The UPPP Project: Assessing politician’s Understanding, cancer risk Perceptions and Policy Positions on alcohol
(2015 - 2016)
(Funded by Cancer Research UK)

Cancer Research UK funding has been secured to develop a project that will focus on analysing and monitoring the public statements of key politicians in relation alcohol policy and alcohol-related harm including cancer risk. Such monitoring is an important part of advocacy work, but there is currently no reliable or consensus-based analysis method. The UPPP project seeks to assess the feasibility and value of a bespoke ‘positional analysis’ tool for analysing and monitoring politicians’ understanding of alcohol-related cancer-risks, alcohol problems, and policy positions relating to alcohol. The project will be conducted by a team led by Dr Niamh Fitzgerald at the Institute for Social Marketing, with involvement from the Alcohol Health Alliance, University of Sheffield, University of the West of England and the University of Newcastle.

ISM Staff: Niamh Fitzgerald

The Content and Design of Alcohol Brief Intervention Training for Practitioners
(Funded by Alcohol Research UK)

Research indicates that patients who are drinking alcohol at a risky or harmful level can reduce their drinking if health professionals identify their consumption and engage them in short, structured conversations about it (brief interventions – ‘BI’s).  The provision of adequate training for health professionals is considered one important factor in enabling routine delivery of BIs.  In research trials, the nature of such training has varied widely. 

This project will:

  • Identify, describe and critically review existing frameworks which may be helpful for describing and analysing training of this kind.
  • Describe how training for professionals has been reported in BI trials to date.
  • Source and describe what detailed information on training is available by contacting researchers from these trials.

The outcomes of this work will inform current practice in delivering BI training, and will lay the foundation for future research exploring how training can support BI delivery and effectiveness. 

ISM Staff: Niamh Fitzgerald and Kathryn Angus

Overprovision of Licensed Premises in Scotland: A Public Health Perspective
(Funded by NHS Health Scotland)

In Scotland, the number of premises licensed to sell alcohol is controlled through a system of local licensing boards. Legislative changes in recent years have given such boards an objective of ‘protecting and improving public health’. Research has suggested that the controlling the number of licensed premises and therefore the availability of alcohol can reduce alcohol-related harm. This study involves qualitative interviews with individuals across Scotland working mainly in public health or in alcohol and drug partnerships who have worked on licensing issues in recent years. The study aims to identify how these individuals and their organisations have attempted to influence local licensing policies and decisions in Scotland, and in their experience, what factors are important in helping and/or hindering those efforts. 

ISM Staff: Niamh Fitzgerald

Fitzgerald N (2015). Influencing the Implementation of a Public Health Objective in Scottish Alcohol Licensing: A Qualitative Interview Study – Summary Report. Stirling: University of Stirling, Institute for Social Marketing. Report

Women and Alcohol: Towards an Equity Review of the Effectiveness of Population-Based Interventions to Reduce Alcohol Use and Harm by Gender
(Funded by Glasgow Centre for Population Health)

There is good evidence to suggest that a range of population-based interventions such as pricing, control of marketing, and reduction in availability of alcohol can reduce alcohol-related harm. This study will analyse published literature reviews of such interventions to determine the extent to which they report participation by women and any specific effects on women in the original studies underpinning this evidence. The results of the study will inform policy decisions as well as providing a basis for more detailed work considering how these kinds of interventions may have a differential effect by gender.

ISM Staff: Niamh Fitzgerald, Linda Bauld, Kathryn Angus and Martine Stead

UK Centre for Tobacco and Alcohol Studies (UKCTAS)

The UK Centre for Tobacco and Alcohol Studies is a network of 13 universities (12 in UK, 1 in New Zealand) funded by the UK Clinical Research Collaboration, which builds on the work and success of its predecessor, the UK Centre for Tobacco Control Studies (UKCTCS).

The UKCTAS is now a leading international centre of tobacco and alcohol research and policy excellence with an extensive research programme. We have established a cohort of early career researchers, provide a teaching programme to train and engage the wider research and policy community in tobacco and alcohol research. We facilitate policy development by informing policy makers of the latest scientific research on tobacco and alcohol use, and thus contributing to the nation's public health.

