alcohol social norms and product marketing are pervasive.

Cross-promotional alcohol discounting in Australia's grocery sector: a barrier to initiatives to curb excessive alcohol consumption?

OBJECTIVE

Excessive alcohol consumption is an increasing issue internationally. Pricing strategies, including discount restrictions, have been identified as one of the most effective policy means by which to reduce heavy alcohol consumption. In Australia, cross-promotional alcohol discounts are increasingly used by supermarket chains as a marketing tool. The purpose of the present study is to provide preliminary data on the nature and extent of cross-promotional alcohol discounting in the Australian grocery sector.

METHODS

A purposive sample of 34 supermarkets in Australia's three largest cities was selected and minor grocery purchases made to uncover the prevalence and level of cross-promotional alcohol discounting.

RESULTS

Cross-promotional 'bundled' discounts were very common with 33 of the 34 supermarkets offering a 'two for one' discount on bottles of wine. Even with minor purchases (mean purchase $1.35), the mean value of discounts received was substantial ($16.23).

CONCLUSIONS

These results appear to be consistent with claims that major supermarket chains are using alcohol discounts as loss leaders to entice new consumers.

IMPLICATIONS

These strategies are antithetical to public health strategies aimed at reducing excessive alcohol consumption. Further examination of the impact of major retailers on public health initiatives is warranted, particularly in light of increasing retailer concentration.

Developing cancer warning statements for alcoholic beverages

Background

There is growing evidence of the increased cancer risk associated with alcohol consumption, but this is not well understood by the general public. This study investigated the acceptability among drinkers of cancer warning statements for alcoholic beverages.

Methods

Six focus groups were conducted with Australian drinkers to develop a series of cancer-related warning statements for alcohol products. Eleven cancer warning statements and one general health warning statement were subsequently tested on 2,168 drinkers via an online survey. The statements varied by message frame (positive vs negative), cancer reference (general vs specific), and the way causality was communicated (‘increases risk of cancer’ vs ‘can cause cancer’).

Results

Overall, responses to the cancer statements were neutral to favorable, indicating that they are unlikely to encounter high levels of negative reaction from the community if introduced on alcoholic beverages. Females, younger respondents, and those with higher levels of education generally found the statements to be more believable, convincing, and personally relevant. Positively framed messages, those referring to specific forms of cancer, and those using ‘increases risk of cancer’ performed better than negatively framed messages, those referring to cancer in general, and those using the term ‘can cause cancer’.

Conclusion

Cancer warning statements on alcoholic beverages constitute a potential means of increasing awareness about the relationship between alcohol consumption and cancer risk.

Building the case for independent monitoring of food advertising on Australian television

Objective

To provide an independent monitoring report examining the ongoing impact of Australian self-regulatory pledges on food and drink advertising to children on commercial television.

Design

Analysis of food advertisements across comparable sample time periods in April/May 2006, 2007, 2009, 2010 and 2011. The main outcome measure comprised change in the mean rate of non-core food advertisements from 2006 to 2011.

Setting

Sydney free-to-air television channels.

Subjects

Televised food advertisements.

Results

In 2011 the rate of non-core food advertisements was not significantly different from that in 2006 or 2010 (3·2/hv. 4·1/h and 3·1/h), although there were variations across the intervening years. The rate of fast-food advertising in 2010 was significantly higher than in 2006 (1·8/hv. 1·1/h,P< 0·001), but the same as that in 2011 (1·5/h).

Conclusions

The frequency of non-core food advertising on Sydney television has remained essentially unchanged between 2006 and 2011, despite the implementation of two industry self-regulatory pledges. The current study illustrates the value of independent monitoring as a basic requirement of any responsive regulatory approach.