Zero Alcohol Products and Adolescents: A Tool for Harm Reduction or a Trojan Horse?

INTRODUCTION: Zero alcohol products (ZAPs) could reduce alcohol-related harms by acting as a substitute for alcoholic beverages. However, concerns have been raised regarding the potential for these products to expose young people to additional alcohol-related stimuli, further normalising alcohol use and acting as a gateway to underage alcohol consumption. Scarce research has examined whether these concerns are warranted. METHOD: This project comprised two parts involving Australian adolescents aged 15-17 years. Part 1 was a series of 5 online focus groups (n=44) that provided initial insights into perceptions of and experiences with ZAPs. Part 2 was a national online survey (n=679) that assessed the generalisability of the focus group findings and identified factors associated with ZAP-related attitudinal and behavioural outcomes. RESULTS: ZAPs were found to be salient and attractive to Australian adolescents. Over a third of surveyed adolescents (37%) had tried ZAPs. The focus group participants and survey respondents generally perceived ZAPs in a positive light, seeing them as a useful alternative to alcohol for both adolescents and adults who want to circumvent social expectations to use alcohol. Some of the study participants acknowledged the potential for ZAPs to serve as a gateway to alcohol use and recommended reducing their visibility and accessibility. CONCLUSION: ZAPs are likely exposing minors to additional alcohol-related stimuli potentially increasing their risk of underage alcohol consumption. Regulatory responses to ZAPS need to protect young people from the potential adverse consequences of ZAPs exposure while enabling the products to be used by adults as an alcohol substitute.

Falling through the cracks: How do policies for alcohol marketing apply to zero alcohol products in Australia?

ISSUES: There is a decline in youth drinking, but also a causal link between alcohol marketing and drinking among young people. Therefore, novel alcohol marketing strategies should be scrutinised, particularly where children are exposed. This includes marketing for zero-alcohol products (ZAP) (containing 0.00% to 1.15% alcohol by volume), which has expanded considerably in recent times. This review examines how the current industry-managed regulatory approach to alcohol marketing applies to ZAPs in Western Australia. APPROACH: The marketing mix (four Ps of marketing: product, promotion, place, price) was used as a framework to examine federal and state government policies and industry managed codes. Policies were included if they applied to marketing of alcohol products, for example, product labelling, promotion and advertising across various media, the place of purchase and pricing measures (taxation). KEY FINDINGS: ZAPs were inconsistently defined, meaning that products between 0.05% and 1.15% alcohol by volume were covered under some but not all alcohol policy measures, and application to products under 0.5% alcohol by volume was limited. IMPLICATIONS: Government policy should more clearly define alcohol marketing and whether ZAPs and other alcohol brand extensions should be treated in the same way as alcoholic products. CONCLUSION: In Western Australia, the ways in which alcohol policy measures apply to ZAPs are limited and close attention must be paid to how ZAPs may provide additional marketing opportunities for the alcohol industry.

The symbolic consumption processes associated with 'low-calorie' and 'low-sugar' alcohol products and Australian women.

The influence of commercial actors, practices and processes on the health and wellbeing of women is still not well understood. The alcohol industry has developed a range of products to appeal to new 'health conscious' markets, such as 'low-calorie' and 'low-sugar' products. While these products may have specific appeal for women, there has been little in-depth research that has sought to understand how women conceptualize these products and the range of symbolic meanings that women associate with these products. An online qualitatively led survey was conducted with n = 497 Australian women who had consumed alcohol in the last year. Questions related to the reasons for and influences on alcohol use, the purchasing of 'low-calorie' or 'low-sugar' products and the influence that these products might have on women's alcohol use. Data were interpreted using reflexive thematic analysis. Women consumed alcohol to relax, cope with everyday stressors and because of the alignment with social practices and social connection. Women perceived that these products provided a healthier alternative to traditional alcohol products and that they aligned with women's values relating to weight and the thin ideal. Some women were concerned that these products could increase alcohol consumption by reducing the perceptions of risk associated with alcohol. Policy consideration is needed to address how product claims and attributes may influence population groups' interpretations of the risks and benefits of these alcohol products, including the illusion that these products have protective potential and are better for overall health and wellbeing.

Evaluation outcomes of a Western Australian campaign designed to reduce alcohol use in pregnancy.