The UKCTAS aims to deliver an international research and policy development portfolio, and build capacity in tobacco and alcohol research. UKCTAS work will include developing strategies for behaviour change in tobacco and alcohol use, assessing risks, identifying measures to reduce harm, monitoring the tobacco and alcohol industries, and developing effective public policies to improve public health and wellbeing.

ISM Staff: Linda Bauld and Gerard Hastings for University of Stirling

Young People, Alcohol Packaging and Digital Media
(Funded by Alcohol Research UK)

Alcohol marketing is a key focus for concern for alcohol and public health researchers because of growing evidence that it is a determinant of uptake and frequency of drinking. To date, research attention has focused on more traditional forms of marketing promotion. However, research needs to keep pace with the fast-changing, multi-platform marketing environment. Two aspects of contemporary alcohol marketing merit particular concern: packaging, and how this relates to online marketing. This research will benefit wider alcohol research and policy by exploring the way in which digital media combines with alcohol labelling and packaging to create a multi-platform marketing environment and to examine to what extent young people interact with this environment.

Research in this new and little understood area needs to use approaches which are reflexive and inductive, and two qualitative methods are proposed - focus groups with young people and netnography of identified social media sites and websites. A total of eight focus groups with 14-17 year-olds (n=48-64) will be used to explore young people’s knowledge, attitudes and behaviour relating to alcohol packaging and labelling. Their levels of awareness and engagement with on-line alcohol marketing through producers’ websites and social media pages, using on-product QR codes, augmented reality packaging and printed web-addresses, will also be explored. The second stage will involve the use of netnography to identify, observe and analyse on-line communications regarding alcohol products on social network pages and websites of certain alcohol brands.

ISM Staff: Richard Purves, Martine Stead and Douglas Eadie

Purves R, Stead M and Eadie D (2014) “What are you meant to do when you see it everywhere?”: Young people, alcohol packaging and digital media. London: Alcohol Research UK; December.

A Process Evaluation of Alcohol Brief Interventions in Wider Settings (Young People and Social Work)
(Funded by NHS Health Scotland)

The detection of alcohol problems is known to be enhanced by the use of appropriate screening tools, and a considerable body of research evidence now supports the use of Alcohol Brief Interventions (ABIs) in reducing health-related harm due to alcohol consumption. ABIs are time-limited interventions that focus on changing drinking behaviour, and their delivery has become a significant component of the Scottish Government Alcohol Strategy. Although studies have indicated that ABIs can be effective with adults in primary care settings, relatively little is known about their use and value when implemented in settings such as social work and the community, and with young people (under the age of 16).

This study aims to explore the feasibility and acceptability of ABIs delivered to young people and in social work settings through two phases of research; the first mapping and scoping current projects across Scotland, and the second examining delivery in a series of case study projects, and developing proposals for a potential future outcome evaluation.  A mixed methods approach is being used involving interviews with project staff and stakeholders and with users of the projects; field visits and observation; and analysis of project documentation and data. 
The study is a collaborative project between ISM, Nursing, Midwifery and Health, and the Faculty of Social Sciences.

Report available here

ISM Staff: Martine Stead, Douglas Eadie and Jennifer McKell, ISM; Dr Tessa Parkes and Avril Nicoll, NWH; Dr Sarah Wilson and Cheryl Burgess, SASS

Stead S, Parkes T, Nicoll A, Wilson S, Burgess C, Eadie D, Fitzgerald N, McKell J, Reid G, Jepson R, McAteer J and Bauld L (2017). Delivery of alcohol brief interventions in community-based youth work settings: exploring feasibility and acceptability in a qualitative study. BMC Public Health, 17: 357. doi: 10.1186/s12889-017-4256-1

Parkes T, Stead M, Eadie D, Nicoll A, McKell J, Bauld L, Wilson S, Burgess C, Reid G, McAteer J and Jepson R (2013). Alcohol brief interventions in youth and social work settings in Scotland. Addiction Science & Clinical Practice, 8(Suppl 1): A52.

