Introduction by Croakey: Advertising restrictions and a multi-faceted policy response are required to minimise potential harms from zero-alcohol beverages, according to PhD candidate and research officer Nathan Harrison.
“This is a complex area, where the right balance is needed, to encourage adult alcohol substitution with zero-alcohol beverages, whilst protecting young people from as much alcohol marketing as possible,” Harrison said in his submission for the Public Health Association of Australia’s Student Think Tank competition.
The National Public Health Student Think Tank Competition run by the Public Health Association of Australia is a chance for students to showcase their innovation and enthusiasm for the field of public health.
Students were invited to submit a written response of no more than 750 words to address the following prompt: In light of the recent Federal election, what key public health policy should the Australian government be implementing to ensure a healthier, fairer & more sustainable future for young people in Australia?
Croakey is publishing a series of edited Think Tank submissions – see other articles in the series here.
Nathan Harrison writes:
Fewer young people in Australia are drinking alcohol compared to generations before them. If sustained further, this promising trend is good public health news, as alcohol remains the leading global risk factor for death and disability among young people.
At the same time, the zero-alcohol beverage market is now booming in countries including Australia and steep growth is forecast over the next few years.
Zero-alcohol beverages (also ‘alcohol-free’ or ‘NoLo’ drinks) contain no alcohol, or very low amounts. In Australia, this is usually between 0.0% and 0.5% alcohol by volume. Many top-selling products are from established parent alcohol brands and are designed to replicate conventional alcoholic beverages in taste and appearance.
This resemblance is often emphasised in marketing and intensified during temporary sobriety campaigns such as Ocsober or Dry July.
Is this good news for public health? Or an emerging public health challenge?
Zero-alcohol beverages could potentially play a harm-minimisation role, particularly for young people, assuming use substitutes alcohol. For example, these drinks could potentially help young people to limit the amount of alcohol they choose to drink, or even help to delay the point at which they start drinking alcohol altogether.
Facilitating some degree of zero-alcohol access may therefore help reduce the harms that alcohol creates.
On the other hand, the proliferation of zero-alcohol beverages and associated marketing face few current controls, which could risk normalising and encouraging earlier alcohol consumption.
Potential for harm
Increasing levels of exposure are problematic, particularly as zero-alcohol beverages are now sold in settings like supermarkets and service stations, with no legal age restriction.
We know that young people are particularly susceptible to marketing from unhealthy industries. By age four, children typically understand unique cultural drinking contexts and have developed beliefs about alcohol’s effects on drinkers.
Both non-alcoholic and alcoholic products use similar branding, which can increase early exposure to alcohol marketing and increase recognition and awareness of the overall parent brand.
Young people generally only recall and associate such brands with the alcoholic products.
Concerns have been raised by researchers that new zero-alcohol products have strong appeal to younger people, and as “gateway drinks”, exposure to zero-alcohol beverage marketing may encourage earlier interest among young people to start drinking alcohol sooner.
There’s also very little empirical evidence available on the impacts of zero-alcohol consumption for young people and the implications for later alcohol use.
This is a complex area, where the right balance is needed, to encourage adult alcohol substitution with zero-alcohol beverages, whilst protecting young people from as much alcohol marketing as possible.
Because of the potential for harm, alcohol advertising restrictions should operate at the brand level and explicitly cover zero-alcohol beverage marketing in order to protect young people.
Whole-of-brand policies
Particularly given the rapid market rise, zero-alcohol beverages often fall outside of the scope of existing policies targeted at alcoholic and sugary soft drinks – the very ones established to reduce the visibility of alcohol marketing to young people.
This ‘brand creep’ is a problem, and a loophole that risks setting back public health progress in reducing both alcohol and soft drink consumption – zero-alcohol drinks can have high sugar levels too.
In the absence of international laws that extend to zero-alcohol beverages, alcohol companies are often promoting whole brands (that is, both their zero-alcohol and alcoholic products), in ways that expose young people to alcohol brand advertising.
In countries where restrictions focus only on alcohol product advertising – according to the percentage of alcohol volume in a product, indirect alcohol brand advertising still occurs.
Zero-alcohol products can still be promoted in a form of alibi marketing and end up having virtually identical appearances in advertising. For example, the visuals and slogans of parent alcohol brands have remained prominent in professional sport and on public transport.
Whole-of-brand policies are therefore warranted. These should restrict marketing to young people by all companies that primarily sell alcohol and of all products that share the same brand of alcoholic drinks.
For example, policy in Norway prohibits the advertising of all products carrying the same brand or characteristics as an alcoholic drink, to better address zero-alcohol. It applies across all forms of advertising and all media including digital media.
Application in Australia
Some individual, international manufacturers already state their commitment to avoid marketing products to young people. However, alcohol industry uptake of other public health initiatives has typically been slow or resisted entirely.
For such policies to work in practice, they would be strengthened considerably by government mandate, rather than being solely in industry hands.
Such responses could be implemented as part of comprehensive marketing regulations, but current Australian alcohol advertising restrictions need to be toughened. Few examples of zero-alcohol beverage marketing have been restricted in practice.
Advertising is governed by only a “quasi-regulatory” Code for Responsible Alcohol Marketing, developed and managed by the alcohol and advertising industries.
Under the existing code, marketing must not specifically target or appeal to minors, be displayed to largely underage audiences, or position alcohol similarly to confectionary or soft drinks. It also applies to the non-alcoholic beverages produced by a parent alcohol brand, but the adjudication panel have also described how zero-alcohol beverage marketing now “sits awkwardly” with the code.
Although there is no formal monitoring system, code circumventions are common, including through advertising to young people. In a strengthened system, restrictions should be monitored by Government, with mechanisms to ensure compliance.
Comprehensive responses
Lessons from other contexts (particularly tobacco control) reinforce the importance of comprehensive advertising restrictions across all forms of promotion, and policy responses to support this effort.
The World Health Organization’s policy suite to reduce harmful alcohol use with maximum population cost-effectiveness (‘Best Buys’) focuses on increasing price and reducing availability, plus reducing alcohol advertising exposure. For example, responses focusing on zero-alcohol availability may also be feasible at the brand level.
Resources that inform and support consumers when considering zero-alcohol beverage purchase also deserve attention.
Similar materials exist overseas, encourage parents to exercise caution when it comes to supplying zero-alcohol beverages to their children, and highlight how parents themselves can model ‘appropriate’ drinking. Combined, these responses can protect against an emerging challenge.
Nathan Harrison is a public health and implementation science student, and an early-career health behaviour scientist. He started PhD studies in June 2022, focused on lung cancer screening, smoking, and stigma. He is also a Senior Research Officer at the National Centre for Education and Training on Addiction, located at Flinders University, where he conducts policy-relevant public health research on tobacco, alcohol, and other drug use.
(Tweet below added after publication, on 25 November.)
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