Exploring Industry Driven Marketing Influences on Young People who Drink Alcohol Stephanie O ...

428 Pages·2012·5.69 MB·English

Exploring Industry Driven Marketing Influences on
Young People who Drink Alcohol

Stephanie O’Neil

Thesis submitted in partial fulfillment for the
qualification of Doctor of Philosophy

Institute of Health and Society, Faculty of Medical
Sciences

Newcastle University

October 2012
Table of Contents
Table of Contents ...................................................................................................................... ii
List of Figures ........................................................................................................................... vi
List of Tables ............................................................................................................................ vi
Abstract ................................................................................................................................. viii
Acknowledgements .................................................................................................................. xi
Abbreviations .......................................................................................................................... xii
Chapter 1: Introduction ...................................................................................................... 1
1.1. Background and area of study .................................................................................... 1
1.1.1. Young people and alcohol consumption ............................................................ 1
1.1.2. Psycho-Social, Structural and Environmental Influences on Young People’s
Alcohol Consumption ....................................................................................................... 4
Parents ......................................................................................................................... 5
Siblings ......................................................................................................................... 9
Peers and Social Networks ...........................................................................................10
Socio-Economic Status (SES) ........................................................................................11
Religion, Ethnicity and Race .........................................................................................13
Gender ........................................................................................................................14
Price and Wider Marketing (industry-driven or otherwise) ..........................................15
1.1.3. Alcohol Policy and Young People ......................................................................19
Youth-specific UK Alcohol Policy ..................................................................................20
UK Policy on the Pricing and Wider Marketing of Alcohol.............................................21
Importance of UK Policy on the Pricing and Wider Marketing of Alcohol to Young
People .........................................................................................................................27
Current Recommendations and The New UK Alcohol Strategy – Signs of Change .........31
Comparing UK alcohol regulations to tobacco control ..................................................34
1.2. Rationale for the Current Study ............................................................................... 36
1.3. Aims and Objectives of the Research ....................................................................... 37
1.4. Overview of the thesis ............................................................................................. 37
Chapter 2: Structure and Agency in Young People’s Health Behaviours (Theoretical
Framework) 40
2.1. Overview of the Chapter .......................................................................................... 40
2.2. What is ‘Choice’? ..................................................................................................... 40
2.3. Structure and Agency in Young People’s Choices about Health Behaviour ................ 42
2.4. Combining Structure and Agency: Bourdieu’s ‘Habitus’ ............................................ 45
2.5. Capitalism and Consumerism ................................................................................... 48
2.6. Constructing ‘Political Economies of Health’ ............................................................ 49
2.7. Chapter Summary .................................................................................................... 51
Chapter 3: Study Design and Research Philosophy .............................................................52
3.1. Overview of the Chapter .......................................................................................... 52
3.2. Research Philosophy ................................................................................................ 52
3.2.1. Ontology and Epistemology..............................................................................53
3.2.2. Realism versus Relativism.................................................................................53
3.3. Critical Realism ........................................................................................................ 55
3.4. Chapter Summary .................................................................................................... 58
Chapter 4: The impact of industry-driven price and other marketing activities on the
drinking behaviour of young people: A systematic review of the primary literature.................60
4.1. Overview of the Chapter .......................................................................................... 60
4.2. Why conduct a systematic literature review? ........................................................... 60
4.3. Limitations of systematic reviews............................................................................. 61
4.4. Context for the current systematic review ............................................................... 62
4.5. Research question, aims and objectives of the review .............................................. 64
4.6. Research Process ..................................................................................................... 64
4.6.1. Assessing the Eligibility of Studies for Inclusion in the Review ..........................65
4.6.2. Searching and Identifying Literature .................................................................66
Electronic searches ......................................................................................................67
Search Terms ...............................................................................................................68
Screening of studies.....................................................................................................69
4.6.3. Quality appraisal and data extraction of included material ...............................69
4.6.4. Synthesis of findings .........................................................................................72
4.7. Narrative synthesis of findings ................................................................................. 73
4.7.1. Papers reporting the impact of alcohol ‘price’ ..................................................74
4.7.2. Papers reporting the impact of alcohol ‘product’ ..............................................82
4.7.3. Papers reporting the impact of alcohol ‘place’ ..................................................91
4.7.4. Papers reporting the impact of alcohol ‘promotion’ .......................................103
4.8. Limitations of the papers included in the review .................................................... 144
4.9. Key Conclusions and Implications for Policy and Practice ....................................... 147
4.9.1. Key Conclusions .............................................................................................147
4.9.2. Implications for policy and practice ................................................................149
Chapter 5: Qualitative Methods and Methodology ..........................................................151
5.1. Overview of the Chapter ........................................................................................ 151
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5.2. Why Qualitative Interviews? .................................................................................. 151
5.3. Research Process ................................................................................................... 153
5.3.1. In-depth Interviews ........................................................................................153
Data collection ..........................................................................................................153