NHS Health Scotland Media release:

Alcohol Policy Interventions in Scotland and England (APISE)
(Funded by National Prevention Research Initiative (NPRI))

The Alcohol Policy Interventions in Scotland and England study (APISE) is part of a multi-country collaborative project to assess the impact and effectiveness of alcohol control policies. The study design is modelled on the International Tobacco Control study. Longitudinal surveys of drinkers in participating countries together with the analysis of the policy context allows for assessment of change over time within countries and comparison between countries. Funding has been secured from the National Prevention Research Initiative (NPRI) to enable collection of baseline data in Scotland and England and a follow-up 12 months later. Three linked stages of research include an audit of alcohol control strategies in each country, exploratory research with adult drinkers and a longitudinal survey. 

The baseline survey, planned for late 2012, will recruit a cohort of 2000 adult drinkers in England and 2000 in Scotland. The cohort will be followed up 12 months later. The survey will be conducted using Computer Assisted Telephone Interviews (CATI) and will collect comprehensive consumption data, using a framework that is beverage and location specific to facilitate identification of impacts of policy change. Policy related measures are measures that are closely linked to a specific policy and therefore expected to be directly affected by the introduction of a particular policy. A range of policy-related measures will be included in the study including for example affordability, which would be a key measure following the introduction of Minimum Unit Pricing (MUP). APISE will provide a comparison between Scotland and England where there is the potential for different alcohol policies to be introduced. APISE will also have an international dimension through collaboration with colleagues in New Zealand, Australia, USA, Thailand and South Korea who are planning analogous studies in their countries.

The study is being led by researchers at the University of Stirling and is being conducted in collaboration with the University of Sheffield, The Open University and the University of Wollongong.

ISM Staff: Gerard Hastings, Anne Marie MacKintosh and Douglas Eadie

Li J, Lovatt M, Eadie D, Dobbie F, Meier P, Holmes J, Hastings G and MacKintosh AM (2017) Public attitudes towards alcohol control policies in Scotland and England: Results from a mixed-methods study. Social Science and Medicine, 177: 177-189.

Research to Develop and Apply a Methodology for Retrospective Adjustment of Alcohol Consumption Trend Data
(Commissioned by the Department of Health, through the Public Health Research Consortium)

Changes over the past couple of decades in glass size and alcohol strength, particularly the trends towards larger measures and higher alcohol content, have made it difficult to obtain a clear picture of alcohol consumption over time, as the underlying assumptions and understanding regarding a standard drink or serving have not been consistent. In order for alcohol policy to be based on accurate consumption data, there is a need to develop and apply a robust methodology for retrospective adjustment of official trend data on alcohol consumption, to take account of changes in glass size and shape and alcohol strength over time. This scoping and feasibility study was commissioned by the Department of Health through the Public Health Research Consortium.  Its objectives were to:

  1. Review available research and other evidence to map key changes in alcohol strength, standard measures, glass size and shape over the period 1990-2012;
  2. Interview key stakeholders to establish relevant assumptions and to inform the mapping exercise;
  3. Develop a robust formula / formulae for use in retrospective adjustment of official data;
  4. Apply the formula /formulae to official data on a selective basis;
  5. Report the results and discuss implications for a full-scale study.

The mapping element of the study was conducted by ISM, while the formulae development was conducted by the National Centre for Social Research (NatCen). The mapping element sought to identify and map key changes in glass size, shape and drink strength (percentage of alcohol by volume) since 1990. Two methods were used, desk-based research involving searches of academic and trade periodicals and commercial market research sources, and interviews with key stakeholders. Overall, the findings indicate that the average strength of beer and wine has increased over the period, such that previous survey data on reported consumption of 'standard drinks' have under-estimated the actual amount of alcohol consumed by a considerable degree. Findings from the mapping informed the formula development strand of the work, which proposes conversion factors to make survey data from different years more comparable. 

ISM Staff: Martine Stead, Kathryn Angus and Laura Macdonald

Stead M, Angus K, Macdonald L and Bauld L (2014). Looking into the glass: Glassware as an alcohol marketing tool, and the implications for policy. Alcohol and Alcoholism, online 9th January. doi:10.1093/alcalc/agt178.

