Youth Drinking. A Bachelor Thesis Investigating the Effectiveness of the Danish Non-statutory Alcohol Marketing System. Kristian Ploug Grut

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1 Youth Drinking A Bachelor Thesis Investigating the Effectiveness of the Danish Non-statutory Alcohol Marketing System. Kristian Ploug Grut Bachelor Thesis 3th of January 2014 Supervisor: Runa Midtvåge Global Nutrition & Health PH. Metropol. Student number: 230E10001 Number of characters:

2 Table of contents Table of contents TABLE OF CONTENTS... 1 ABSTRACT... 2 ABBREVIATIONS INTRODUCTION POLITICAL BACKGROUND STATE OF THE ART PROBLEM STATEMENT RESEARCH QUESTION DEFINITION OF KEY CONCEPTS THEORETICAL FRAMEWORK A PUBLIC HEALTH PERSPECTIVE AND WHO GUIDELINES THE DANISH MARKETING REGULATIONS AND HE NON-STATUTORY REGULATION PHILOSOPHY OF SCIENCE AND METHODOLOGY HERMENEUTICS ABDUCTIVE REASONING TEXT ANALYSIS STUDY DESIGN LITERATURE SEARCH QUALITATIVE INTERVIEWS TARGET GROUP AND DELIMITATIONS FINDINGS & ANALYSIS FINDINGS FROM LITERATURE REVIEW ALCOHOL ADVERTISING AND ITS EFFECT ON DANISH YOUTH INEFFECTIVE REGULATION NEW TYPES OF MARKETING THE DANISH NON-STATUTORY REGULATION DISCUSSION DANISH ACTIONS IN RELATION TO WHO STRATEGIES WAYS FORWARD CONCLUSION FUTURE PERSPECTIVES IN RELATION TO PUBLIC HEALTH BIBLIOGRAPHY APPENDICES...44 APPENDIX 1. WHO ETHICAL GUIDELINES, THE NON-STATUTORY GUIDELINES AND THE DANISH LEGISLATION APPENDIX 2. INTERVIEW GUIDE AND QUESTIONNAIRE APPENDIX 3. SELECTED STAKEHOLDERS FROM LITERATURE REVIEW APPENDIX 4. PICTURES OF ALCOHOL PROMOTION USED FOR INTERVIEWS APPENDIX 5. TRANSCRIPTION OF INTERVIEWS Page 1 of 112

3 Abstract Abstract The youth in Denmark has a history of drinking more alcohol than most other youth groups within the European Union (EU). Such extensive use of alcohol has documented consequences for the health and wellbeing as well as it has an economic impact on the Danish welfare state as such. Not much attention is given to how Danish legislation can sufficiently decrease exposure to alcohol marketing and thereby protect this group from the negative consequences of high alcohol consumption. This thesis investigates the effectiveness of the Danish non-statutory alcohol marketing system in relation to protecting the Danish youth from alcohol marketing. Through a combination of qualitative interviews and literature review the non-statutory alcohol marketing code and its effect on the youth are investigated in relation to an ethical set of guidelines provided by the World Health Organization (WHO). Findings from the literature indicate that the current alcohol commercials and marketing affect the youth and increase their willingness to drink and give them a more positive view on drinking in general. The thesis also shows that the Danish marketing prevention is focusing more on how to interpret the wording of the code rather than focusing on how the commercials affect the youth. Examples from the current Danish marketing campaigns show that there is room for improvements in order to fulfil the ethical guidelines as well as it highlights the importance of having transparent regulation that covers all types of marketing, and is easy to uphold and measure. Page 2 of 112

4 Abbreviations Abbreviations ABM AMMIE ESPAD EUCAM WHO Alcohol Branded Merchandise Alcohol Marketing Monitoring in Europe European School Survey Project on Alcohol and Other Drugs European Centre for Monitoring Alcohol Marketing World Health Organisation Page 3 of 112

5 1. Introduction 1. Introduction The first part of this chapter provides an introduction on the underlying health problems and political background which form the foundation of and motivation for this thesis. Subsequently, it introduces the research problem and question section and lastly describes the aim of the thesis and gives definitions of different key concepts. According to the World Health Organization (WHO) countries that take stronger actions on alcohol face considerable gains in terms of better population health and well-being, enhanced employment and productivity, increased health and social welfare savings, greater health and economic equality, and greater social cohesion and inclusion (WHO 2011 p.1). In Denmark alcohol as a single risk factor stands for 10% of the total burden of diseases (Sundhedsstyrelsen, 2006). It is a documented cancer-causing agent and contributes to at least 60 known diseases such as liver failure, high blood pressure, cardiovascular disease, gastrointestinal disease, anxiety and depression (ibid.). However, the Danish population and specifically the youth have one of the highest intakes of alcohol in the European Union (Hibell et al., 2011). Of the adult population 10.6% exceeds the National Board of Health s high-risk limit for alcohol consumption during a typical week, which is 21 units for males and 14 for women (Sundhedsstyrelsen, 2010). Additionally 24.3% of all Danes above 15 years exceeds the low risk limit set at seven and 14 units per week for women and men respectively (ibid.). Studies from The European School Survey Project on Alcohol and Other Drugs (ESPAD) indicate that there has been a tendency towards a reduced intake and a postpone alcohol debut within the youth population (Hibell et al., 2011). This trend can be attributed to a more strict legislation on alcohol sale; however, the Danish youth still has a higher consumption and drink more often than the youth in other parts of Europe (Ibid.). Of the years old 22% exceeds the high risk limit of alcohol intake, and 8.2% of this group wishes to reduce their alcohol consumption (Sundhedsstyrelsen, 2011). Moreover, alcohol does not only affect the youth directly when consumed, The National Board of Health estimates that 122,000 children between 0-18 years of age grow up in families with alcohol related problems, and a total of 632,000 people have been brought up in families with alcohol related problems (Sundhedsstyrelsen, 2008) 1. Despite these statistics and the growing amount of evidence from several sources which identify the increased morbidity and mortality associated with excessive use of alcohol, Denmark is still one of the only countries within the European Union that does not have a national 1 According to Statistics Denmark the total population was 5.6 million in [Accessed ] Page 4 of 112

