CHW: You have sometimes described yourself as a “reluctant activist.” What do you mean by that?
RP: I patterned the phrase after the novel and film “The Accidental Tourist.” In November 2001, my ex-wife pointed out to me a billboard for Captain Morgan rum that was across the street from an inner city high school in a multi-ethnic, multi-racial neighborhood in Syracuse. The high school has a low graduation rate – about 36% – and is located in one of the most impoverished neighborhoods in America (http://www.unitedway-cny.org/results/initfund/index.html). The Captain Morgan ad had a scantily-clad woman and the message and iconography of the ad was “Drink this and you’ll get her.” It just shouldn’t have been so close to a high school, it was directly across from the school, maybe 100 feet away.
I hadn’t been directly involved in fighting against something like that, but I believed somebody had to do something. I sent an e-mail to the Director of Public Affairs for the mayor at the time and I got a pleasant reply but there was no committment to do anything about it. At the time I was a temp worker for a New York State agency and my supervisor was a member of the Syracuse Onondaga Drug & Alcohol Abuse Commission. She suggested I talk to the Commission about it. I did and soon after the company removed the billboard. Apparently the contract was up anyway. But a few months later, that same billboard had beer advertisements on each side.
CHW: So what did you do then?
RP: I investigated and found out that the Outdoor Advertising Association of America, the primary billboard trade group, had a self-regulatory ethical code stating that they would not place billboards advertising products illegal for minors 500 feet from schools or churches. I also found out that the primary local billboard company was routinely violating this rule all around the city. So I documented the problem, going around to measure billboards with a measuring wheel and taking photos. Also, I read up on alcohol marketing practices and current industry marketing strategies, liquor industry attempts at “cultural normalization.” After documenting the problem, I went to a few local organizations to ask them to sign on to a request to have this company abide by this code. A big key for me was contacting people in other cities and getting their input. We called ourselves the Syracuse Partnership for Responsible Outdoor Advertising, based on a similar group in San Diego. They were very helpful. About a year later the Syracuse billboard company agreed to abide by the code and, with a couple of exceptions, it has abided by it ever since. By the way, it was exactly 7 years ago today that the company agreed to abide by this standard. It was personally rewarding to see that I could make a difference.
CHW: But you didn’t stop then, did you? What made you stick with this activism?
RP: Through research I had learned about the staggering impact that alcohol abuse and dependence has on our society – the impact on public health both mortality and morbidity and public safety. My experience with alcohol marketing showed me that the alcohol industry was a big contributor to those problems. And I also learned, with regard to alcohol, research shows that downstream, individual-level prevention is not that effective in the long-term. What does seem to work are broader environmental measures such as restrictions on pricing, availability and marketing. I decided to get involved more seriously so I founded a 501(c) (3) called the Alcohol Advertising Reform Initiative (AARI) that looked at environmental prevention of alcohol across the board. By the way, we’ve since changed the name to the Center for Alcohol Policy Solutions.
In addition, I was encouraged by contact I had had with national organizations working on the issue: the Center for Science in Public Interest, the Center on Alcohol Marketing and Youth, and the Marin Institute. I wouldn’t have continued to work on those issues without their help.
CHW: Can you talk a bit more about what that organization does?
RP: When AARI began, we focused primarily on alcohol advertising and marketing. For example, in the fall of 2003 we filed a formal complaint against a campaign for Goldschläger liquor, a so-called “shooter” liquor. Syracuse seems to be a big target for campaigns of this nature because of Syracuse University and some other colleges. The campaign was actually brought to my attention by friends of mine who are social drinkers and not at all involved in public health advocacy. They asked “Have you seen those Goldschläger billboards around town? Those models look awfully young.” I get a lot of my best information from those friends. So we sent a formal complaint to DISCUS, the Distilled Spirits Council of the United States, which is the industry council representing “producers and markets of America’s favorite brands of distilled spirits.”
CHW: So what happened?
RP: Diageo, the company that makes Goldschläger, is the world’s largest liquor company. DISCUS and Diageo seemed to formulate a very careful PR response, whereby the company was able to withdraw the campaign, kind of like a sports coach resigning before being fired. Their statement was along the lines of “Our Goldschläger ad doesn’t really violate anything but we’re going to take it down because we’re so intensely socially responsible.” However, after the campaign was supposed to have been terminated, I contacted people in other states and these ads still weren’t down, leading me to believe that part of the strategy for these companies is to placate local activists while continuing to run the campaign elsewhere, counting on a lack of communication. The crux of the matter is that there are no sanctions for violations, so the worst they’ll have to do is take the billboard down. Here’s a comparison: Let’s say I cheat on my taxes, I have to pay a penalty to the IRS. If the worst thing that could happen would be that someone would just have to pay what they owe anyway, then there would be a lot more tax cheats. That’s the fundamental flaw with the “self-regulatory” process.
