Abstract
Alcohol is the most widely used psychoactive drug (Crocq, 2003; Global Drug Survey, 2018), responsible for approximately 3.3 million deaths each year (World Health Organization, 2014), and a large global burden of disease, injury, and economic cost (Rehm, Mathers, et al., 2009; World Health Organization, 2015). The global pervasiveness of alcohol consumption is partly fuelled by extensive alcohol marketing efforts that occur in the absence of effective communication about alcohol-related harms. Given the fact that the alcohol industry marketing practices are beverage-specific, and that alcohol is sold and consumed in the form of beer, wine, spirits, and mixed drinks, there is a need for beverage-specific counter-marketing campaigns (mass media anti-alcohol campaigns and alcohol warning labels) to help balance the effects of beverage-specific pro-alcohol marketing messages. Existing alcohol counter-marketing campaigns are scarce and limited in scope. These campaigns have increased consumer awareness and knowledge of the health risks (Andrews, 1995; MacKinnon, Nohre, Pentz, & Stacy, 2000; Wilkinson & Room, 2009), but have not changed drinking behaviour (Anderson, Chisholm, & Fuhr, 2009; Greenfield, Graves, & Kaskutas, 1993; MacKinnon & Nohre, 2006; MacKinnon et al., 2000; Scholes-Balog, Heerde, & Hemphill, 2012; Stockley, 2001; Wakefield, Loken, & Hornik, 2010; Wilkinson & Room, 2009). Conversely, tobacco counter-marketing campaigns have increased public knowledge about tobacco's harmful effects, and decreased smoking prevalence (Azagba & Sharaf, 2013; Farrelly, Davis, Haviland, Messeri, & Healton, 2005; Hammond, Fong, McNeill, Borland, & Cummings, 2006; Kennedy et al., 2012; Wakefield et al., 2010). Lessons from the tobacco experience suggest the need to: (a) identify the full range of alcohol-related harms, including the unquantifiable ones, and (b) conduct formative research to more clearly understand the target audiences of counter-marketing campaigns. This thesis addressed these research needs through three separate research studies.
Study 1 (Chapter 2) argues that lessons from the tobacco experience suggest that alcohol counter-marketing campaigns that communicate the full range of harms may be more effective than the currently existing ones. The current lack of focus on the full range of alcohol-related harms is possibly due to the absence of a comprehensive study examining the full range of harms. Previous reviews are mainly systematic reviews that were aimed at quantifying the harms associated with alcohol use. Consequently, the harms that could not be quantified were generally ignored. Since previous systematic reviews do not provide a clear picture of the full range of harms, and are insufficient from a health communication perspective, there arose a need for conducting an integrative review to address the existing limitations in the literature. This chapter found that alcohol consumption is associated with a wide range of specific harms that were categorised into six broad harm themes, namely, chronic health effects of alcohol consumption that manifest internally, chronic health effects of alcohol consumption that manifest externally, acute problems of alcohol use that affect the drinker, social and financial harms experienced by the drinker, harms caused to others due to the drinker’s alcohol consumption, and alcohol-attributable costs. Moreover, the present review identified specific harm subjects within almost all broad harm themes that were generally ignored in past reviews. Overall, the findings offer insights into a much richer range of harms caused by alcohol consumption, and suggest that the reality of adverse health and social effects of alcohol consumption far exceeds what has been previously quantified in past reviews.
Chapter 3 (Study 2) argues that there is a lack of detailed knowledge on beverage consumer group characteristics, which is crucial for the development of targeted messages. To generate much-needed insights into beverage consumer group characteristics, this study segments a nationally representative sample of drinkers from New Zealand into beverage consumer groups, and examines their: (a) demographic characteristics, (b) psychographic characteristics (the Big Five personality traits and ten universal human values), (c) drinking behaviours exhibited on peak drinking occasions, and (d) alcohol-related concerns that are top-of-mind. The results of this study highlight the unique characteristics of each beverage consumer group that may enable researchers and campaign planners to properly target the right audience with the right messages. For instance, the present study found that ready-to-drink (RTD) beverage drinkers are more likely to be young, single female students with a low income, who have completed high school or less. They attributed significantly more importance to Hedonism, Stimulation, and Power than other beverage consumer groups, indicating that they are likely to be more self-indulgent, thrill-seeking, and dominant, respectively, than the other groups (Schwartz, 1992). They engage in low-risk and risky drinking on peak drinking occasions, and are mainly concerned about acute problems and harms caused to others.
Apart from being informed by knowledge generated through audience segmentation and profiling, tobacco counter-marketing campaigns are also informed by insights into people’s perceptions of threat and efficacy. More specifically, the fear appeal theory is generally used for developing the message content of tobacco counter-marketing campaigns, which suggests that alcohol counter-marketing campaigns that are based on the principles of the fear appeal theory are likely to be more effective than existing efforts. Consequently, Chapter 4 (Study 3) measures the current perceptions of threat and efficacy exhibited by beverage consumer groups for each major alcohol-related harm type (established in Chapter 2); estimates the strength of these current perceptions; and uses these strength estimates to determine separate categories of message arguments aimed at producing high levels of threat and efficacy. This study determined the current perceptions of threat and efficacy exhibited by beverage consumer groups for 33 alcohol-related harm types. Estimates of the strength of these current perceptions revealed eleven separate categories of message arguments aimed at producing high levels of threat and efficacy. Out of these eleven categories, six will conflict the least with current perceptions, and thus, will typically not create defensive responses among target audiences. These six categories apply to 19 different harm types, including unintentional injuries, hangovers, and regrettable social behaviours.
In sum, the present thesis: (a) provides a comprehensive integrative review of existing research on alcohol-attributable harms to capture the full magnitude of harms, including the unquantifiable ones; (b) focusses on audience segmentation and profiling to generate detailed insights into beverage consumer group characteristics, which is crucial for the development of targeted messages; and, (c) utilises principles of the fear appeal theory to determine eleven separate categories of message arguments aimed at producing high levels of threat and efficacy that cover the full range of harms. By doing so, the present thesis contributes to the literature surrounding alcohol counter-marketing campaigns and extends past research aimed at improving the effectiveness of these campaigns. The knowledge base generated by the three studies making up this thesis will inform future research and contribute to the development of beverage-specific counter-marketing campaigns that are required to balance the negative effects of beverage-specific alcohol marketing. Counter-marketing campaigns informed by the findings of the present thesis can not only fulfil the World Health Organization’s call to communicate the full magnitude and nature of the health, social, and economic problems associated with alcohol use, but also potentially reduce population alcohol consumption.