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Program Health Policy International -Thailand Program Policy Health International -Thailand E L S A project report on the evidence to strengthen regulation to protect young people The Impact of Alcohol Advertising: Young People & Commercial Communications Peter Anderson on behalf of the National Foundation for Alcohol Prevention, the Netherlands and the ELSA project 2005-2007 Orratai Waleewong (IHPP) International Health Policy Program Ministry of Public Health, Thailand 7-Nov-09 1 -Thailand Program Health Policy International -Thailand Program Policy Health International The ELSA Project (Enforcement of National Laws and Self-regulation in Advertising & Marketing of Alcohol) Period 2005 – 2007, Participants: 23 Member States and Norway Funded by EU (the European Commission); Partnership of STAP with Actis and Alkokutt (Norway) Assess and report on the enforcement of national laws and selfregulations on the advertising and marketing of alcoholic beverages in EU member states, the applicant countries and Norway. 2 Deliverables of ELSA 1.Training Manual: Description method used in ELSA, use for follow-up studies 2. Report on Regulations: Overview existing national regulations on alcohol marketing Program Health Policy International -Thailand Program Policy Health International -Thailand in Europe, level of integrating EU, recommendations in national regulations, overview existing procedures in European countries 3. Report on Adherence: Collecting existing documents written between 2000-2005 on the adherence & efficiency to national regulations. 4. Report on Impact: Overview of findings in scientific studies on the effects of alcohol advertising and marketing. 5. Appealing Alcohol Beverages and Marketing Practices in Europe: Overview of most appealing alcoholic beverages & alcohol advertisements among minors in Europe 6. Report with Conclusions: Summary of main findings of other deliverables, Policy recommendations 3 Program Health Policy International -Thailand Program Policy Health International -Thailand Commercial communication • This vulnerability is exacerbated by the enormous exposure to commercial communications • All type of media are used for commercial communication • • • • • • • Television Music & music videos Films Paid placements in films, TV shows, books & videogame The internet >>increasing & difficult to regulate Grass roots word of mouths (viral marketing technique) Sports sponsorship • In USA, mostly targeted to young people. 4 Advertisement rate ratio Program Health Policy International -Thailand Program Policy Health International -Thailand • In USA, mostly commercial communications targeted to young people. 5 Young people are vulnerable to alcohol advertising Program Health Policy International -Thailand Program Policy Health International -Thailand View of the neuroscience, psychology and marketing. • The adolescent brain undergoes major development >>makes adolescents more vulnerable to impulsivity with greater sensitivity to pleasure and reward. - Adolescents are more impulsive and self-conscious than adults. - The adolescent brain's plasticity makes it more vulnerable to harm. Thus, there is emerging justification for restricting adolescents' exposure to advertising and promotions for highrisk, addictive products, especially if impulsive behaviors or image benefits are depicted. - Adolescents, because of how the human brain develops, may be particularly attracted to branded products such as alcohol that are associated with risky behavior and that provide, in their view, immediate gratification, thrills and/or social status. 6 Program Health Policy International -Thailand Program Policy Health International -Thailand Adolescents have 3 distinctive vulnerabilities: (Pechmann et al.2005) • Impulsivity, linked to a temporal gap between the onset of hormonal and environmental stimuli into the amygdala and the more gradual development of inhibitory control through the executive planning and decision-making functions of the prefrontal cortex • Self-consciousness & Self-doubt, attributable at least in part to the emergence of abstract thinking, but evident in the greater frequency and intensity of negative mood states during adolescence • Elevated risk from product use, including impulsive behaviour such as drinking and driving, but also greater susceptibility to toxins because of the plasticity of the developing brain as well as greater sensitivity to the brain’s “stamping” functions identifying pleasure and reward 7 Program Health Policy International -Thailand Program Policy Health International -Thailand Neural response to alcohol stimuli in adolescents with alcohol use disorder. ( Tapert et al.2003) BACKGROUND: - Cue reactivity studies in alcohol-dependent adults have shown atypical physiological, cognitive, and neural responses to alcoholrelated stimuli that differ from the responses of light drinkers. - Cue reactivity and its neural substrates are unclear in youth. Hypothesis: “Teens with alcohol use disorder would show greater brain response than nonabusing teens to alcohol images relative to neutral beverage images in limbic and frontal brain regions.” 8 Program Health Policy International -Thailand Program Policy Health International -Thailand Neural response to alcohol stimuli in adolescents with alcohol use disorder. ( Tapert et al.2003) METHODS: - Cross-sectional functional magnetic resonance imaging study. - Adolescents aged 14 -17, local high schools. - Teens with alcohol use disorders (n = 15) & demographically similar infrequent drinkers ( control group n = 15) - Strict exclusion criteria (no left-handedness or neurological, other psychiatric, or other substance use disorders). - Diagnosed by means of structured and semistructured clinical interviews. - Subjects were shown pictures of alcoholic and nonalcoholic beverage advertisements during blood oxygen level-dependent functional magnetic resonance imaging. - Self-reports of craving were obtained before and after cue exposure. 9 Program Health Policy International -Thailand Program Policy Health International -Thailand Cross-sectional functional magnetic resonance imaging Teens with alcohol use disorders showed substantially greater brain activation to alcoholic beverage pictures than control youths, predominantly in the brain areas linked to reward, desire , positive affect and episodic recall.(left anterior, limbic, and visual system areas) 10 The degree of brain response to the alcohol pictures was highest in youths who consumed more drinks per month and reported greater desires to drink. This study extends this relationship to adolescents with relatively brief drinking histories using visual alcohol stimuli, and suggests a neural basis for response to alcohol advertisements in youths with drinking problems. 