3. Rationale for intervention – How will restricting alcohol marketing prevent and reduce alcohol-related harms?
Children and Young People
3.1 Despite alcohol being a health harming and age-restricted product, children and young people are readily exposed to alcohol marketing in Scotland. Although the current self-regulatory system has been in place, and strengthened, over a number of decades, there is little evidence that this is working in terms of reducing young people’s exposure and providing adequate protection.
3.2 A survey of over 3,000 young people aged 11-19 years old in the UK found that half of the sample recalled seeing 32 instances of alcohol marketing in the last month, effectively one piece of alcohol marketing every day. Within the under 18 demographic, one third of those sampled recalled 54 or more instances of alcohol marketing – almost twice a day. This is simply far too high.
3.3 This exposure is cumulative; it is made up of exposure to a range of different market channels. Looking at specific channels, the survey conducted over April – May 2017, found that 42.9% had seen an alcohol advert on television in the last week, 27.9% on a billboard, 27.3% on social media, 30.7% in the form of sponsorship and 18.8% in newspapers or magazines. This reflects the dynamic nature of ‘360-degree’ marketing campaigns and how they reach young people in a multitude of formats.
3.4 It is likely that seeing alcohol marketing increases knowledge and awareness of alcohol brands over time. Nine in ten under 18’s in the UK recognise at least one alcohol brand, with recognition increasing with age from 82% of 11-12 year olds to 91% of 13-15 year olds and 97% of 16-17 year olds.
3.5 Studies in the UK have shown that children as young as ten can readily identify alcohol brands, logos and characters from alcohol advertising. In a survey within primary schools in the north of England and in Scotland, nine out of ten children recognised a particular beer brand.
3.6 Two youth led projects in Scotland, facilitated by the Children’s Parliament and Young Scot, specifically considered alcohol marketing. The Children’s Parliament project on an alcohol-free childhood involved children aged 9-11 in workshops in their schools and found that:
“Children demonstrate awareness and knowledge of alcohol branding and advertising, with some children clearly identifying and referencing certain brands, logos and advertising strategies in their discussions and artwork…When talking about her illustration of a bottle of alcohol in her fridge at home, one child noted that she had chosen to label the bottle with the word ‘fancy’ as it was a type of alcohol she knew. The child had adopted the word seen in a billboard campaign to advertise a popular brand of vodka and had taken care to emulate the same font-style used in the advert.”
3.7 This demonstrates another aspect of exposure to alcohol marketing; that children do not just see it; they also understand it and their thinking may be influenced by it. Children and young people can link alcohol brands to particular drinking occasions and settings, in line with the marketing strategies of these brands. For example, Scottish children aged 14 to 17 linked a particular brand of beer with watching football, a rum brand with holidays and a cider brand with drinking outdoors and barbeques.
3.8 The Young Scot Health Panel, made up of young people aged from 14 to 25, found that “all panel members had been exposed to alcohol marketing in one form or another, and had high brand recognition, despite most of the group being under the legal drinking age.”
3.9 Although the alcohol industry may not intend for children and young people to see and interact with marketing content, there is likely to be an inevitable spillover effect from campaigns that target new legal drinkers or young adult drinkers.
What impact does exposure to alcohol marketing have on children and young people’?
“It’s harmful. It’s just telling children to buy it even though they’re not old enough. It’s not a good message for children” (Children’s Parliament).
“(brand name deleted) vodka is cool” (Female, 13, C2DE, drinker).
“I prefer (brand name deleted) to (brand name deleted). It’s just because most people would probably rather drink that one and be seen with it, it’s got a better image. I’ve seen them advertised, the X, the adverts are good, dead funny” (Female, 14, ABC1, drinker).
3.10 Academic studies from different countries have followed young people over time, tracking their exposure to alcohol marketing and their subsequent alcohol consumption. A number of systematic reviews of these studies assert that there is a strong relationship between children and young people seeing or interacting with alcohol marketing and then starting to drink alcohol, or if they already drink alcohol, drink more. A range of alcohol marketing channels were studied including outdoor advertising, print advertising, cinema advertising, television advertising, online advertising, in-store advertising, sponsorship and ownership of branded clothing and merchandise.