CHW: What else did your group do?
RP: Thanks to Brad Finn of the Prevention Network in Syracuse, our nonprofit group got a small grant to get a laptop and buy some advertising data. Otherwise, I did everything as a volunteer. I did a lot of PowerPoint presentations and I would go wherever people would hear me. It was a personal passion for me, and so few people were really dealing with alcohol advertising in our area at the time. As a public health issue, alcohol often gets overlooked.
We also worked locally around awareness about alcohol advertising and violence against women. We modified a campaign from California called Dangerous Promises that the Berkley Media Studies Group worked on. [See Woodruff, K. Alcohol advertising and violence against women: A media advocacy case study. Health Education Quarterly, 1996 23(3):330-345, for more information]. I designed a presentation based on theirs and we looked at a Molson Canadian marketing campaign called the “Making Friends” campaign where they promote the beer as a facilitator of sexual activity. I connected with our local domestic violence shelter and rape crisis center, and their Executive Directors and I collaborated on a letter to the editor and tried to raise awareness. Promoting alcohol that way is extremely irresponsible considering that alcohol is the a date rape drug and it’s connected to so many health problems related to sexuality and sexually transmitted infections.
CHW: What do you think has been your biggest success since you started this advocacy work?
RP: That’s not an easy question, because most of the time prevention work has what Bernard Turnock has called an “invisible constituency.” To paraphrase him, there haven’t been a lot of state capitols who have seen candlelight demonstrations by people who have not been a victim of alcohol-related violence. But I’d say the forced withdrawal of the Goldschläger campaign was certainly our effort that got the most public attention. I’ve also been encouraged about some of the work we’re doing around GIS – Geographic Information Systems – in communities. My desire to push further in this work, from an avocation to a vocation, led me to pursue a Masters in Public Health (MPH) degree, which I just finished this past March. My MPH practicum project was looking at alcohol outlet density in the city of Syracuse using GIS. I did it to show the problems of alcohol density here and to suggest policy changes that would be beneficial to the community.
CHW: What did you find in that research?
RP: I found that some residential neighborhoods in Syracuse had unexpectedly high densities of alcohol outlets. The project was not designed to prove causation through sophisticated statistical analysis, but it did suggest that there was a relationship between the density of alcohol outlets and assault and DWI arrests. In some ways, that seems like a no-brainer.
CHW: Well a lot of the research that we do just shows common sense problems but you need it to push forward advocacy efforts, right?
RP: Exactly. The alcohol industry and their allies try very hard to frame those problems in a way that advances their economic interests. They try to cast doubt on even the most basic research. It’s similar to what the tobacco industry did with lung cancer, just trying to create enough of a doubt to freeze advocacy efforts and stop policy change.
Our GIS project has led to working with communities who are interested in using GIS as a tool to reduce alcohol problems. There are advocates in several counties in New York State who are at some stage of a GIS project—including Madison, Jefferson, St. Lawrence, Oneida, Cortland, and Franklin, among others.
CHW: Along those lines, how do you think researchers can contribute to more effective oversight of the alcohol industry?
RP: There’s a delicate balance there. A recent article by James Marks in Preventing Chronic Disease discusses the creative tension between advocacy and research. Researchers are careful to remain objective, while advocates sometimes don’t want to wait for the fifth confirming study, they want to forge ahead and improve health policy. Obviously, there are ethical standards for academic research. No matter how strong the results are, academic integrity requires careful wording and explicit acknowledgement of a study’s limitations. According to Thomas McGarity and Wendy Wagner, some researchers even avoid policy-relevant science because they dislike controversy and conflict. At the same time, Marks quotes Bill Foege as saying that public health is inherently activist. That connection between research and activism has to be reaffirmed.
Right now, in the alcohol field, there’s a good news/bad news situation. On the one hand, there has been a lot of solid, exciting research on alcohol and alcohol policy over the last several years. We have a much better understanding of what really works to reduce alcohol problems. On the other hand, there is a kind of advocacy deficit. There needs to be a lot more advocacy work, more additional energy and encouragement for advocacy, particularly as resources have been diverted from the alcohol field to other areas of public health and human services in recent years—and those resources were meager to begin with.