6 1. Introduction action plan for reducing the consumption. At the same time The Danish Alcohol Marketing Committee 2, the agency which has the authority to decide whether the advertising guidelines are violated, only has the authorisation to give a reprimand, if a company violates the regulation in a particular situation (Alkoholreklamenævnet, 2011). This leaves little incentive for the companies to follow the guidelines. In addition to this alcohol marketing has moved from promotion on more traditional platforms such as television, radio, and printed media to a broader almost ubiquitous promotion, which also includes specialized online platforms such as social media. This merely amplifies the need for clearer guidelines as the report from The European Centre for Monitoring Alcohol Marketing also expresses the need for (EUCAM, 2009). Based on this the focus on alcohol commercials seems more relevant today than ever before. This is further underlined by the fact that regulation within the commercial policies is one of the most cost effective prevention mechanisms in relation to the before mentioned health problems caused by alcohol consumption only surpassed by increased taxation and restrictions in availability (WHO 2011). 1.1 Political Background In 1995 Denmark participated in the European Conference on Health, Society and Alcohol held in Paris. It was during this conference that Denmark along with the other members of the EU signed the European Charter on alcohol. The charter consists of five ethical principles and ten strategies for alcohol reducing actions, which main purpose is to reduce the alcohol related harms across the European region (WHO, 2006) 3.This charter laid the foundation for later publications from WHO. There are, however, major differences on how the different member states have used and implemented these strategies in their prevention policies. In Denmark the procedure towards alcohol promotion has gone through the nonstatutory regulation, which is a set of guidelines enforced by the Alcohol Marketing Committee (see chapter 4.2). In the recent years there has been an increasing interest in the effectiveness of self-regulatory organs such as the Danish Alcohol Marketing Committee. Critics argue that such organs are unable to make an unbiased decision due to the influence from the alcohol industry, which is permanently represented in the board in Denmark. Moreover, the committee has no real mandate to sanction and can only post critique of producers who do not comply with the guidelines on the board s website. In situations where the regulations are being continuously violated the committee can hand over the case to the consumer ombudsman 4, which is the organ handling marketing complaints in Denmark 5. 2 In Danish: Alkoholreklamenævnet 3 For more details see Theory chapter 2 4 In Danish: Forbrugerombudsmanden 5 For more information on The Danish marketing regulations see section 2.2 Page 5 of 112

7 1. Introduction 1.2 State of The Art In 2011 EUCAM published a report called the Seven Key Messages of the Alcohol Industry. This report uncovers how the alcohol industry attempts to influence alcohol policy globally, and which methods they use to prevent effective policies from being made (EUCAM, 2011). In relation to marketing and prevention the report states that the industry consider alcohol marketing as something that is not harmful, and which intends to assist the consumer in selecting a certain product or brand rather than increase sales. In regard to alcohol-related problems the industry argues that these can only be solved when all parties work together, and that education about responsible use is the best method to protect society from alcoholrelated problems (EUCAM 2011, p.9-12). Furthermore, the report finds that the industry is marginalising the harmful effects of alcohol by supporting the idea that consuming alcohol is normal, healthy, and part of a responsible way of living (EUCAM 2011, p.3-8.). Despite the massive amount of alcohol commercials present in all types of media today and the growing amount of international research within the topic, little research has been carried out on how commercials affect the Danish youth, which is problematic when taking their drinking habits into consideration. However, growing evidence indicates that not only content, but also the volume of commercials have an effect on youth 6. In 2009 the project Alcohol Marketing Monitoring in Europe (AMMIE) was carried out in five European countries (Bulgaria, Denmark, Germany, Italy and the Netherlands) with the overall aim to provide insight into the effectiveness of existing alcohol marketing regulations. In order to do so the AMMIE project had special focus on the opinion of young people about the attractiveness of alcohol advertising and the amount of alcohol advertisements the youth was exposed to (AMMIE 2012). The project covered the following topics in all countries: trends and innovations in alcohol marketing, volume of advertisement, sports sponsorship and the effectiveness of self-regulative content restrictions (ibid.). The AMMIE project monitored the underage youth s exposure to alcohol advertising on television by monitoring the top three TV channels watched the most by children aged in Denmark during a six month period between May-October 2010, it found that alcohol commercials were broadcasted within that period (AMMIE 2012), and that the total number of times a Danish minor was exposed to one of these commercials was approximately 10 million (ibid.). Regarding new trends in alcohol marketing, the report found that relative new media such as the Internet, social media, and various mobile phone services involve a great deal of alcohol marketing, and that this tendency expands rapidly (Jensen, 2010). Another new trend in marketing is a closer cooperation between alcohol producers and rock bands. Since 2010 the Danish beer producer Royal Unibrew has used famous Danish rock bands such as Kashmir and other 6 See findings from literature review, section 4.1 Page 6 of 112