3.11 Researchers recently concluded that a causal link might exist between exposure to alcohol marketing and consumption amongst young people, using the Bradford Hill criteria (a set of criteria academics use to assess the strength of causality).
3.13 In addition to the international evidence, research carried out in Scotland and the UK supports a link between exposure to marketing and consumption. A survey carried out in the UK with over 3000 11-19 year olds demonstrates that awareness of alcohol marketing is associated with increased alcohol consumption and a greater likelihood of higher-risk consumption for those who had started drinking. This is not limited to alcohol marketing and studies in children have shown that under 5 minutes of food advertising increases children and young people’s calorie consumption by 60kCal.
3.14 The overall effect of alcohol marketing is cumulative; the amount and frequency of drinking by young people rises in line with the degree of exposure to alcohol marketing. This is why it is important that any potential restrictions reduce the total volume of marketing seen.
3.15 Being exposed to a piece of alcohol marketing does not necessarily cause immediate or short-term alcohol consumption of the product advertised amongst children and young people. It is not a simple relationship.
3.16 The effect and impact of alcohol marketing on consumption is complex and multi-faceted, as well as cumulative. Marketing influences a network of indirect processes that work together to ultimately guide people towards a particular action and choice. Seeing alcohol marketing likely influences pro-alcohol feelings and attitudes, and shapes positive associations and expectancies around alcohol in general, as well as around specific alcohol brands. The more channels and content people are exposed to the more likely that they will be influenced.
3.17 Academic evidence is clear that in the alcohol context specifically, future attitudes are set in adolescence, a crucial period for identity and attitude forming. If pro – alcohol attitudes and drinking patterns are formed in adolescence then these build over time and positively influence alcohol consumption decisions later in life. If drinking patterns are set at dangerous levels in childhood or in young adult stages then this will have an on-going effect on adult health. Alcohol marketing provides the building blocks for current and future behaviour by affecting how young people think and feel.
3.18 The way that pro-alcohol attitudes inform decisions to drink alcohol and drinking patterns likely involves complex psychological and cognitive processes over time. It is theorised that the way alcohol is marketed, in a desirable way with fun and sociable occasions depicted, influences young people to like the marketing, want to emulate it and may create positive expectancies around alcohol or positive ideas about the effects of drinking. Children move through different stages of response to alcohol marketing from exposure, to noticing, remembering, liking and then participating.
3.19 We know that children and young people find alcohol adverts and brands appealing. Seeing and liking alcohol marketing, and the product being displayed in a positive and attractive way, sets expectations of certain positive benefits from drinking e.g. having a good time with friends.
3.20 Multiple studies, including in Scotland, have shown a link between how much a young person likes an alcohol advert and their drinking behaviours. For example, young people who had positive reactions to adverts were 40% more likely to be a higher-risk drinker.
3.21 Branding forms a crucial part of this, as it does in alcohol marketing campaigns. Underage adolescents in Scotland demonstrate high levels of brand knowledge and preferences for certain brands, even before they have started to drink.
3.22 Young people perceive some brands as desirable with a positive image and others as undesirable. Some brands are seen positively to encapsulate maturity, masculinity or femininity and an acceptance amongst peers whilst others are seen negatively to encapsulate immaturity or embarrassment among peers.
3.24 Advertising industry case studies of alcohol advertising campaigns bear this out with internal documents referencing aspirations of campaigns to increase sales, introduce consumers to the product and, in some cases, to recruit young heavier drinkers or “the heavy-using loyalists of tomorrow”.
3.25 The claim often made that alcohol marketing only influences switching between brands and does not have any influence on attitudes or feelings towards alcohol generally is not consistent with the academic evidence. Nor the direct feedback from children and young people in Scotland and around the world. It is unlikely that alcohol marketing has one effect only i.e. switching between brands.
3.26 The strength of this evidence is endorsed by the World Health Organization and has formed the foundation for the action a number of countries around the world have taken to restrict alcohol marketing.