CHW: Could you talk about some of the strategies that the alcohol industry uses to promote youth drinking?
RP: Contrary to their claims that they have an interest in preventing underage drinking, the prime movers in the alcohol industry want youth consumption to be as high as reasonably possible. Currently, the underage market accounts for between 10 and 20% of consumption. [For more discussion, see The More Things Change: Examining Alcohol Industry Issues Management Strategies.] While alcohol companies claim they do not want those profits, if the industry lost between 10 and 20% of sales, they would be in dire straits. A friend of mine who’s an aerospace engineer pointed out to me that there have been airlines that have gone under because they lost 10% of their fares. So their current business model requires those youth sales. Moreover, they know that they have to cement brand identity fairly young. The prime example of a brand that has been successful at this is Budweiser, they’re very good at putting their logo everywhere. One of the ways they do that is through sport sponsorship and sports signage. Young men, especially, watch a lot of televised sporting events and thus are constantly exposed to those marketing messages. I would challenge anyone to turn on ESPN at any hour of the day—even in the morning—and see if a half-hour passes without seeing an advertisement or logo for a product from Anheuser-Busch InBev or MillerCoors. It’s no wonder that market research organizations and other studies have found disturbing levels of brand awareness for Budweiser, Bud Light, and among teenagers and even elementary school-aged children.
I also believe that their frequent use of animals in their advertisements—cute animals, funny animals—have a particular appeal to young people. The industry and their allies maintain, “Adults like them too.” Well, there are adults who like everything—after all, there are adults that collect Hello Kitty merchandise. The issue is whether or not the advertising has a disproportionate appeal to youth. Kids marketing guru Dan Acuff points out that children have a very special relationship with animals, with animals making up to 90% of the content of the dreams of young children.
If the alcohol industry genuinely worked to de-market to children and youth—keeping ad content limited to adult appeal and reducing media exposure to levels proposed by David Jernigan at CAMY—they could significantly reduce levels of underage drinking, I believe. But the question goes beyond acts of omission to those of commission – whether the marketing to youth been intentional. A lot of evidence seems to point to the fact that it has. For example, the youth appeal of the Captain Morgan brand seems to be too strong to be accidental. And it’s that lifestyle advertising—where you see attractive people having a great time without any hint of negative consequences—that propelled beer to its status and that the distilled spirits sector is working hard to emulate.
CHW: I was riding the subway in New York, and I saw the Remy Martin cognac ads showing all these attractive people connected by chains around their neck and the ad just says “Things are getting interesting” and kids are riding the subways.
RP: That’s a good example. It’s really inappropriate for public transportation systems to have alcohol advertising. The Marin Institute has done a great job of bringing attention to that issue. They had success in removing it from the Bay Area, and there’s been movement on the issue in Boston. Our elected officials in New York need to be made aware of the disconnect between making pronouncements about the evils of underage drinking and then turning around and exposing kids to Corona ads on their way to school. [See an earlier CHW report on a campaign to rid NYC subways of alcohol ads.]
CHW: That leads into my next question, how do you think alcohol advertising encourages irresponsible drinking patterns?
RP: Jean Kilbourne has done excellent analysis of that issue. She suggests that alcohol companies understand the minds of problem drinkers better than many treatment providers. For example, in some beer advertisements, the wife or partner is interested in some type of romantic activity and the man has no interest until she says his favorite brand of beer is available, and then, all of a sudden, he’s interested. These ads feed into an alcoholic mindset that sees the beverage as the be-all and end-all—where the drinker is literally willing to jump off a plane to get the Bud Light. Or sometimes the ads show people drinking in isolation, for stress relief. We have a series of ads for a regional beer called Saranac that show a beautiful bucolic scene on a lake with the text “Unwind.” That sounds perfectly innocent. Except when one considers that if somebody has to have that alcohol to unwind, they’re really advocating alcohol as stress reduction – which is problematic alcohol use. Does that mean everybody who has a beer to unwind is drinking in an irresponsible way? No, of course not. But when you bring it in as a deliberate advertising point you run the danger of promoting alcohol to relieve stress. I would call that irresponsible advertising. Another ad for a bourbon brand shows a scene from a saloon in the Old West with the tag line “When the bottle was the glass.” If we were to make a formal complaint, the company would likely claim that it’s a historical reference.