8 1. Introduction upcoming bands on their website. The website facilitates an interactive forum for new upcoming bands with more than 600 bands subscribed (AMMIE 2012). The above mentioned examples give an indication of the massive exposure and how integrated alcohol marketing is becoming in a Danish context, which leads to the research problem of this thesis defined in the following section concerning Danish alcohol marketing. 1.3 Problem Statement This thesis investigates how alcohol commercials affect the intake of alcohol among the Danish youth. Furthermore, it analyses the effectiveness of the Danish political strategy towards limiting the exposure of alcohol commercials to the youth. The Framework for Alcohol Policy within the European Region (WHO, 1995) provides both practical and ethical guidelines for countries to follow in the European Union. These guidelines function as the theoretical framework and facilitate the analysis of to what extent the Guidelines for Marketing of Alcoholic Beverages from the Alcohol Marketing Committee take effect as intended, i.e. in order to protect persons under the age of 18 from unfavourable exposure of alcohol commercial. The aim of this research is to examine, interpret and understand how alcohol marketing affects the youth population in Denmark, and to evaluate if the present Danish marketing legislation and non-statutory measures are functioning as intended in order to prevent minors from alcohol targeted marketing. 1.4 Research Question In order to investigate the above mentioned problem statement this thesis asks: How do alcohol commercials affect the alcohol consumption patterns among the Danish youth, and to what extent is the current Danish alcohol policy and marketing legislation suitable for protecting Danish youth from unfavourable exposure? 1.5 Definition of Key Concepts Through this thesis several terms and expressions are being used and interpreted in a certain way, therefore a short definition of selected key concepts is provided here: Marketing and Promotion: According to The Free Dictionary marketing is generally understood as the process of communicating the value of a product or service for customers for the purpose of selling the product or service (The Free Dictionary 2013). Often this is done by information campaigns through channels such as radio and/or TV (ibid.). In a Danish marketing context of alcohol promotion sponsorships and branded merchandise are not considered a part of marketing and are therefore only treated by the marketing committee s non-statutory code if it is directed directly at minors (more information on the nonstatutory code below). However, when used in this thesis both marketing and promotion are considered as Page 7 of 112

9 1. Introduction effective strategies, which the industry uses to increase sales of alcohol. Thus the concepts are equally important to target in regard to protecting the youth. Co- and Self-regulatory organisations: In this thesis self-regulatory organisations are understood as an organization that exercises some degree of regulatory authority over an industry or profession. The regulatory authority could be applied in addition to some form of government regulation, or it could fill the vacuum of an absence of government oversight and regulation (The Free Dictionary 2013). Statutory regulation and Non-statutory regulation: Statutory regulation is understood as a written law passed by a legislature on the state or federal level. Statutory regulation set forth general propositions of law that courts apply to specific situations. A statutory regulation may forbid a certain act, direct a certain act, make a declaration, or set forth governmental mechanisms to aid society (The Free Dictionary 2013). On the contrary non-statutory regulation refers to a code or rule, which is not found in law and are being enforced by a self-regulatory organisation; in this case the Alcohol Marketing Committee. The alcohol industry: In this thesis the alcohol industry embraces economic operators which have a vested interest in producing and/or selling alcoholic beverages. Examples of these are producers, nightclubs, restaurants, and retailers. Page 8 of 112

10 2. Theoretical Framework 2. Theoretical Framework This assignment will use the ethical framework provided by the WHO to analyse the Danish alcohol marketing situation, since Denmark has signed the WHO charter and thereby agreed on taking active action towards limiting the harmful alcohol intake and the above mentioned negative health effects. The ethical principles can be seen as the overall goals, whereas the strategies are the means to get there and can be used in order to determine how a given country proceeds in achieving them. The rationale behind choosing this framework to analyse tendencies in a Danish context is that it has been commonly agreed upon by the politicians who signed it and due to the fact that this framework has formed precedent in terms of preventions in other countries. However, the non-statutory regulation is not legally binding, and therefore the Danish marketing legislation has also been included in order to compare differences and similarities between those two. 2.1 A Public Health Perspective and WHO guidelines In 1948 the WHO defined health as: A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 2013, p.1). The definition was adopted at the International Health Conference held in New York and has not been amended since. In this definition health is not only understood as the absence of illness or a diagnosed disease, but also as the overall well-being and people s possibilities to thrive. The definition contributed to a paradigm shift in health-related topics and is one of the cornerstones of WHO s further work including the European Charter on Alcohol. Page 9 of 112

