40
Social Marketing Research & Public Health Policy Linda Bauld
Social Marketing Research
& Public Health Policy
Linda Bauld
Outline
ISM at Stirling
Social marketing and public health
Case Studies:
Plain packaging of tobacco products
Alcohol strategy for the UK
Tobacco harm reduction
Current & Future priorities
Institute for Social Marketing
at Stirling Gerard Hastings
Martine Stead
Anne Marie Mackintosh
Douglas Eadie
Crawford Moodie
Niamh Fitzgerland
Lesley Sinclair
Fiona Dobbie
Kathryn Angus
Richard Purves
Aileen Paton
Carol Anne Greenan
Georgina Cairns
Mark Grindle
Marisa de Andrade
Allison Ford
Social marketing & public health
Social marketing aims to develop activities that
change or maintain people’s behaviour for the
benefit of individuals and society
Social marketing research has particular
relevance to public health as it provides a basis
for doing more than increasing awareness or
changing attitudes
It can help policy makers identify activities,
interventions or policies that have the potential
to improve health.
Public Health & NCDs
Causative risk factors
Tobacco
use
Unhealth
y diets
Physical
inactivity
Harmful
use of
alcohol
No
n-c
om
mu
nic
ab
le d
isea
ses
Heart
disease and
stroke
Diabetes
Cancer
Chronic lung
disease
Social marketing has
potentially important
current role to play in
helping governments
and societies meet the
challenge of non-
communicable diseases
(a global priority)
Plain packaging of tobacco
One in five adults in the
UK smoke
More than two thirds of
these smokers started
under the age of 18
Marketing has been key
to the uptake of smoking
and to maintaining the
appeal of tobacco
products
With the removal/restriction of many forms of tobacco
advertising and promotion, increased attention has been
paid to packaging as a marketing and communications
tool.
Articles 11 and 13 of the WHO Framework
Convention on Tobacco Control recommend
standardised tobacco packaging in order to:
1. reduce pack and product appeal;
2. increase the prominence of health warnings;
3. remove packaging elements that may mislead about
product harm
Plain packaging as a public health policy
2012 Review and Consultation
In 2011 the UK governments announced a joint public
consultation on the plain packaging of tobacco
products
A systematic review was commissioned by the
Department of Health in 2011 and completed by a
team led by ISM at Stirling
This built on a series of studies on tobacco marketing
over several decades
Consultation & Deliberation
The ISM-led review served as the basis for the
UK-wide consultation
Over 2,000 responses received
A series of delays followed
Scotland committed to the policy
Australia introduced it at the end of 2012
The UK government were unclear throughout
2012 and 2013
Updates & Chantler Review
Sept 2013: ISM conducted an update on new studies
published since original systematic review and
distributed it to key stakeholders
Nov 2013: Further review of plain packaging
announced, led by paediatrician Sir Cyril Chantler
Chantler Review
ISM researchers called to
give evidence and answer
questions January 2014
Original systematic review
was reviewed and re-
assessed
Chantler Review published
April 2014
Chantler Review Findings
There is very strong evidence that exposure to tobacco advertising and
promotion increases the likelihood of children taking up smoking. Industry documents
show that tobacco packaging has for decades been designed, in the light of market
research, with regard to what appeals to target groups. Branded cigarettes are ‘badge’
products, frequently on display, which therefore act as a “silent salesman.”
…it is not plausible that the effect of
branded packaging is only to encourage
brand swtiching amongst adult smokers,
and never to encourage non-smokers
from taking up smoking
…packages that are designed to appeal to a young
adult, also, albeit inadvertently, appeal to
children…once the are exposed to this packaging,
they are susceptible to its appeal whether it is
intended to target them or not.
I see the importance
of Stirling as being
the consistency of its
results on appeal,
salience and
perceptions of harm,
most notably that
standardised
packaging is less
appealing than
branded
packaging.
The “Stirling Review” constitutes the most extensive and
authoritative piece of work on the issue of standardised
packaging yet undertaken
…it is in my view highly likely that standardised packaging
would serve to reduce the rate of children taking up
smoking…I am persuaded that branded packaging plays an
important role in encouraging young people to smoke and in
consolidating the habit irrespective of the intentions of the
industry.
Alcohol & Health
0
100
200
300
400
500
600
Chan
ge fr
om b
asel
ine
(197
0 =
100)
liver disease circulatory disease ischaemic heart disease
cancer respiratory disease diabetes
Source: WHO, 2011
The UK now has one of the highest rates of liver disease in the developed world and much of
this is due to alcohol consumption that rose steadily over several decades.