But if you gauged the actual perceptions of the people in the target psychographic who read that ad—as opposed to the claimed intentions of the alcohol company—they would perceive it as glorifying that kind of hypermasculine excess. “Drink this bourbon because it’s what hard drinkin’ menfolk drink! It will make you a latter-day cowboy!”
That is why the only accurate way to determine the impact of a marketing campaign is to determine the perceptions of the target market. Anyone can claim innocent intentions.
CHW: In your opinion, what is the top alcohol control issue that advocates like you should focus on in the coming year.
RP: I’ll talk about two different issues: an overarching national issue that reaches across the federal, state, and local levels, and a concern about New York State.
The national issue is that of alcohol taxes. George Hacker of the Center for Science in the Public Interest has rightly called increases in alcohol taxes the gold standard of evidenced-based alcohol control policy. The body of research shows that increasing alcohol taxes limits alcohol abuse, especially among young people who are particularly price-sensitive. Alex Wagenaar at the University of Florida has been a leader in assembling that evidence, and the book Paying The Tab: The Costs and Benefits of Alcohol Control by Philip J. Cook does an excellent job of presenting what he calls the “unique advantages” of alcohol taxes as an alcohol control measure.
When you combine all that evidence with state governments’ “revenue hunger” precipitated by the economic crisis, increased alcohol taxes should be on the top of the public policy agenda. But that hasn’t been the case.
CHW: Why is that?
RP: A lot of it is due to the influence of the alcohol industry. Earlier this year, there was a bill proposed in the House of Representatives to roll back the beer tax from what it’s been since 1991 (H.R. 836). Now, bear in mind, this is a tax that hasn’t been adjusted for inflation, so it’s already historically low—about one-fourth the value it was fifty years ago. Even so, 242 members of Congress signed on as co-sponsors of the beer tax rollback, which really shows the enormous power the alcohol industry has in Washington. [In 2008, according to Open Secrets, the beer, wine and liquor industries made political contributions totaling $14,122,519, the highest level since reporting began in 1990.]
CHW: You also mentioned a New York State concern?
RP: Yes, many of my colleagues – most notably my colleagues with the Council on Addictions of New York State (CANYS) – are concerned about recent attempts to deregulate our state alcohol control system. There have been several bills proposed in our state legislature that appear to have been written by alcohol industry lobbyists. One bill (A08026) actually proposes that wine be excluded from the state sales tax on wine, arguing that because current guidelines exclude products that are over 70% fruit juice, and is a “beverage made wholly from fruit juice.” It would be laughable if it were not for the fact that an elected official actually. Another bill (S6184) seeks to shift the mission of the New York State Alcohol Beverage Control law from one of public safety and public health to one where the state would “promote economic development and job opportunities by promoting the expansion and profitability of the beer, wine and liquor production industries in this state.” It’s difficult to imagine a proposal that is more radical or more wrong-headed.
Another New York State issue that has been bubbling over is the proposed expansion of wine and/or liquor into grocery and drug stores. The proponents of that expansion have framed it as an economic issue of grocery stores versus liquor stores, conveniently sidestepping the public health implications. In reality, research has shown that states that offer wine and/or liquor in more places have higher levels of alcohol consumption, and thus more alcohol problems. In addition, big grocery stores in New York State have pushed the local economic benefits, as if the primary effect will be greater availability of boutique New York State wines in their gourmet section. But the proposal would result in corner stores, conveniences stores and bodegas being allowed to sell fortified wines like Thunderbird and Mad Dog, which are street drinks that are designed for abuse. To make these products available so widely would really be a nightmare for public health and public safety.
Our leaders need to realize that alcohol—in the words of the World Health Organization—is “no ordinary commodity”. Or, as alcohol policy consultant Pam Erickson has put it, we can’t sell alcohol like tires and mayonnaise.
CHW: You mentioned the alcohol tax, what are some other alcohol control measures that have reduced harm associated with drinking in the past few decades?
RP: The reraising of the Minimum Legal Drinking Age, putting it back to 21 after it had been lowered to 18 or 19 in several states—has been shown to have a number of positive public health effects.
Also, the lowering of the Blood Alcohol Content standards for driving to .08 grams of alcohol per 100 grams of individual’s blood has been unquestionably positive.
CHW: How would you try to persuade those who aren’t involved in public health or substance abuse issues that alcohol control policies are worth while, How do you convince the general public that alcohol control policies are a critically important issue?
