Regulations and legislation to limit advertising that may negatively influence the health behaviours of children and adolescents - current practice and evidence of effectiveness WHO Technical Meeting, Vancouver June 2007 Ross Gordon, Gerard Hastings & Laura McDermott Institute for Social Marketing: University of Stirling & The Open University ISM Institute for Social Marketing

structure 1.The Problem: Effect of food, tobacco & alcohol advertising on behaviour 2.Current regulations and effects 3.Potential Solutions 4. Conclusions

The Problem - Food advertising: Effect on Behaviour ISM Conducted a systematic review of the evidence of the extent, nature & effects of food promotion to children (Hastings et al 2003, 2006, McDermott et al 2004) Comprehensive, rigorous, transparent and replicable procedures Reports prepared for Safefood (Ireland), Food Standards Agency (UK) & the WHO. Review identified 63 studies on the extent & nature of food promotion to children & 70 on its effects

Does food promotion influence children’s: –nutritional knowledge? Yes –food preferences? Yes –purchasing and purchase-related behaviour (eg. ‘pester power’) Yes –consumption? Yes –diet and health-status? Yes If food promotion has an effect, what is the extent of this influence relative to other factors? ? Does food promotion affect total category sales, brand switching, or both? BOTH The Problem - Food advertising: Effect on Behaviour

Similar research in Australia also concluded that food advertising has an effect on children’s behaviour Therefore evidence base is well established.

The Problem - Tobacco advertising: Effect on Behaviour Clear evidence base of effect of tobacco advertising on children’s behaviour. Cross sectional survey in the BMJ found that teenagers were aware of and participated in tobacco marketing, & both awareness and participation were associated with smoking status (McFadyen et al 2001).

The Problem - Tobacco advertising: Effect on Behaviour Cochrane Systematic Review on the impact of tobacco advertising & promotion found that: “tobacco advertising and promotion increases the likelihood that adolescents will start to smoke” (Lovato et al 2003)

The Problem - Alcohol advertising: Effect on Behaviour Longitudinal studies in U.S have established a causal link between alcohol marketing and youth drinking. – Ellickson et al (2004) –Stacy et al (2004) –Snyder et al (2006)

The Problem - Alcohol advertising: Effect on Behaviour However there are gaps in the evidence base: –No longitudinal studies carried out in the UK –Few studies have looked at the impact of new media and viral marketing –No attempt has been made to examine the cumulative impact of alcohol marketing –No one has checked for any differential effect on gender and inequality

The Problem Evidence is there to show that the marketing of food, tobacco and alcohol has an effect on children’s behaviour Marketing not advertising: products, price and place as well as promotion Our task then is to make marketing healthier

Current regulations of food advertising Hawkes (2005) questioned the effectiveness of Self Regulatory Systems in their current form Called for time period restrictions, no branded promotional activity at schools, no targeting of certain products at children, restrictions on certain marketing practices used to target children (e.g viral marketing, product placement), restrictions on use of celebrities & cartoons

Current regulations of food advertising Self regulation with teeth required. Multi-stakeholder regulation with independent body concerned with public health guiding the process Otherwise statutory regulation will be required (Hawkes 2005)

Current regulations of food advertising Food advertising in the UK was self regulated under the Advertising Standards Authority (ASA). Ofcom the communications regulator in the UK recently announced a ban on TV junk food advertising to children under 16. Therefore in food advertising voluntary regulation alone has not worked. Move towards statutory regulations and ad bans.

Current regulations of food advertising Will take time & good quality research to assess the effectiveness of the ban. In Sweden food advertising to children under 12 is banned as part of a wider ban on advertising to children. However there has been no reduction in obesity rates in Sweden. Yet ban on advertising is only part of the solution for obesity

Current regulation of Tobacco Advertising Reg campaign in the UK Paper in BMJ (Hastings et al 1994) found campaign was getting through to children more effectively than adults & held most appeal for young smokers aged Advertising Standards Agency withdrew the campaign. However damage was already done. Indicated the co-regulatory system was not working.