Data analysis .............................................................................................................155
5.3.2. Sampling, Recruitment and Participants .........................................................156
5.4. The nature of conducting research with young people ........................................... 162
5.4.1. Ethical considerations ....................................................................................162
5.4.2. Further methodological issues of conducting research with young people .....168
5.5. Chapter Summary .................................................................................................. 169
Chapter 6: ‘Intoxigenic’ Environments - Extending Interpretations of Young People’s
Engagement with Alcohol Marketing (Qualitative Interview Findings) ...................................170
6.1. Overview of the Chapter ........................................................................................ 170
6.2. Young people’s engagement with price and other marketing techniques ............... 170
The ‘cost’ of alcohol and the role of ‘price’ ................................................................170
The Role of Wider Alcohol Marketing ........................................................................177
6.3. Young people as ‘sophisticated’ and ‘critical’ consumers........................................ 179
6.4. Personal Relationships: The ‘Fifth P’ in Alcohol Marketing ..................................... 181
6.5. Chapter Summary .................................................................................................. 183
Chapter 7: Using Structure and Agency and Bourdieu’s ‘Habitus’ as a Framework for
Exploring Young People’s Alcohol Use (Qualitative Interview Findings)..................................185
7.1. Overview of the Chapter ........................................................................................ 185
7.2. ’Choosing To Drink’ ................................................................................................ 185
7.3. Alcohol Rules, Rituals and Patterns ........................................................................ 187
7.4. Social control, Sites of Consumption and Changing Drinking Behaviours ................ 193
7.5. Chapter Summary .................................................................................................. 196
Chapter 8: Q Methodology ..............................................................................................198
8.1. Overview of the Chapter ........................................................................................ 198
8.2. What is Q Methodology? ....................................................................................... 198
8.3. Key principles of Q methodology ........................................................................... 199
8.3.1. Epistemology and Ontology............................................................................199
8.3.2. Subjectivity and Self-Reference ......................................................................199
8.3.3. Operant Subjectivity .......................................................................................200
8.4. Research Process ................................................................................................... 201
8.4.1. The Concourse ...............................................................................................201
8.4.2. Selection of Statements (developing the Q set) ..............................................202
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8.4.3. Sampling and Participants (the P Set) .............................................................204
8.4.4. The Q Sort ......................................................................................................205
8.5. Analysis ................................................................................................................. 207
8.5.1. Data Entry ......................................................................................................208
8.5.2. Factor Analysis in Q methodology ..................................................................208
8.5.3. Factor Extraction and Rotation Techniques ....................................................211
Principle components analysis and varimax rotation ..................................................211
Centroid factor analysis and theoretical rotation .......................................................212
8.5.4. Interpretation and deciding on a number of factors .......................................213
8.6. Strengths of Q Methodology .................................................................................. 214
8.7. Criticisms of Q Methodology .................................................................................. 216
8.8. Why use Q? ........................................................................................................... 219
8.9. Chapter Summary .................................................................................................. 220
Chapter 9: The Q Study ...................................................................................................222
9.1. Overview of the Chapter ........................................................................................ 222
9.2. Research Question ................................................................................................. 222
9.3. The Q set ............................................................................................................... 222
9.4. The person sample................................................................................................. 224
9.5. Administering the Q sort ........................................................................................ 230
9.6. Analysis ................................................................................................................. 231
9.7. Findings: The Factors ............................................................................................. 233
9.7.1. Factor One: Autonomous, Mature and Active Choosers. ................................238
9.7.2. Factor Two: Freebies, Accessibility and Special Offers ....................................243
9.7.3. Factor Three: Pragmatic Hedonism… ..............................................................249
9.8. Discussion and Chapter Summary .......................................................................... 256
9.8.1. Items of consensus .........................................................................................257
9.8.2. Bipolarity .......................................................................................................260
9.8.3. Deciding on a final number of factors .............................................................264
9.9. Chapter Summary .................................................................................................. 266
Chapter 10: Discussion and Conclusions ............................................................................267
10.1. Overview of the Chapter .................................................................................... 267
10.2. Summary and Interpretation of Key Findings ...................................................... 267
10.2.1. Price ...............................................................................................................267
10.2.2. Engagement with Wider Marketing Techniques .............................................270
10.2.3. Choosing to Drink and the Wider Alcohol ‘Habitus’ ........................................272
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10.3. Limitations of the Study ..................................................................................... 275
10.4. Contributions of the Study ................................................................................. 280
Theoretical Contributions ..........................................................................................280
Methodological Contributions ...................................................................................281
Practice and Policy Level Contribution .......................................................................282
10.5. Areas of Future Research ................................................................................... 284
10.6. Concluding Remarks ........................................................................................... 285
References ............................................................................................................................290
Appendices ...........................................................................................................................325