RP: Sometimes it’s a tough sell now, for several reasons. Most Americans accept that tobacco is a threat to public health, and that we should be moving toward a tobacco-free society. In addition, with all the research and the exposure of the tobacco industry after the Master Settlement Agreement, it’s been relatively easy to portray the tobacco industry as largely irresponsible. There’s a different reality and a different history with alcohol. Most people outside of the field really don’t have a lot of information about the impact of alcohol or the tactics of the alcohol industry. And the goal for alcohol control advocates is arguably more complex: reducing overall consumption, reducing high-risk drinking, reducing underage drinking, and limiting alcohol-related harms while still acknowledging the role of low-risk drinking and the possible health benefits of light consumption for individuals over the age of 35.
And the people in the alcohol industry and their allies and symbionts have used public relations techniques effectively to polarize that debate. They’ve done this pretty explicitly—painting anyone who wants to implement effective alcohol control policy as a “Neo-prohibitionist,” tied to a cartoonish popular understanding of Prohibition. So it’s the false dichotomy with Prohibition on one side and laissez-faire and “self-regulation” on the other.
As a result, most of our societal efforts are still focused on education and reactive punitive approaches. It’s going to take sustained advocacy to help people understanding the public health research of the last 30 years, especially the relationship between general availability and alcohol problems. We need to disseminate the research in ways that people can relate to. It’s really basic economics. If you make something more available, reducing the opportunity cost, the more you’ll get of it.
CHW: What about educating the public about the cost burden associated with the misuse of alcohol and greater per capita consumption like Fetal alcohol syndrome, domestic violence and drunk driving. I know with drunk driving you have organizations like MADD but it seems like there isn’t a cohesive manner going about this kind of advocacy.
RP: Yeah, getting folks to communicate across these silos is one crucial element. A broad, national public health campaign – whether from a private public health organization or the Office of National Drug Control Policy—would also be beneficial. It’s a matter of finding the political will.
Alcohol is the third leading cause of mortality and it’s extremely costly to society, because many its victims are often young, resulting in considerable DALYs [Disability Life Years].
As Lori Dorfman and her colleagues at the Berkley Media Studies Group have pointed out, changing hearts and minds about these issues is largely about media advocacy and framing. When an alcohol-related tragedy affects our community, how do we frame it?
CHW: Can you give me an example?
RP: We had a tragic case in the Syracuse area a few years ago, where an underage drinker drove under the influence and crashed, killing her best friend who was a passenger in her car. At this young lady’s funeral, her young friends put bottles of Captain Morgan and Bud Light on her tombstone because those were her favorite beverages. When we consider a tragedy such as this, how are we going to frame the problem? Are we just going to see it in terms of individuals and poor choices and not look at the environments which contributed to those poor choices? Or should we also point out that the alcohol brands placed on her tombstone are brands that have been aggressively marketed and have been shown to have youth appeal?
CHW: How can our readers learn more about alcohol control policy? How can they be better advocates, whether with their local elected officials representatives or in their community?
RP: As for resources, I’ve put together a resource list on alcohol policy at my blog.
First, I would say don’t underestimate alcohol as a problem, regardless of your personal experience with drinking. Pathological drinking is more of a burden to society than they probably suspect. For example, when I talk about the connection between alcohol and gonorrhea, people are frequently surprised. [Cohen DA, Ghosh-Dastidar B, Scribner R, Miu A, Scott M, Robinson P, Farley TA, Bluthenthal RN, Brown-Taylor D. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: a longitudinal analysis. Soc Sci Med. 2006; 62(12):3062-71.] Alcohol problems are so systemic and ingrained in our society that they touch on nearly every social problem and public health issue. We in the alcohol control field need other public health practitioners to become our allies and to find ways to help each other.
Secondly, I would urge advocates not to underestimate the impact of the alcohol industry on alcohol-related problems. In some ways, the alcohol industry has been even more effective than the tobacco industry in stanching reform. They’ve picked their fights more carefully and learned from the tobacco industry’s mistakes. If they can’t beat ’em, they buy ’em, as when Anheuser-Busch hired Mike Moore, the Attorney General of Mississippi who led the Master Settlement against the tobacco industry, as a consultant. That tactic is typical of that industry’s ethical orientation.
Clearly, it’s going to take sustained, united effort to reverse these trends.
1. Bulleit Bourbon Credit: schluesselbein
2. Saranac Credit: mdu2boy