11 2. Theoretical Framework The European Charter on Alcohol provided by WHO in 1995 states five ethical principles and ten strategies for alcohol actions aimed at minimizing the harmful alcohol intake. The ethical principles indicate that the absence of disease has been incorporated here as well; this becomes especially clear when looking at principle number five concerning the individual s right to be safeguarded from pressure to drink and be supported in its non-drinking behaviour. Listed below are the five ethical principles and the alcohol strategies from the WHO charter that are most relevant for this thesis since they pay special attention to alcohol promotion and youth. For a full list of all ten strategies see appendix 1. Principle 1. All people have the right to a family, community and working life protected from accidents, violence and other negative consequences of alcohol consumption. Principle 2. All people have the right to valid impartial information and education, starting early in life, on the consequences of alcohol consumption on health, the family and society. Principle 3. All children and adolescents have the right to grow up in an environment protected from the negative consequences of alcohol consumptions and, to the extent possible, from the promotion of alcoholic beverages. Principle 4. All people with hazardous or harmful alcohol consumption and members of their families have the right to accessible treatment and care. Principle 5. All people who do not wish to consume alcohol, or who cannot do so for health or other reasons, have the right to be safeguarded from pressures to drink and be supported in their nondrinking behaviour. (WHO, 1995) The following are the most relevant alcohol strategies for this thesis with focus on Danish youth and marketing: 1. Inform people of the consequences of alcohol consumption on health [ ] beginning in early childhood. 5. Implement strict control(s), recognising existing limitations or bans in some countries, on direct and indirect advertising of alcoholic beverages and ensure that no form of advertising is specifically addressed to young people, for instance, through the linking of alcohol to sports. Page 10 of 112

12 2. Theoretical Framework 7. Foster awareness of ethical and legal responsibility among those involved in the marketing or serving of alcoholic beverages. 9. Support non-governmental organisations and self-help movements that promote healthy lifestyles, specifically those aiming to prevent or reduce alcohol-related harm. 10. Formulate broad-based programmes in [European] Member States [ ], specify clear targets for and indicators of outcome; monitor progress; and ensure periodic updating of programmes based on evaluation. 2.2 The Danish Marketing Regulations and he Non-Statutory Regulation In Denmark there are one non-statutory regulation upheld by the Alcohol Marketing Committee, 7 and two statutory regulations which restrict the content of alcohol marketing (the Marketing Law and the Radio and TV Law). The most relevant set of Danish regulations for this thesis is the non-statutory regulation and the Marketing Law. 8 The Danish Marketing Law states that: Operators covered by this Act shall exercise good marketing practice with reference to consumers, traders and public interests (Danish Law on Marketing, 2005). Further, in relation to marketing targeted at children and adolescents the Act states that: According to Article 8, Marketing directed at children and adolescents should be designed with particular attention to children and young people's natural credulity, lack of experience and critical sense, which means that they are easily manipulated and easy to shape. (ibid.). And further in paragraph 2 Advertising aimed at children and young people must not directly or indirectly encourage to violence, use of drugs, including alcohol, or other dangerous or reckless behaviour or improper use of violence, fear or superstition (ibid.). In 2012 a third paragraph was added to Article 8, the paragraph states that Marketing directed at children and adolescents under the age of 18 must not contain, mention or include pictures of, or references to drugs, including alcohol. (Act on Marketing, 2005). The non-statutory regulation Below are stated selected guidelines from the non-statutory regulatory code formulated by the Alcohol Marketing Committee 9. 7 see more in section for more details on regulation see definition of key concepts section 1.5 and for full version of The Danish Marketing Law see appendix 1. 9 For full version of the non-statutory code see appendix 1 Page 11 of 112

13 2. Theoretical Framework It is within this legislative and ethical framework, including the prevention strategies, the Danish alcohol marketing situation will be analysed. The Ethical guidelines and prevention strategies will be used in order to describe the role of alcohol promotion within a political context, whereas the legislative framework will be incorporated in the analysis of the actual cases that has been tried out in self-regulatory Danish system to see if there is cohesion between the two. Article 1 Aim The Guidelines are intended to fill the legal standard of good marketing practices for alcoholic beverages according to the Danish Marketing Law. Paragraph 2: These guidelines are especially designed to protect children and young people. In addition, the guidelines aim to be generally protective of consumers. Article 4 Content of marketing Paragraph 4: Marketing may not use people whose opinion or appearance will be of particular importance because of the person's position or place in society. Further comments for this it that: People who have a particular position in society are understood as: politicians, sports stars, musicians, actors and the like. Paragraph 5: Marketing should not connect alcoholic beverages with active sports. Article 6 Children and Youth The marketing of alcoholic beverages cannot, no matter what form it takes, be directed at children and adolescents. Paragraph 2: Marketing should never use people because of their young appearance in that it gives the impression that young people drink alcoholic beverages. Paragraph 3: Models, actors, and the like, used in marketing should be and appear to be at least 25 years. Paragraph 4: Marketing should also never take place in the media, where over 30% of the audience is, or is reasonably believed to be children and adolescents. Page 12 of 112