11 Program Health Policy International -Thailand Program Policy Health International -Thailand Young people are vulnerable to alcohol advertising • Alcohol advertising manipulates adolescents’ vulnerability by shaping their attitudes, perceptions and particularly expectancies about alcohol use, which then influence youth decision to drink. (Grube and Waiters 2005) 12 Program Health Policy International -Thailand Program Policy Health International -Thailand Young people are vulnerable to alcohol advertising • There seems to be a cognitive progression from liking of alcohol advertisements (an affective response associated with the desirability of portrayals in the advertisements and a resulting identification with characters in the advertisements) to positive expectancies about alcohol use, to intentions to drink or actual drinking among young people. (Austin and Knaus 2000; Austin et al. 2000) 13 -Thailand Program Health Policy International -Thailand Program Policy Health International Alcohol advertising are related to young people’s expectancies about alcohol and their desire to consume alcohol. Enormous wealth of evidence that • Alcohol ad >>related to positive attitudes & belief about alcohol among young people. • The content of advertisements >>related to expectancies about use of alcohol among young people and the role of alcohol in their lives. 14 -Thailand Program Health Policy International -Thailand Program Policy Health International Alcohol advertisements (volume and exposure) increase the likelihood of young people starting to drink, the amount they drink, and the amount they drink on any one occasion. • Similar to the impact of advertising on smoking and eating behavior. Although causal effects are uncertain, we can see that the joint effect of exposure from different types of marketing practices is strongly associated with drinking behaviour and intentions to drink. (exposure beer ads on tv, alcohol advertising in magazines, radio listening, exposure to beer concessions, exposure to in-store beer displays, promotional items) (Collins et al. 2007; US) 15 -Thailand Program Health Policy International -Thailand Program Policy Health International 8 Results of (good quality) longitudinal studies on impact of media and advertising exposure on alcohol use & youth drinking behaviour Robinson et al (1998): follow up 18 months Each 1-hour increase in television viewing >>associated with a 9% increased risk for initiating drinking. Each 1-hour increase in watching music videos associated with a 31% increased risk for initiating drinking. Wingood et al (2003) : follow up 12 months High exposure to rap music leads to 1.5 times greater likelihood to use alcohol compared with low exposure. 16 -Thailand Program Health Policy International -Thailand Program Policy Health International 8 Results of (good quality) longitudinal studies on impact of media and advertising exposure on alcohol use & youth drinking behaviour Stacy et al. (2004) : follow up 12 months Those who watched 60% more alcohol advertisements on TV one year later, - 44% more likely to have used beer, - 34% more likely to have ever used wine/liquor, - 26% more likely to have had 3 or more drinks on one occasion. Van Den Bluck & Beullens (2005) : follow up 12 months Quantity of alcohol consumed while going out related to overall TV viewing and their music video exposure. 17 -Thailand Program Health Policy International -Thailand Program Policy Health International 8 Results of (good quality) longitudinal studies on impact of media and advertising exposure on alcohol use & youth drinking behaviour Ellickson et al. (2005) : follow up 36 months Exposure to in-store beer displays, advertising in magazines and beer concession stands at sports/music events predicted drinking onset for non-drinkers after 2 years. Note!! effects of sponsorship Snyder et al. (2006) : follow up 26 months For every 4% more alcohol advertisements seen on TV, radio, billboards and in magazines drank 1% more drinks per month, (at base line saw 23 advertisements/month, 38.5 drinks/month) For every 15% more exposure in their media market on alcohol advertising, drank 3% more drinks per month. 18 Program Health Policy International -Thailand Program Policy Health International -Thailand 8 Results of (good quality) longitudinal studies on impact of media and advertising exposure on alcohol use & youth drinking behaviour Sargent et al (2006) : follow up 12-24 months Significant linear and quadratic relationship between movie alcohol exposure and initiation of drinking ,with the effect strongest at lower levels of exposure . This strengthened the case for an independent effect of exposure to alcohol use in films on early-onset drinking, as opposed to the observed relationship being simply an artefact of the frequent movie-watching of poorly supervised or academically disengaged young people. McClure et al. (2006) [Same study as Sargent et al (2006)] Owners of alcohol branded merchandise had higher rates of alcohol initiation (25%) compared with non-owners (13.1%). Alcohol producers distribute branded clothing, toys, game equipment and so on as part of embedding their brands in daily life. 19 -Thailand Program Health Policy International -Thailand Program Policy Health International How mass media advertising links in with wider marketing communications (including consumer & stakeholder marketing) to impact not just individual consumers but overall social norms about alcohol. 20 Program Health Policy International -Thailand Program Policy Health International “Integrated marketing communications mix” 21 -Thailand Program Health Policy International -Thailand Program Policy Health International -Thailand The main conclusions of ELSA study 1 Alcohol advertisements are related to positive attitudes and beliefs about alcohol amongst young people, and increase the likelihood of young people starting to drink, the amount they drink, and the amount they drink on any one occasion. 2 There is no available scientific evidence which shows that the non-statutory regulation of commercial communications impacts on the content or volume of advertisements 3 There is great variety in regulations related to the advertisement of alcoholic products in the European Member States 4 There is very little documentation on adherence to the existing regulations 5 The most appealing alcoholic beverages and alcohol advertisements to young people use elements associated with youth culture 6 There is no informative body which systematically monitors the impact of regulations on alcohol marketing and its adherence 22 Program Health Policy International -Thailand Program Policy Health International Thank You 23 -Thailand