OBJECTIVE: To assess (i) the effectiveness of a mass media campaign communicating the potential harms associated with consuming even small amounts of alcohol in pregnancy and (ii) changes in females' intentions to abstain during pregnancy after campaign exposure. METHODS: Independent samples of ∼400 Western Australian adults (18-45 years) were recruited at two time points (before and after the 'One Drink' campaign) to complete online surveys. Attitudinal and behavioural intention outcomes were assessed at both time points. Descriptive analyses and generalised linear models were used to assess outcomes. RESULTS: Three-quarters (76%) of the post-campaign sample members reported awareness of the campaign. In the descriptive analyses there were significant improvements in three of the seven attitudinal items. The regression models yielded significant increases in agreement that pregnant women should not drink alcohol (assessed among females and males) and intentions to abstain during pregnancy (assessed among females only). CONCLUSIONS: The results indicate favourable understanding and behavioural intention effects from exposure to a campaign promoting alcohol abstinence during pregnancy. IMPLICATIONS FOR PUBLIC HEALTH: This study demonstrates that investment in campaigns warning about alcohol use in pregnancy is likely to be a worthwhile approach to reduce the burden of alcohol-related harms to individuals and society.

Evaluating an alcohol harm-reduction campaign advising drinkers of the alcohol-cancer link.

INTRODUCTION: Public awareness of the alcohol-cancer link is low. Provision of this information could reduce alcohol consumption and related harms. The Spread campaign is a multi-media education campaign implemented in Western Australia to inform people about the carcinogenic properties of alcohol and associated harms. The aims of the present study were to (i) examine attitudinal and behavioural outcomes of the Spread campaign and (ii) identify demographic and drinking status factors associated with enactment of harm-reduction behaviours resulting from exposure. METHOD: A cross sectional survey of Western Australian drinkers (consumed alcohol at least a few times in the previous 12 months, n = 760) examined campaign recognition, campaign perceptions, and behaviours resulting from campaign exposure. Chi-square analyses and a generalised linear model were used to identify demographic and alcohol-related factors associated with behavioural outcomes. RESULTS: Around two-thirds of respondents recognised the campaign (65%), and of these, 22% reported successfully reducing how often or how much they drank due to seeing the campaign. Three quarters (73%) of all respondents considered the campaign message about the alcohol-cancer link to be believable. Respondents drinking at levels above the Australian guideline were less likely to have positive perceptions of the campaign than those complying with the guideline, but were more likely to report enacting the assessed harm-reduction behaviours as a result of campaign exposure. DISCUSSION AND CONCLUSION: The results suggest that provision of information about the alcohol-cancer link has the potential to motivate reduced alcohol consumption. Implementing such campaigns could constitute an effective alcohol harm-reduction strategy.

Alcohol brands' use of age-restriction controls on Facebook and Instagram in Australia.

OBJECTIVES: Since 2017, the self-regulatory alcohol advertising system in Australia has required alcohol marketers to activate age-restriction controls on social networking sites to prevent access to children. With no monitoring mechanisms, the level of compliance with this requirement is unknown. We aimed to identify the extent to which the dominant alcohol companies in Australia have activated age-restriction controls on their official brand accounts on Facebook and Instagram. STUDY TYPE: Nonexperimental descriptive study. METHODS: We identified the brands owned by the top three beer, wine and spirit companies by market share in Australia, and located their official Facebook and Instagram accounts. International accounts were used when Australia-specific accounts did not exist. Two researchers independently attempted to access all accounts on a computer by entering the URL into a web browser that was not logged into either platform. We recorded the accessibility and audience size of each account. RESULTS: For the 195 alcohol brands that were available for sale in Australia through the nine top companies, we identified 153 Facebook accounts (84 Australian, 69 international) and 151 Instagram accounts (77 Australian, 74 international). We found 28% of Instagram and 5% of Facebook accounts did not have age-restriction controls activated. Similar proportions of Australian and international accounts on both platforms were not using controls. Only two companies were compliant across all of their accounts. CONCLUSIONS: Compliance with the industry marketing code requirement for age-restriction controls is inconsistent among the largest alcohol companies operating in Australia. The industry-managed regulatory system is not preventing children's access to alcohol content on social networking sites.

Health halo or genuine product development: Are better-for-you alcohol products actually healthier?