List of Figures

Figure 4.1: Flow chart of study selection process (based on PRISMA statement) .....................71
Figure 4.2: Breakdown of papers (by marketing element) included in the review ....................74
Figure 8.1: Q Sort Response Grid ...........................................................................................206
Figure 9.1: Factor array for Factor One ..................................................................................239
Figure 9.2:Factor Array for Factor Two ..................................................................................244
Figure 9.3: Factor Array for Factor Three ...............................................................................250
Figure 9.4: Individual Q Sort for Participant 32 ......................................................................261
Figure 9.5: Individual Q Sort for Participant 39 ......................................................................261

List of Tables

Table 3.1: Methodological strategy of the research .................................................................58
Table 4.1: Systematic Review Inclusion and Exclusion Criteria .................................................66
Table 4.2: Studies reporting the impact of ‘price’ on young people’s drinking behaviour .........78
Table 4.3: Studies reporting the impact of ‘product’ on young people’s drinking behaviour ....85
Table 4.4: Studies reporting the impact of ‘place’ on young people’s drinking behaviour ........95
Table 4.5: Studies reporting the impact of ‘promotion’ on young people’s drinking behaviour
.............................................................................................................................................112
Table 5.1: Characteristics of Qualitative Interview Participants ..............................................161
Table 7.1: Differences in young people’s narratives in relation to sites of discipline and sites of
control ..................................................................................................................................194
Table 8.1: Glossary of Q factor analysis terms used ...............................................................209
Table 9.1: Age and Gender Breakdown of Q Study Participants .............................................226
Table 9.2: Summary of characteristics of Q study participants ...............................................227
Table 9.3: Q study characteristics by individual participants ..................................................228
Table 9.4: Factor matrix with an X indicating a defining sort ..................................................234
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Table 9.5: Factor arrays, factor scores listed by statement ....................................................237
Table 9.6: Factor Three and Hedonism: words and phrases grouped together in the positive
pole of the factor array. ........................................................................................................251
Table 9.7: Factor Three and Purpose: words and phrases grouped together in the positive pole
of the factor array. ................................................................................................................252
Table 9.8: Consensus statements which specifically relate to alcopops. .................................258

