Transcript How Marketing Impacts Health, Jon Noel, MPH

Marketing and
Health:
How What We See Shapes What We
Do
WEDNESDAY, JUNE 10, 2015
JONATHAN NOEL, MPH
PHD CANDIDATE
UNIVERSITY OF CONNECTICUT
What Does Marketing Mean?
Marketing Budgets Are Huge

Advertising Budgets for 2014 (select companies)

McDonald’s = $904 million

Pepsi Co = $753 million

Coca Cola = $401 million

Anheuser Busch = $538 million

MillerCoors = $165 million

Altria (Philip Morris) = $435 million

Pfizer = $1.4 billion
Marketing is Also Diverse
Large Advertising Budgets =
High Marketing Exposure

Food

881,942 food or beverage ads in programs with ≥20% children audience
or more than 100,000 child viewers (2009)

Children exposed to 10.9 food related ads per day


Hispanic children view up to 12.4 food ads per day
Coca Cola products seen 198 times per year by the average child and
269 time per year by the average adolescent in prime time shows only
Large Advertising Budgets =
High Marketing Exposure


Alcohol

2,664,919 ads on U.S. TV from 2001-09

196,494 TV ads during the 40 most popular youth programs (25 largest
markets)

29,026 ads placed in U.S. magazines from 2001-08

798,847 ads on radio in the 75 largest U.S. markets (2009)
Alcohol ad exposure is increasing among youth faster than all other
age groups combined
Marketing Is Effective
High Levels of Exposure Leads to
More Use

2 seminal reviews on alcohol marketing exposure (2009)

Exposure increases alcohol initiation, alcohol consumption
levels, and intentions to use alcohol

Effect sizes are variable and modest

Between 10%-40%

Each additional ad seen increased the number of drinks
consumed by 1% in youth

Each additional dollar per capita spent on advertising
increased the number of drinks consumed by 3%

Ownership of alcohol-branded merchandise is the
strongest predictor of early initiation and excessive
consumption
High Levels of Exposure Leads to
More Use

A review of 115 studies of food marketing exposure
concluded that food promotion…

Is a significant, independent determinant of children’s
food behaviors and health status

Can directly influence purchasing choice and requests

Children buy foods without parents consent

Parents accede to children’s purchase requests

Has a modest influence on food consumption behaviors

Influences food choices at the category and brand level
High Levels of Exposure Leads to
More Use

Exposure to e-cigarette advertising has been associated with ecigarette use

Exposure increasing up to 13% per month
Product is Important

Mentholated cigarettes

Ventilated cigarettes
Place Also Has an Effect

Alcohol outlet density is related to the level of alcohol consumption
and alcohol related health effects


Consistent relationship across states and countries
Higher rates of obesity in food deserts and food swamps
The Role of Social Media
What is Social Media?

Any website or application that allows users to create and share
their own content

Over 260 active social media websites

Largest include

Facebook – 1.3 billion users

Youtube – more than 1 billion users

Twitter – 645 million users

Tumblr – 227 million users

Instagram – 150 million users
Social Media Has A Lot of
Advertising



Facebook

Over 2 million advertisers

~8% of all digital marketing

57% of ads appear on your Newsfeed
YouTube

1 million advertisers

Year over year revenue has increased over 100%
Twitter

Yearly ad revenue = $479 million
Social Media Is Popular Among
Youth
Unhealthy Products Are Popular

Facebook Likes

YouTube Video
Views

McDonald’s = 56,749,632

Pepsi = 32,926,867


Coca Cola = 90,173,021


 Twitter
Followers

McDonald’s = 2,810,000
McDonald’s = 47,856,916

Pepsi = 2,850,000

Pepsi = 209,027,390

Coca Cola = 2,960,000
Budweiser = 11,994,036

Coca Cola = 578,622,358

Budweiser = 125,000
Heineken = 18,978,267

Budweiser = 153,253,464

Heineken = 120,000

Heineken = 49,028,824
Social Media Advertising Is Different

Advertising on social media is different than traditional advertising

Less irritating

Children cannot identify digital marketing as advertising

Messages resonate more

Appear to come from a trusted source rather than a corporation
Social Media Advertising Is Different
Social Media Advertising Is Different

Characteristics of social media affect our perceptions of social
media advertising

Emotions expressed in Facebook posts impact our emotions

Positive responses increase as user engagement increases

Popularity may be a function of user engagement numbers

User-generated comments influence our perception
Age-Gating Technology Doesn’t
Work

24% of all teens have lied
about their age to access
adult content

39% of African-American
teens
U.S. Marketing Regulations

Continuum of regulations
Food and Alcohol
No Regulations or
Self-Regulation
Prescription Drugs
Tobacco
Strict
Regulations
Tobacco


Fairness Doctrine

Required broadcasters to present both sides of
controversial topics

Applied to cigarettes in 1967 (upheld by federal
courts in 1969)