ISSUE ADDRESSED: Alcoholic products marketed as better-for-you is an emerging trend in Australia that has received limited research attention to date. This study aimed to examine the nutrient profiles of alcoholic products marketed as better-for-you that are available in the Australian market. METHODS: We extracted the details of alcoholic product announcements published on the Drinks Trade website in 2019 and 2020 containing at least one keyword used to promote better-for-you products. The alcohol, energy, carbohydrate and sugar content of each product was recorded and assessed against existing classifications for alcohol strength and sugar and carbohydrate content. RESULTS: We identified 144 products promoted as better-for-you. The majority of products (85%, n = 122) were classified as full-strength, and the median alcohol content across each alcohol product category was classified as full-strength. Most of the energy content came from alcohol, with 62% of products deriving at least 75% of their energy content from alcohol. CONCLUSIONS: Alcoholic products marketed as better-for-you appear to rely on an illusion of healthfulness, without addressing the ingredient of most concern to health, the alcohol content. SO WHAT?: Controls on alcohol marketing should be expanded to limit the use of health and nutrient claims. Mandatory labelling of alcoholic products with nutrition information would support consumers to be better informed about the contents of alcoholic products.

Are Australian regulatory codes adequate in scope to protect youth from alcohol advertising?

ISSUE ADDRESSED: Exposure to alcohol advertising has been found to be associated with more positive attitudes toward alcohol and heavier drinking among youth. Appropriate regulation of alcohol advertising is thus crucial for reducing use among members of this population group. To assist policy makers in their alcohol control efforts, this study explored the scope of Australian alcohol advertising codes and the extent to which they address issues relating to youth exposure. METHODS: Two researchers assessed 628 unique alcohol advertisements against youth-related provisions of the Alcohol Advertising Review Board (AARB) Code and Alcohol Beverages Advertising Code (ABAC). A third researcher resolved discrepancies. The ads sampled were those that had been the subject of formal complaints to the AARB. RESULTS: Most (94%) ads were assessed as violating at least one of the AARB Code provisions relating to youth, while 36% were found to violate at least one of the ABAC youth provisions. The most frequently violated AARB Code provision related to placement, with 88% of ads located in places or broadcast at times where young people were likely to be exposed. The most frequently violated ABAC provision related to appeal to minors (33%). CONCLUSIONS: Results indicate that self-regulation is an ineffective means of protecting youth from alcohol advertising, with the ABAC failing to capture many ads featuring content that appeals to youth. SO WHAT?: Greater efforts are required to protect youth from alcohol advertising. Findings from the present study reinforce calls for mandatory, evidence-based regulation that is administered independently of the alcohol industry. SUMMARY: An analysis of 628 unique alcohol advertisements found that the vast majority were in violation of the AARB Code's youth-related provisions whereas substantially fewer were in violation of the ABAC, supporting arguments that self-regulation is an ineffective means of protecting youth from alcohol advertising.

Alcohol industry arguments for putting profit before health in the midst of a pandemic: The Western Australian experience.

In an effort to limit the impact of alcohol on the Western Australian (WA) health system during the coronavirus disease (COVID-19) pandemic, the WA Government introduced temporary restrictions on takeaway alcohol purchases for several weeks in March and April 2020. In response, alcohol industry representatives encouraged the WA Government to remove the restrictions and replace them with a voluntary alcohol industry initiative. We looked at alcohol industry representatives' comments in media and online publications during this period. We found that the industry framed alcohol as an essential product, focused on the impact of the restrictions on WA businesses and framed the restrictions as complex and ineffective. The themes and arguments we identified are commonly used by the alcohol industry and are not unique to the pandemic. The alcohol industry's response to the COVID-19 restrictions in Australia provides a unique case study of how the alcohol industry attempts to interfere in public health policy.

Get Them Laughing to Get Them Drinking: An Analysis of Alcohol Advertising Themes Across Multiple Media in Australia.