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Abstract

Background: While the overall proportion of young people who report drinking alcohol
in the UK appears to have decreased over the past fifteen years, those who do drink
are consuming in larger quantities, and drinking more frequently. An association
between industry-driven alcohol marketing and young people’s drinking behaviour has
been demonstrated in a number of cross-sectional, longitudinal and qualitative
studies, but less is known about how young people are affected by alcohol marketing
and how marketing processes knit with other widely studied influences on young
people’s drinking behaviour. This study aimed to investigate the influence of industry-
driven alcohol marketing processes (price, promotion, product branding and placing)
on young people’s drinking choices and behaviour.
Methods: A mixed-methods approach underpinned by a critical realist perspective was
adopted. A systematic review examined empirical studies concerning the impact of
industry-driven price and other marketing techniques on young people’s drinking
behaviour. Qualitative interviews were conducted with young people aged 14-17 from
NE England (n=31) to explore accounts of when, why, where and how they drink
alcohol. Q methodology was used to derive ‘factors’ underlying alcohol choices, based
on the results of a card sorting procedure undertaken with young people aged 14-17
from NE England (n=28).
Findings: The systematic review identified 32 papers which were predominantly cross-
sectional in design, and focused on the impact of alcohol promotion on young people’s
alcohol use. Although industry-driven alcohol marketing appeared to influence young
people’s drinking behaviour, studies reported on a variety of populations, study
designs, exposure measures and outcome measures, making synthesis and
extrapolation difficult, as well as underlining a shortage of longitudinal work
establishing the effect of alcohol marketing over time. The review highlighted a paucity
of studies conducted in the UK as well as a lack of research examining the influence of
price for those under the legal drinking age only and exploring the impact of digital or
social media marketing on young people’s drinking behaviour. Young people
interviewed in the qualitative study appeared to make micro-level choices about
alcohol (between products and brands), positioning themselves as autonomous agents
and unaffected by overt forms of alcohol marketing. However, the majority of
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participants were able to recount brands and slogans, did not recognise less visible
aspects of promotion (e.g. sponsorship, viral and digital marketing) and did not
associate the pricing of alcohol as a form of marketing. Therefore, advertising and
other promotional activity seemed to play a role in building recognisable imagery
linked to alcohol products, as well as associations and expectancies related to drinking.
The advisability of drinking per se did not appear to have been questioned by
participants and was considered an acceptable and normal practice. Participants
reported that they were not exclusively price-led and choices were made in
conjunction with other criteria (e.g. taste, availability, strength and image). Q factor
analysis revealed three accounts: Factor one illustrates a sense of individuality,
autonomy, and maturity in alcohol choices; factor two is price-led, choosing to drink
whatever is most accessible, cheapest or on special offer; and factor three is an
account of bounded adventure, pleasure and hedonism.
Conclusions: Bourdieu’s concept of ‘habitus’ is drawn on to illustrate that young
people’s alcohol choices are influenced by structural predispositions (including
industry processes and alcohol marketing) but that ‘taste’, social norms and inter-
personal relationships (recognised as agency) can also play a role in reinforcing,
normalising and driving behaviour. Deeply embedded social norms and industry
processes culminate in ‘political economies of health’ where health behaviours are
governed by historical traditions and the logic of advanced capitalism (the need to
make a profit), and choices constrained into seemingly free, naturalised directions.
Thus, a description of young people as individual, rational agents, who can make the
‘correct’ choices about alcohol use, minimises structural and cultural factors that are,
in part, shaped by the alcohol industry in conjunction with other influences such as
inter-personal relationships and social norms, and which constrain health choices and
behaviours of young people. Public Responsibility Deals and voluntary self-regulation
of alcohol marketing may be inadequate to counter this. Instead, it needs to be
identified that young people are being subtly bombarded and further work is required
to ‘unravel’ this impact. Nevertheless, tighter restrictions on the marketing of alcohol,
such as a policy resembling France’s Loi Evin should be given consideration. The
current alcohol strategy for England and Wales includes a commitment to
implementing an alcohol minimum unit price. However, findings from this doctoral
work demonstrate that it is difficult to disentangle the four elements of the marketing
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mix. Price encompasses just one facet of alcohol marketing and makes up only a small
part of the external world in which young people are becoming acculturated. The
effect that price changes alone could have on young people’s alcohol use should not
be overemphasised. Thus, as well as examining the impact of price on young people’s
drinking behaviour pre and post legislative change, further work should also explore
the changing nature of industry-driven alcohol marketing processes. In particular, the
influence of digital and social media marketing on young people’s drinking behaviour
needs to be examined further, as well as the combined contribution that alcohol
marketing, long-standing social norms and inter-personal relationships (‘the alcohol
habitus’) all can make towards a ubiquitous culture of alcohol consumption.

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