14 2. Theoretical Framework In the following chapter the methodology and philosophy of science that form the foundation for this thesis are outlined. Page 13 of 112

15 3. Philosophy of Science and Methodology 3. Philosophy of Science and Methodology 3.1 Hermeneutics Hermeneutics is an analytical tool originated around the 15th century as an attempt to interpret the true meaning of biblical and ancient texts. Here the interpretation of a text was found by analysing it until a meaning was found without inner contradictions (Vallgårda & Koch, 2008). In order to understand the true meaning of a spiritual product or text, the analyser has to understand it in relation to the context it has been created, and to what it was an expression of. This relationship between text and context is called the hermeneutical circle (Vallgårda & Koch, 2008, p ). Within this traditional hermeneutical understanding the interpretative subject is outside the circle and interprets texts, contexts and relationships as an object (ibid.). In contrast Hans-Georg Gadamer s philosophical hermeneutic, which is what this thesis is based on, challenges this belief of separation between subject and object. Gadamer states that it is not possible to apply the ideal of objectivism known from natural science within a hermeneutical context, since we investigators are affected by our own set of prejudices and interpretations. This leads to a new hermeneutical circle (figure 1), which main purpose is to create universal conditions for understanding, where both the subject and object are an integrated part of the circle and cannot be separated (Gadamer in Vallgårda & Koch, 2008). Figure 1. The hermeneutic cycle. Within this new understanding the text is not only understood literally, also as where we point our attention towards. Therefore, it can be understood latterly as a written text, as well as an object, a cause, a picture or a person (Vallgårda & Koch, 2008, p.155). Within this context prejudices are not seen as something negative, and Gadamer states that even though a researcher was able to erase his prejudices, this would not be fruitful since, if he did, he would not know which research questions to ask. To Gadamer prejudices are a historical affected process, and history is at stake in all types of understanding (Gadamer, 1998). As an extension to this he introduced the concept of fusion of horizons: Page 14 of 112

16 3. Philosophy of Science and Methodology The horizon is the range of vision that includes everything that can be seen from a particular vantage point... A person who has no horizon is a man who does not see far enough and hence overvalues what is nearest to him. On the other hand, "to have a horizon" means not being limited to what is nearby, but to being able to see beyond it...[w]orking out of the hermeneutical situation means the achievement of the right horizon of inquiry for the questions evoked by the encounter with tradition (Gadamer, 1998, p.302). In this view horizons cannot be seen as something static and are continuously changing, just as the understanding of a specific topic of investigation. The way things are interpret today is different from how it is understood yesterday, and will continue changing due to changes in the lived world. Therefore, the interpreted texts will also change, along with the new understanding (Vallgårda & Koch, 2008, p.161). It is important to mention here that fusion of horizons does not necessarily include unity or agreement: it shall rather be seen as the ability to comprehend and understand what others communicate (Højberg, 2004, p. 328). The fusion of horizons is not about adopting another person prejudice or pre-understanding. Instead it is about challenging own beliefs, and through this process expanding the pre-understandings and thereby be able to see and understand the complexities and layers within the constant changes of the lived world (Højberg, 2004, p. 329). Figure 2 shows how all these new horizons affected my own horizon during the writing of this thesis. Figure 2. My different horizons as a researcher. Page 15 of 112

17 3. Philosophy of Science and Methodology As a researcher I am aware of my prejudices and bias and have tried to use it in a positive way in order to ask the right questions and to put myself in my interviewees place in order to gain a deeper understanding of the topic of investigation. One example of this is that I have adapted some of the interviewees arguments and used them in later interviews with other stakeholders, even though I did not agree with the argument in order to gain another and deeper insight into the topic. Even though I tried to cover everything in the interviews I conducted, I later discovered during the analysis of the interviews that I might have forgot to ask a question, that I should have rephrased or have asked some follow-up questions, which can be seen as an example on how the process of understanding is a continuously and on-going process and how the hermeneutical way of interpreting both can be used as an analytical and methodological tool. In figure 1 the process of understanding within hermeneutics are circular rather than linear; it has no bottom, top, beginning or end, no subject-object distinctions and is described as the hermeneutic cycle. It is proposed that the interpretation in human science takes place within this cycle in order to avoid possible loss of meaning (Højberg, 2004 p. 325). An example on how this concept can be applied to is my interviews. Here the interviewee s stories were not linear, and these stories moved between the whole of the subject that is a broad all-embracing discussion of, among others, prevention of exposure, effectiveness of legislation, global context, to a more specific part of a commercial, and understanding of this. So within the hermeneutic cycle the whole can be understood by studying the particular and the particular can be understood with reference to the whole. Philosophical hermeneutics is in this thesis drawn upon in order to reflect on my own approach towards investigating the research question and to analyze the current situation of alcohol consumption among youth in Denmark in regard to the cultural context. 3.2 Abductive Reasoning When working with qualitative data such as interviews a way of interpreting these data is through abductive reasoning. Abduction is in this assignment understood the way the social researcher Norman Blaikie describes it; as a retrieving of, or gaining insight into a contexts, founded on several observations that leads to a plausible explanation (Blaikie in Fuglsang & Olsen, 2004, p.463). In this thesis observations comes from interpreting current marketing campaigns as well as from the interviews, and the explanation is understood as several elements that lead to an understanding of a given event or situation. Thus, it is not a logical construction that excludes other ways of describing the situation; rather it is a way of explaining the situation with the information available. The sociologist Poul Bitsch Olsen explains it in this way: Page 16 of 112