Higher-risk adult drinkers and those in recovery
“I found it difficult seeing alcohol advertised everywhere: bus stops, TV, newspapers. Even now – I am in recovery and have been sober two and a half years – I find it triggering still. Tobacco adverts aren’t a thing anymore and nor should this. People with alcohol addiction aren’t given a fighting chance.” Millie, Alcohol Health Alliance survey respondent
3.27 Higher-risk adult drinkers are those who drink at levels that are hazardous or harmful to their health, above the UK Chief Medical Officers’ low-risk drinking guideline of 14 units per week. In Scotland, around one in four people drink at hazardous or harmful levels, and 1% (around 38,000 people) may be dependent on alcohol.
3.28 Academic evidence demonstrates that advertising can affect behaviour by presenting cues – such as a picture of an alcoholic drink or a brand – that stimulate consumption. Heavy and binge drinkers react more strongly – and differently – to these cues compared to lighter drinkers. The more someone drinks, the more likely they are to pay attention to alcohol cues, which in turn leads to increased cravings.
3.29 Those in recovery from problematic drinking cannot easily exclude alcohol marketing from their lives. A recent literature review on the impact of alcohol marketing on higher-risk drinkers and those in recovery found that this can act as a ‘trigger’ or incentive to drink for those in treatment or recovery from alcohol dependence. This can make it difficult to abstain from alcohol consumption and can contribute to relapse. Individuals can find it difficult to avoid alcohol imagery and adverts that promote consumption, when going about their daily lives.
3.30 Those in recovery report a need to use strategies to avoid alcohol marketing and certain environments with high visibility of alcohol, including in-store. Alcohol marketing can lead to negative emotions including loss, lack of belonging, anger, sadness, guilt and exclusion from the norm.
3.31 These results are consistent with research undertaken by Scottish Families Affected by Alcohol and Drugs, and the Alcohol Health Alliance which found that people in recovery experience persistent and ubiquitous alcohol marketing messages in their daily lives. Excerpts from a survey undertaken as part of this work are set out below, and in other parts of this consultation.
“I worked as a detox nurse for 20 years, all my patients struggled with alcohol adverts when trying to control or abstain from drinking.” Fiona, AHA Survey respondent
“There really is no escape from alcohol imagery. Waiting for the tube at 8am, I look at a 6-foot bottle of whisky. The side of a bus tells me there is an app that can get me ‘booze in under 15 minutes’. Some of my favourite TV shows are sponsored by alcohol. I receive emails from supermarkets telling me how they have slashed their prices of spirits.” Melissa, in recovery
3.32 Dependent drinkers often have challenging and difficult recovery journeys, due to the addictive relationship they have with alcohol. Sustaining recovery is beneficial to the mental and physical health of the person drinking and their loved ones.
Other adults within the population
3.33 Although there is limited research on the impact alcohol marketing has on adults in the general population, it is likely that alcohol marketing also makes alcohol more attractive to adults generally and influences consumption.
3.34 Adults in Scotland will likely be exposed to similar volumes of alcohol marketing as children and young people are. In many circumstances this could be higher. For example, a recent University of Stirling study analysed alcohol references within a televised Six Nations match in Scotland in 2020 and found an average of approximately 5 alcohol references per broadcast minute. This is the equivalent of one alcohol reference every 12 seconds. A survey in Ireland found that 9 out of 10 adults recalled seeing alcohol marketing in the prior month, and at least half recalled seeing alcohol marketing approximately 2-3 times a day.
3.35 Alcohol marketing by its nature involves featuring alcohol in a desirable way and reinforcing the idea of alcohol as a positive product. This means that the range of harms surrounding alcohol, including increased risks of cancer and heart disease, are not given the same attention and not front of mind for individuals. Marketing contributes towards sustaining social norms around alcohol, that this is positive, normal and desirable. We know that social norms are amongst the most powerful drivers of behaviour, including drinking. Studies indicate that the way alcohol is portrayed within alcohol adverts acts as a cue for drinking and influences consumption.
3.36 Although alcohol companies state that they use marketing techniques to retain consumers and inspire switching between brands and products, research demonstrates that campaigns also recruit new drinkers and increase overall alcohol consumption.
3.37 It is very unlikely that alcohol marketing only influences adults on switching between brands and that this does not influence increased consumption of alcohol. It can have a number of impacts on behaviour including encouraging someone to try an alcoholic product for the first time, encouraging someone to buy more or more frequently, capturing market share from competitors or enticing previous consumers to return.
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