Gradual phase-out of cigarette ads on TV and
radio in 1969
Public Health Cigarette Smoking Act (1970)


Tobacco advertising on TV and radio has been
banned since 1971
Master Settlement Agreement (1998)

Ban on outdoor billboards, transit vehicles

Restrictions on sports marketing, event
sponsorships, promotional products
Tobacco

Family Smoking Prevention and Tobacco Control Act

Bans sales to minors, vending machine sales, sale of packages of fewer
than 20 cigarettes, all sponsorships of sports, entertainment, social,
cultural events, free giveaways of cigarettes or branded merchandise

Requires scientific evidence to use reduced harm claims like “light” or
“mild”

Bans characterizing flavors except menthol and tobacco

Gives FDA authority to regulate levels of nicotine and other ingredients
Loop-holes in Existing Tobacco
Regulations

Harm reduction descriptors are not always needed
Post
Pre
Loop-holes in Existing Tobacco
Regulations

Only applies to specifically identified products
Prescription Drugs

U.S. is one of the few countries to allow direct-toconsumer (DTC) advertising of prescription drugs

Product Claim Ads


The name of the drug (brand and generic)

At least one FDA-approved use for the drug

The most significant risks of the drug
Reminder Ads


Gives the name of a drug but not what a drug is used
for or risk information
Help-Seeking Advertisements

Describes a disease or condition but does not
recommend a specific drug
Prescription Drugs

Ads monitored by the Office of Prescription Drug Promotion

Enforcement actions taken regularly

10 in 2014; 4 in 2015

Can allow companies the opportunity to change promotional
materials or voluntarily discontinue them

Can also require companies to create a new campaign correcting
false or misleading information from a past campaign
Prescription Drugs
Food and Alcohol

Food and alcohol marketing is self-regulated

Each industry has created their own marketing guidelines


Monitoring and enforcement is performed by the industry
Completely voluntary
Food

Children's Food and Beverage Advertising Initiative

17 companies pledge to follow CFBAI guidelines

Exposure guidelines


Content guidelines


Audience will consist of no more than 35% of individuals under 12
Will not create advertising that is primarily directed to children under 12
Only applies to food that does not meet minimum nutrition
requirements
Food


Kunkel et al. (2015)

25% decline in food ads directed at children between 2007 & 2013

Still 24.5% of all advertising on children’s TV

80.5% of foods advertised to children on TV are unhealthy

30.2% of ads from companies that do not participate in self-regulation
Ustjanauskas et al. (2014)

3.4 billion food ads on population children’s websites

84% for high fat, sugar, and/or sodium products
Alcohol

Alcohol self-regulation is product specific


Beer, wine, and distilled spirits have unique alcohol marketing codes
Exposure guidelines

Communications only in media where the audience is ≥ 70% over 21


Content guidelines


Or benchmarked to the proportion of under 21 year olds
Don’t promote excessive consumption, avoid content that primarily appeals
to minors, don’t associate alcohol with health effects, don’t associate
alcohol with success
Applies to all alcoholic products advertised in all media

Excludes alcohol sellers, corporate messaging, or educational materials
Alcohol

Self-regulation fails to limit exposure to underage populations

33% of all TV impressions occurred during programming that violates
exposures guidelines in 2010

Exposure is increasing fastest in underage populations


Even as more ads are compliant with exposure guidelines
Most ads placed where underage audience is 15-30%
Alcohol

Content guidelines are frequently violated as well

Beer ads during the NCAA tournament (1998-2008)

Anheuser-Busch and SABMiller broadcast the most ads

Overall Violation rate = 62-74% depending on the code version

83% of A-B and 72% of SABMiller broadcasts contained 1 or more code
violations

Most common violations were associating drinking with social success
and content appealing to minors
Alcohol

2014 FIFA World Cup Tournament

42 unique alcohol ads shown during U.S.
broadcasts

ABC, ESPN, WatchESPN, Univision

Overall violation rate = 88.1%

Most common violations were presenting alcohol
has a stimulant or sedative and suggesting alcohol
can enhance physical or social success

40% of ads depicted an individual who looked like
they could be underage drinking alcohol
Alcohol

2014 FIFA World Cup Tournament

2.74 in-game alcohol brand logos per minute during the match

Occur at pitch side and on the fans
Alcohol

A complaint process exists for any ad you believe is non-compliant
with a marketing code

Highly biased


William Cunningham, PhD – Marketing professor at UT-Austin, published
against restrictions on marketing

Rory Davies – Producer for the Commission on Presidential Debates,
commission is sponsored by A-B

Paul Summers – Retired judge, previously ruled alcohol marketing
restrictions as unconstitutional
Highly ineffective
Take Away Messages

We are exposed to a lot of advertising for unhealthy products

Social media provides a potentially more powerful advertising
avenue than traditional media

Self-regulation is the predominant model for regulating how
products are marketing


Exceptions being tobacco and prescription drugs
Self-regulation does not work
Questions?