18 3. Philosophy of Science and Methodology It is not a logical construction, which excludes other ways of explaining the course, but is on the other hand a construction that can be used to understand an incident with the information available, and which by provocation, stimulate the search for better ways to describe the explanation (Olsen in Fuglsang & Olsen, 2004, p.463) In this view abduction contributes with possible explanations that can either challenge or support the dominant understanding or paradigm due to its different explanations to a given phenomenon depending of the context. It is through this process that new knowledge is being created and it is therefore vital for new scientific progress. The method has in this thesis added new perspectives on how the Danish alcohol marketing regulation is being upheld, and has further led to a more nuanced picture of how the different stakeholders navigate within their field of interest and lastly contributed with more knowledge on the complexities within a Danish context. Although this thesis does not contribute with new theories within the field of social sciences, it contributes with in depth knowledge on the current situation. 3.3 Text Analysis According to Vallgårda and Koch text analysis can be used in health research projects as a method to characterise a written text and as a method to uncover unclear, contradictive or hidden meanings and correlations (Vallgårda & Koch, 2008, p ). This is especially useful in projects with focus on health behaviour, communication and compliance (ibid.). Besides being useful in qualitative studies, text analysis is useful when working with literature reviews of existing research in order to analyse content and to visualize other researchers norms and values of the topic of investigation (ibid.). In this thesis this method logical approach is applied to analyse the regulations, the interviews, the literature review and concrete examples of alcohol advertisements. 3.4 Study Design As the research question can be divided in two so will the structure of this thesis, the first part analyses how the commercials affect the Danish youth in regard to attitudes and consumption. The second part discusses what role the commercials have in the current Danish alcohol policy and to what extend the Danish legislation is suitable for protecting the youth. Finally, this thesis looks at future trends and ways forward in terms of reducing alcohol marketing with appeal to minors. For the first part a literature review will form the foundation of the analysis and give an insight into how the commercials affect the youth s norms and consumption patterns. The second part rely both on selected findings from the literature review and empirical data in form of qualitative interviews. These interviews will mainly focus on topics based on the individual interviewee s knowledge, although they will have the overall themes in common. Page 17 of 112

19 3. Philosophy of Science and Methodology The thesis answers the research question by focusing mainly on the situation in a Danish context. The Danish situation will, however, be analysed by looking both at what is being done within the EU and in a Danish context, since alcohol marketing has a border-crossing nature due to the free trade regulations within the European Union (EU), and further, due to the fact that other member states have applied other approaches when it comes to regulating alcohol marketing. In the discussion all findings will be combined and discussed in more details. The main advantage of the mixed methods, which this thesis relies on, is to gain a deeper understanding of the cultural and political aspects regarding alcohol use in Denmark. Founded in the multiple interpretations within the abductive reasoning, the qualitative interviews add insight into how the political and practical framework are working in present day legislation; an insight that cannot be covered by quantitative research alone. On the other hand, the quantitative data from the literature review provide a solid foundation for the interviews and insight into trends and tendencies in the current alcohol patterns among the youth as well as marketing strategies. Moreover, based on the public health interest within the field of my education as a Public Health Nutritionist, it is considered insufficient to rely solely on a single method. Therefore it is relevant to apply both methods in order to use and understand the results and grasp the full picture of the topic. 3.5 Literature Search The data collected from the literature review are primarily from quantitative studies, however, some qualitative studies such as the work by Jørgensen et al. (2006) has also been included in order to describe the situation within a Danish context and will be part of the foundation for the literature review as well. A broad variety of search strategies were used in order to keep abreast of the relevant existing literature in relation to the topic: Firstly, the following databases were searched: Pubmed, Web of Science, WHO, EUCAM and Google Scholar using a combination of relevant search terms such as: Alcohol, Alcohol culture, Alcohol politics, Policies, Danish, Youth, Commercials, Promotion, Prevention, Health. Secondly, Internet searches of reports, books, theses and the like was carried out. Thirdly, weekly searches and updates from selected journals and databases were done. Fourthly, newspapers and other media reports that referred to new national and international studies within my topic of interest. The search on Pubmed and Web of Science was carried out with a search on: Page 18 of 112