Evidence based convinced the UK government to take action. A ban on tobacco promotion was introduced in the UK from February 2003 Prohibited tobacco marketing through print & broadcast media, billboards, the internet, direct mail, product placement, promotions, free gifts, coupons & sponsorship Current regulation of Tobacco Advertising

Evidence has emerged that suggests the UK ban has significantly reduced awareness of and exposure to pro-tobacco influences (Harris et al 2006) Reviews on the effectiveness of tobacco advertising bans have suggested they reduce tobacco consumption (World bank 1999, Saffer 2000) In Norway the introduction of a ban appeared to reduce the prevalence of young smokers, particularly females (Rimpela 1993)

Current regulation of Alcohol Advertising Largely self regulated in the UK Industry body the Portman Group employs a voluntary code of regulations Advertising on TV and in the Print media overseen by the Advertising Standards Agency Does it work? ISM has carried out research

Current regulation of Alcohol Advertising Interviews with practitioners & regulators: “I think the major change recently that will continue is much more experiential marketing” “What often happens in advertising is advertisers try to push the rules as much as they can because obviously that is how you get…racier ads and you get a bit of controversy now and then and that has never hurt any brand” “they're using more 'under-the-radar' tactics to target young people”

Current regulation of Alcohol Advertising Interviews with practitioners & regulators: “Brand marketers are accepting that we have got to move towards a day when – it will just have to be a different way of getting your messages across” “I think it is well accepted that this is how advertising has to be these days” “it is a realistic scenario to say that in five years time alcohol advertising will be banned…everyone has got to behave as an industry pretty impeccably to stop that process speeding up”

Current regulation of Alcohol Advertising So practitioners raise some doubts What about children? “Yeah I drink quite a bit. You want to get a wee buzz out of it. It feels good.” (Males, 13, C2DE, Drinkers) “For the tonic wine its £5.15 for a full bottle and for a half bottle, its £2.89 in my local shop.” (Female, 14, ABC1, Drinkers)

Current regulation of Alcohol Advertising “On the internet I get pop ups for alcohol, and if you go to the Rangers website, or Celtic then a Carling sign comes up.” (Females, 14, ABC1, Drinkers) “I prefer WKD to Bacardi Breezer. 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 WKD” (Females, 14, ABC1, Drinkers) “Smirnoff vodka is cool.” (Female, 13, C2DE, Drinkers)

Potential Solutions – Self Regulation - This is part of the solution - Can control inappropriate content - Involvement of industry and advertising trade bodies is therefore to be welcomed. - However the limitations of self regulation have to be recognised.

Potential Solutions – Self Regulation Can often lack teeth Does not limit the amount of ads Doesn’t deal with the other three P’s It is arguably not advertising that is the problem but what is advertised

Potential Solutions – Statutory Regulation Makes the regulatory environment clearer to everyone: industry, practitioners, regulator, public Can control the amount of ads However: can be costly to implement Needs to be well constructed to be effective. Can produce complexity and loss of flexibility

Potential Solutions – Ad bans Have been shown to have an effect on behaviour (Saffer 2000, 2002) One thing we no works, certainly in tobacco However viewed as draconian – a last resort Tobacco is different to food and alcohol Doesn’t do anything to promote responsible marketing or recognise the potential positives of marketing

Potential Solutions - Social Marketing Marketing can be used to encourage healthy behaviours: Social Marketing There is evidence that it works (McDermott et al 2005, Stead et al 2007) Social marketing also includes critical research on the effects of commercial marketing. Helps build the evidence base and inform regulation

Potential Solutions - Social Marketing In alcohol ISM is carrying out research to address Gaps in the evidence base: 1.Using a cohort design to investigate the impact of whole marketing mix used by UK alcohol industry 2.2 wave survey. Random sample of year olds (period when most young people start experimenting with alcohol) 3.Will assess for differences by levels of affluence and disadvantage, and by gender

Potential Solutions - Social Marketing Similar research has recently commenced in New Zealand. Findings from the research will inform practice in two ways: 1.Will help social marketing efforts, develop interventions 2.Will inform the debate surrounding the regulation of alcohol marketing

Conclusions There is a problem - Marketing has an effect on children’s behaviour with negative health effects. Regulation can work but only part of the solution. Need the right mix of voluntary, statutory regulation, outright ad bans. Consider the whole marketing mix including price and place, deploy social marketing. Multiple stakeholder involvement is needed and we need to realise that this is a long term, global problem; it will need a long term global solution