Stead M, Bauld L, Angus K, Macdonald L, Munafò M, Attwood A, Ataya A, Fuller E, Pickering K (2013). Scoping and Feasibility Study to Develop and Apply a Methodology for Retrospective Adjustment of Alcohol Consumption Data. Final Report. London: Public Health Research Consortium; October. Report  Executive Summary

Addictions and Lifestyles in Contemporary Europe - Reframing Addictions Project (ALICE RAP)
(2011 - 2016)
(Funded by the European Commission)

ALICE RAP aims to study and analyse the development and place of well-acknowledged and new addictions as a major societal trend in Europe in relation to governance and public policies and responses. The study involves 67 research institutions from 25 European countries covering the humanities, social sciences and biological and medical sciences. Its scientific objectives are:

  1. To describe the ownership of addictions through a historical study of addiction over the ages, an analysis of public and private stakeholder views and through image analyses, of professional and citizenship views.
  2. To study how addictions are classified and defined, followed by estimates of their health, social and economic impact.
  3. To investigate determinants of addiction through a coordinated and cohesive social, economic and biological analysis of initiation, transition into problem use and transition into and out of dependence.
  4. To analyse the business of addiction through studies of revenues, profits and participants in legal and illegal trade, the impact of suppliers on addictive substance use and behaviours, and analyses of webs of influence on policy responses.
  5. To study addictions governance by describing the views and forces that determine the ways societies steer themselves and by stock-taking of present governance practices to old and emerging addictions.
  6. To analyse youth as customers through considering the impacts of new technologies on promoting and mitigating use, by studying the interrelations of culture and biology, and by determining features that promote resilience and nudge young people to reduce problematic use.

ISM is contributing specifically to Objectives 1 and 4.

ISM Staff: Martine Stead, Kathryn Angus, Richard Purves, Gerard Hastings, Anne Marie MacKintosh and Crawford Moodie

Stead M, Dobbie F, Angus K, Purves RI, Reith G and Macdonald L (2016). The online bingo boom in the UK: A qualitative examination of its appeal. PLoS ONE, 11(5): e0154763. doi:10.1371/journal.pone.0154763

McLeod J, Gell L, Holmes J, Allamani A, Bjerge B, Bühringer G, Forberger S, Frank V, Lingford-Hughes A, Meier P, Neumann M, Room R, Baumberg B, Eiroa-Orosa FJ, Lees R, Meerkerk G-J, Schmidt L, Stead M, van de Mheen D, and Weirs R (2016). Determinants of risky substance use and risky gambling.  Chapter 3 in:  Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press, pp35-76. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0003

Gell L, McLeod J, Holmes J, Allamani A, Baumberg B, Bjerge B, Bühringer G, Eiroa-Orosa J, Forberger S, Frank V, Lingford-Hughes A, Meerkerk G-J, Meier P, Neumann M, Room R, Schmidt L, Stead M, van de Mheen D, Weirs R, and Withington P (2016).  Determinants of harmful substance use and gambling. Chapter 4 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0004

McLeod J, Gell L, Holmes J, Allamani A, Baumberg B, Bjerge B, Bühringer G, Eiroa-Orosa FJ, Forberger S, Frank V, Lingford-Hughes A, Meerkerk GJ, Meier P, Neumann M, Room R, Schmidt L, Stead M, van de Mheen D, Wiers R and Withington P (2016). Determinants of transitions from harmful to low-risk substance use and gambling. Chapter 5 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0005

Gell L, Bühringer G, Room R, Allamani A, Eiroa-Orosa FJ, Forberger S, Holmes J, Lingford-Hughes A, McLeod J, Meier PS and Stead M (2016). Discussion and Integration of Key Findings. Chapter 6 in: Gell L, Bühringer G, McLeod J, Forberger S, Holmes J, Lingford-Hughes A and Meier PS (eds), What Determines Harm from Addictive Substances and Behaviours? Oxford: Oxford University Press. ISBN: 9780198746683. doi:10.1093/acprof:oso/9780198746683.003.0006

Alcohol and Public Health Strategy
(Funded by Cancer Research UK, British Liver Trust, UKCTCS, Alcohol Focus Scotland, Nottingham University Hospital, Balance North East, Our Life, Alcohol Research UK and Breakthrough Breast Cancer)

This project involved the development of an alcohol and public health strategy independent from government and the alcohol industry. It was developed by a steering group of experts drawn from a range of sectors, chaired by Sir Ian Gilmore of the Alcohol Health Alliance, and supported by researchers from ISM and other Universities. The strategy was informed by reviews of relevant literature and a public opinion element.