20 3. Philosophy of Science and Methodology Appendix 3 shows a table of the Danish AND Alcohol policy AND youth studies that met the inclusion criteria which were: studies that describe the Results: 9 & 4 characteristic of the youth s alcohol Alcohol AND commercials AND youth consumption and/or alcohol culture Results: 16 & 80 in Denmark in general, or had the Alcohol prevention AND youth AND Denmark explicit objective to determine the Results: 64 & 6 effect of alcohol promotion. Inclusion Alcohol AND promotion AND Prevention Denmark criteria were that the literature was written in English or Danish and no Results: 21 & 12 older than ten years of age. During the time of data collection for this thesis there was no longitudinal study carried out in a Danish context. However, since longitudinal studies are often the best choice when examining the effect of exposure to alcohol marketing and drinking behaviour in relation to young people, this type of study is included in the table even though they are not conducted in Denmark. A possible explanation for the limited amount of these studies could be due to their expensive, complex and resource demanding nature. 3.6 Qualitative Interviews According to psychologist Steinar Kvale qualitative interviews are particularly suited for studying people s understanding of the meanings in their lived world, describing their experiences and self-understanding, and clarifying and elaborating their own perspective on their lived world. (Kvale, 2007, p.45-46).therefore, this interview form are in line with the hermeneutical interpretation and will be employed in order to give a more nuanced picture of the complex topic. The interviews will then contribute with new perspectives, which otherwise would not have been included. Due to the complexities within the field of interest the interview guide for each qualitative interview has the overall themes in common, but is, however, adapted to the individual interviewee in order to get the optimal outcome of their knowledge within the topic. Due to this it is necessary to understand the interviewees prejudices and life worlds in order to fully interpret the meaning of the answers given, since these are not only based on facts alone but also on the subjective opinions of the interviewee. The structure of the interviews is semi-structured explorative interviews with follow-up questions and shift in focus when relevant. Possible risks when working with qualitative data collection are leading questions, misinterpretation of results and subjectivity. However, these biases will be taken into consideration in the discussion and will further be considered in the target group description below. Page 19 of 112

21 3. Philosophy of Science and Methodology Four interviews have been conducted; three as face-to-face interviews with a total of five interviewees, one from WHO and two from both the Danish Brewery Association and Alcohol & Society 10 and lastly an interview questionnaire was sent out on paper to Royal Unibrew. The decision to hand out the questionnaire to one of the stakeholders was based on the rationale that their opinion is important to include in the thesis, but due to the physical distance and the fact that they also wanted their law department to look at the questions before participating, a face-to-face interview was not possible. All the interviews were conducted in the period between seventh and 28 th of October A free version of the audio tool Express Scribe was used for the transcription that was conducted in Microsoft Word. All transcriptions were done in Danish and only citations used directly in the thesis were translated into English, for full length transcriptions see appendix 5. Before each interview a short briefing about purpose, theme and duration was send to the interviewees and informed consent was obtained from all interviewees prior to the interview. 3.7 Target Group and Delimitations This thesis investigates the current situation when it comes to alcohol marketing in a Danish context. Thus the target group chosen for data collection have been selected with focus on professionals who have knowledge within this specific field, either from their knowhow, educational background or through their position as representatives from the organisation they are employed in. The selection of interviewees has been conducted on the basis of their qualifications and various viewpoints in relation to alcohol marketing. Nevertheless, the strategy of including expert interviews cannot escape criticism, since the inclusion of some experts will leave to the exclusion of others, in this thesis for example politicians, the commercial industry, lawyers, or the consumers. However, the decision of who to include have been based on who it was possible to include, within the limited amount of time available and further on their willingness to participate in the interviews. WHO The first interview was conducted with a representative from WHO at the office in the UN-city in Copenhagen, with the interviewee Lars Møller. He is Programme Manager on Alcohol and Illicit Drugs in the Division of Non-communicable Diseases and Life-Course, and is working at the Regional Office for Europe where he represents 53 member states and works to reduce the harmful effects on alcohol and illegal drugs. He and his team has among other things counselled member states on how to implement the 10 action areas, which WHO has focus on in their report mentioned above(in the introduction). 10 See also Target Group section 3.7 Page 20 of 112