Alcohol-related hospital admissions per 100,000
population in England 2002-2012
0
500
1000
1500
2000
2500
Alc
oh
ol-
rela
ted
ho
spit
al a
dm
issi
on
s p
er 1
00
,00
0
po
pu
lati
on
Source: ONS, 2013
Weekly drinking by 13-year-olds and 15-year-olds in
Great Britain, 2009/10
0%
5%
10%
15%
20%
25%
30%
35%
40%
Europe England Scotland Wales Europe England Scotland Wales
13-year-olds 15-year-olds
% w
ho
dri
nk
alco
ho
l at l
east
on
ce a
wee
k
boys girls
Source: WHO, 2011
Alcohol Strategy for the UK
‘Civil society’ response to
addressing alcohol harms
in the UK
Group established in
2011 by ISM in
partnership with the
Alcohol Health Alliance
and with the support of a
range of funders
Report published March
2013
Recommendations
30 Recommendations developed focusing on
the 4 ‘Ps’ of marketing - price, promotion, place,
product and also other policy areas
10 chosen as key recommendations
Positioned as a long term strategy for all parts of
the UK, with broad policy areas that have
international applicability.
Price
• A minimum unit price of 50p per unit of alcohol
should be introduced for all alcohol sales,
together with a mechanism to regularly review
and revise the price
• Tax on an alcohol product should be
proportionate to the volume of alcohol it
contains
Products and Packaging
• At least one third of every alcohol product label
should be given over to an evidence-based
health warning
• Every alcohol product label should describe the
product’s nutritional, calorie and alcohol content
Promotion
• A ban on alcohol sponsorship and restrictions
on alcohol advertising .
• Mass media health promotion campaigns to
reduce harm from alcohol.
Developing new options for smokers
Cutting down in England
Source: West, 2013, www.smokinginengland.info
0%
10%
20%
30%
40%
50%
60%
% o
f cig
are
ttes s
mokers
(3 m
onth
movin
g a
vera
ge)
Cutting down
Using NRT tocut down
Using ecigsto cut down
Tobacco harm reduction
Harm reduction options NICE guidance
• Stop smoking in one step then use licensed nicotine products,
possibly indefinitely.
• Cut down prior to quitting with or without the help of
licensed nicotine-containing products.
• Smoke less with or without the help of one or more
licensed nicotine-containing products.
• Temporarily abstain with or without the help of one or
more licensed nicotine-containing products.
NICE & Nicotine-containing products
The guidance states that:
There is reason to believe that lifetime use of
licensed nicotine-containing products will be
considerably less harmful than smoking
There is little direct evidence on the
effectiveness, quality and safety of nicotine-
containing products that are not regulated by the
MHRA. However, they are expected to be less harmful
than tobacco.
E-cigarettes/vapourisers
Key points following evidence
reviews conducted for the guidance
Cutting down ‘alone’ (without a nicotine
containing product) has few if any health
benefits (some reduced risk of tobacco related
cancers)
Cutting down with NRT may lead to cessation
Long term use of NRT is safe for most groups
E-cigarettes may operate like NRT in some
respects
Nicotine Use in England
Source: West et al, 2014 N=5,272 from Nov 2013
Nicotine use, including e-cigarettes, by never
smokers is negligible
Use by children?
Youth Uptake
Review published in May 2014
Identified 9 studies on use in
children. Difficult to compare due
to methods and questions asked.
One UK study
In the studies we reviewed, with
the exception of one Polish survey,
ever use was reported by fewer
than one in ten children and was
concentrated in young people who
smoke
What about the marketing?
Countries vary in the extent to
which they allow marketing
ISM conducted a systematic
audit and content analysis of
all marketing in the UK from
May 2012 to June 2013.
Included: traditional media reports,
press releases, web and trade press
publications, magazines, tobacco industry
periodicals, television adverts and social
media platforms
Marketing is extensive.
Concerns about it
need to be addressed
and some discussion
of the content as well
as reach is required
Countries need to
consider what -if any -
action to take.
Source: de Andrade M, Hastings G, Angus K, Dixon D and Purves R (2013). The Marketing of Electronic Cigarettes in the UK. Cancer Research UK:
London. http://www.cancerresearchuk.org/prod_consump/groups/cr_common/@nre/@pol/documents/generalcontent/cr_115991.pdf
E-cigarette marketing: useful ?
E-cigarette marketing:
still useful…?
Monitoring attitudes to
harm reduction
Source: Cheeseman, H (2014) Implementing the NICE guidance on tobacco harm reduction, ASH, London.
What about the tobacco industry? NicoventuresVoke inhaled nicotine
Cigarette smoking prevalence
Source: West et al, 2014 ENGLAND ONLY Base: All adults
Prevalence is declining faster than in
previous years since 2008
Queen’s Anniversary Prize
Stirling submitted ISM work on
‘protecting children from marketing’ to
the Queen’s Anniversary Prizes
This made particular reference to work
on plain tobacco packaging & alcohol
marketing (along with food marketing)
In Nov 2013 winners of Queen’s
Anniversary Prizes announced
Current & Future Priorities A social marketing perspective on public health
continues to make a distinctive contribution in
current work on:
The CMO’s revision of current drinking
guidelines
The introduction and implementation of the
EU’s Tobacco Products Directive
Digital alcohol marketing
Financial incentives for behaviour change
…and a range of other public health issues