OBJECTIVE: Efforts to develop and implement effective advertising regulations require a comprehensive understanding of alcohol promotion techniques used across a rapidly growing range of media platforms. The aim of this study was to analyze themes commonly used in alcohol ads in order to identify commonalities and differences by media type and the implications for existing regulatory frameworks. METHOD: In total, 628 Australian alcohol advertisements were coded according to media used for dissemination and themes known to be attractive to children and young people or problematic in other ways (humor, sport, mateship/friendship, manliness, value for money, buying in bulk, partying, sexual attraction, and adrenaline activities). RESULTS: The largest proportion of analyzed ads belonged to the out-of-home category (41%), followed by the online category (27%), indicating the importance of ensuring that these media are appropriately covered by regulations. Overall, humor was the most common theme (present in 18% of ads), followed by value for money (14%), sports (14%), and bulk purchases (10%). Humor often co-occurred with other themes: 59% of ads with a sexual attraction theme, 40% of ads depicting mateship/friendship, 31% of ads depicting manliness, and 27% of ads with a partying theme also featured humor. Trends were evident in the types of themes most commonly used in ads disseminated via specific media, indicating that alcohol marketers are strategically selecting media platforms for particular themes. CONCLUSIONS: The results of this study demonstrate that alcohol advertising controls need to cover all media, be clear in delineating inappropriate themes, and be adequately authorized to ensure compliance.

Alcohol advertisement characteristics that increase the likelihood of code breaches.

BACKGROUND: Exposure to alcohol advertising is associated with adverse outcomes among youth. Alcohol advertising codes attempt to ensure that alcohol promotion meets community standards, especially in relation to minimising the exposure of children and young people. The aim of the present study was to assess the characteristics of Australian alcohol advertisements that breach the Alcohol Advertising Review Board's (AARB) Code, with a particular focus on provisions relating to youth exposure. METHODS: The sample comprised 628 unique ads that were the subject of complaints to the AARB in its first five years of operation. The assessed characteristics were product type, company type, media type, and ad themes used. All ads were coded by two coders, with a third coder resolving any disagreements. RESULTS: On average, each of the assessed ads breached four AARB provisions, of which three breaches pertained to youth-related provisions. Across all categories, the proportion of youth-related provisions violated was significantly larger than the proportion of total provisions violated. CONCLUSION: Results suggest beer and spirits producers that use partying ad themes, engage in sponsorship arrangements, and use online advertising platforms should be a particular focus of alcohol advertising regulations.

Proliferation of 'healthy' alcohol products in Australia: implications for policy.

OBJECTIVES: The Australian alcohol industry has observed that increased health consciousness among consumers is a threat to industry revenue, but also an opportunity for innovation and growth within the sector. METHODS: This paper examines how the alcohol industry has responded to a perceived increase in health consciousness among consumers, considers policy implications and provides recommendations to address supposedly healthier alcohol products. We collected examples of new product developments and monitored alcohol industry publications for information on key trends and comments from alcohol company executives to inform the paper. RESULTS: We found that existing regulations do not appear to be sufficient to adequately restrict health-related claims made by alcohol marketers and producers, as alcohol products continue to be advertised in association with health. Research shows that this can have significant implications for the way consumers view these products. LESSONS LEARNT: Restrictions on health-related claims should form part of broader reforms to alcohol marketing that should include strong, independent, legislated controls.

Regulation of alcohol marketing in Australia: A critical review of the Alcohol Beverages Advertising Code Scheme's new Placement Rules.

INTRODUCTION AND AIMS: Rules concerning the placement of alcohol advertisements (Placement Rules) were added to the industry-managed Alcohol Beverages Advertising Code Scheme in November 2017. This study aimed to critically review the Placement Rules and evaluate their ability to effectively regulate the placement of alcohol marketing and provide safeguards for young people in Australia. DESIGN AND METHODS: An established framework for evaluating the design of an effective self-regulatory system was applied to the substantive content of the Placement Rules and associated regulatory processes. Publicly available documents, including recent Alcohol Beverages Advertising Code Scheme determinations, informed the review. RESULTS: The objectives and key terms of the Placement Rules are inadequately defined and narrow in scope, resulting in the dismissal of almost all relevant complaints. Weaknesses identified in the regulatory processes include limited representation from external stakeholders in the development of the Placement Rules, a lack of transparency and independence in the Scheme's administration, and limited monitoring and enforcement options. DISCUSSION AND CONCLUSIONS: The Placement Rules are unlikely to reduce young people's exposure to alcohol marketing and hence fail to meet public health objectives. This review adds to the body of literature that demonstrates that industry-managed systems fail to effectively regulate alcohol marketing. Government intervention is needed if young people's wellbeing is to be prioritised.