22 3. Philosophy of Science and Methodology Alcohol & Society The second interview was conducted with Alcohol & Society 11 at their office in Copenhagen where both the director of the organisation, Johan Damsgaard, and marketing responsible, Ina Johansen, participated in the interview. Both Johan and Ina have contributed to the country specific AMMIE reports, including the reports on: trends in alcohol marketing (Johansen, 2010b), complaints on alcohol marketing (Johansen, 2010a), and volume of youth exposure (Jensen, 2010).These reports combined form the foundation for the final AMMIE report (AMMIE 2012). The organisation works in close cooperation with other volunteer organisations such as Magasinet RUS and the Danish Alcohol Policy Network 12 which has its origin in the Danish temperance movement. Both organisations are located on the same premises as Alcohol & Society. The organisation s main purpose is to reduce the alcohol-related harm in Denmark by challenging the drinking culture and by creating more awareness on alcohol-related topics. At the same time Alcohol & Society is the organisation that files the main part of complaints to the Danish Alcohol Marketing Committee 13. According to their own statement they file about 90% of all the cases brought to the Committee. The Danish Brewery Association The third interview represented the Danish Brewery Association 14, which is a permanent member of the Danish Alcohol Marketing Committee and one is of the major Danish stakeholders in relation to alcohol promotion, it took place at their premises located in Copenhagen under the presence of director Nils Hald and chief of communication Per Sten Nilsen. According to the organisation s website their main purpose is to undertake and disseminate the beer and beverage industry s interests in relation to environment-, foodand health related topics 15. Royal Unibrew A questionnaire with the same themes as for the other interviews, although with other specific questions (see appendix 2), was sent to Morten Wilms, brand manager at Royal Unibrew, which answered the questions together with the law department of Royal Unibrew. The rationale behind choosing this specific 11 Danish: Alkohol & Samfund 12 Alkoholpolitisk Landsråd 13 It is under the Act on marketing that the Danish Alcohol Marketing Committee operates. The Committee which is a joint venture consist of three Ministries, different organizations from the alcohol industry, Trade organizations, The Consumer ombudsman and NGOs. The Consumers ombudsman and Brewers Association are permanent members. The marketing Committee designed a selfregulatory code that became effective in March 2000 (and revisited in 2010) where private persons, companies and organisations can file a complaint, which will be handled and a decision will, according the council s homepage, be reached within two-three months (Alkoholreklamenævnet, 2011, p.3-7). 14 Danish: Bryggeriforeningen 15 bryggeriforeningen.dk 2013 Page 21 of 112

23 3. Philosophy of Science and Methodology brewery over so many others is that Royal Unibrew is considered a proactive company that makes an active effort to follow the Non-statutory code. Furthermore, it is one of the companies that has been filed the fewest number of complaints against during the ten years the alcohol committee has been functioning. Besides these four interviews contact with the Danish Ministry of Health, The Danish Alcohol Marketing Committee and the consumer ombudsman was attempted. The Ministry did not respond to the request for an interview, and the consumer ombudsman did not have the resources to participate in an interview. They did, however, initiate contact by phone where they informed that they have the power to report a given company if they find that they violate the Danish Marketing Law (See section 2.2). They also told that they handle around marketing related cases annually, and further referred to the Danish constellation where it is the Danish Alcohol Marketing Committee that are the main responsible for handling alcoholrelated complaints. The President of the Danish Alcohol Marketing Committee, Ejvind Sandal, first agreed to participate in an interview, however, after receiving the briefing in advance he initiated contact with the Danish Brewery Association that participated in the interview on behalf of the committee. The only two stakeholders, besides Ejvind Sandal, that requested to see the specific questions beforehand, was Royal Unibrew, since they got the questions via mail, and The Danish Brewery Association. Page 22 of 112

24 4. Findings & Analysis 4. Findings & Analysis 4.1 Findings From Literature review Alcohol Consumption Patterns Among Danish Youth Regarding youth consumption of alcohol the report by the European School Survey Project on Alcohol and Other Drugs shows that there are significant differences between countries within the European region (Hibell et al., 2011). The proportion of students in Iceland who reported in 2011 that they had been engaged in a heavy episode drinking during the past 30 days was 13%. In Denmark it was four times higher, 56% (ibid.). Despite a small reduction in the overall intake the Danish youth still (on average) drink more than three times as much as the youth in Albania and Moldova, and regarding the frequency of alcohol use more than 75% of the Danish youth reported that they had consumed at least once during the past 30 days (ibid.). In comparison this was only seen in 17% of the cases in Iceland (ibid.). Jørgensen et al. found through their ethnographic field study that the Danish youth preferred drinking with known and trusted peers and that social factors such as exclusion from other peers were more important than increased health risk (Jørgensen et al., 2006). A study conducted by Stock and colleagues further showed that in contrast to other countries, socio-economic variables such as school district was not directly associated with early alcohol initiation; here the Danish welfare state was mentioned as a possible explanation for this (Stock et al., 2010). Instead, factors such as peer and parental alcohol drinking behaviour as well as low school performance and school enjoyment was identified as risk factors for Danish youth. Where it is more unclear, to what extend socio-economic variables affect the youth and how these differ between countries (ibid.), there seems to be a more clear correlation on the impact from alcohol marketing and the effect this has on the youth despite cultural differences. Marketing and Alcohol Promotion s Influence on the Youth The two-stage cohort study by Gordon et al. shows that several factors influenced the youth s drinking behaviours. The study found a relationship between early onset of drinking and having siblings who drink (adjusted OR = 1.97, P < 0.05 compared with having non-drinking siblings) (Gordon et al., 2010, p. 475). Other factors were involvement in and awareness of alcohol marketing, which led to an increased initiation to drink and increased drinking frequency. Among the 350 study participants who were non-drinkers at baseline 47% (n= 165) started drinking between baseline and follow-up. Logistic regression found that uptake of fortnightly drinking was more likely among those with a higher involvement in alcohol promotion for example having alcohol branded clothing or free merchandise than at baseline (adjusted OR = 1.43, P < 0.05) (ibid.). Furthermore, in relation to marketing of alcohol and how it affects the youth s perception towards drinking Chen and colleagues showed with their cross-sectional study that advertisement with Page 23 of 112

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