The report 'Health First: An evidence-based alcohol strategy for the UK', was published on 1st March 2013, and sets out key recommendations, and the evidence to underpin them, to reduce the harm from alcohol in the UK. The report was endorsed by more than 70 organisations from across the UK.


ISM Staff:
Gerard Hastings, Linda Bauld, Martine Stead, Anne Marie MacKintosh and Richard Purves

Click here to see 'Voice of Russia' interview

Click here for condensed download version of the report (PDF - 730KB)

An Evaluation to Assess the Implementation of NHS Delivered Alcohol Brief Interventions in Primary Care: Case Study Analysis
(Funded by NHS Health Scotland and carried out in collaboration with Nursing and Midwifery, University of Stirling, and the School of Business, University of Dundee)

Alcohol Brief Interventions (ABIs) are short evidence-based, structured conversations that focus on changing drinking behaviour. In support of the SIGN Guideline 74 that ABIs should be delivered to harmful and hazardous drinkers in Primary Care settings, A&E Departments and Antenatal Care settings, the Scottish Government established a new health improvement target for NHS health boards (H4: HEAT target - Health Improvement, Efficiency, Access and Treatment) to deliver 149,449 ABIs between April 2008 and March 2011 in these settings.

Commissioned by NHS Health Scotland, this project evaluated the implementation of ABIs in all three priority settings with a specific emphasis on primary care. Focusing on how screening and ABIs have been implemented, practitioners (n=35) and patients (n=25) were interviewed across eight practices and three health boards, representing a mixture of urban and rural, high and low socio-economic areas and high and low ABI recording rates. These data were supplemented by additional interviews with key informants in each case health board (n=21). Considering processes at both the individual and organisational level, and the level of overall adoption and reach, the findings will support improved delivery of ABIs when embedded into the mainstream delivery of the NHS.

Abstract and Report available from the Health Scotland website.

ISM Staff: Douglas Eadie, Susan MacAskill, Stuart Bryce (left 2011) and Oona Brooks (left 2010)

Parkes T, Eadie D, Petrie D et al  (2011). An evaluation to assess the implementation of NHS delivered alcohol brief interventions: Study summary. Drugs and Alcohol Findings. Posted 10th Dec 2012.

The Use of New Media in Alcohol Marketing
(Commissioned by SHAAP (Scottish Health Action on Alcohol Problems))

In analysing the internal marketing documents from both alcoholic beverage producers and their advertising agencies for the Health Select Committee (see below), it was apparent that there has been a rapid growth in the use of new media (ie. digital forms of communication such as the internet, mobile devices, electronic games, blogs and podcasting) to market alcohol in recent years, yet this is an area which presents particular challenges to the current system of self-regulation. This report examines the use of new media to market leading alcohol brands in the UK using a case study approach.

ISM Staff: Oona Brooks (left 2010)

Report: Brooks O (2010). “Routes to Magic” - The Alcoholic Beverage Industry’s Use of New Media in Alcohol Marketing. Stirling: Institute for Social Marketing.
Full report
SHAAP Research Briefing

Health Select Committee Alcohol Document Analysis
(Commissioned by the Health Select Committee and the Alcohol Education and Research Council (AERC))

As part of its 2009 investigation into the conduct of the UK alcohol industry, the House of Commons Health Select Committee obtained access to internal marketing documents from both producers and their advertising agencies. These documents were then analysed by the Institute for Social Marketing.

These revealed major shortcomings in the current self-regulatory codes covering alcohol advertising. Specifically, the codes do not, as they are supposed to, protect young people from alcohol advertising; prevent the promotion of drunkenness and excess; or the linking of alcohol with social and sexual success. Nor do they even attempt to address sponsorship, and the documents show this is being systematically used to undermine rules prohibiting the linking of alcohol with youth culture and sporting prowess. Finally, the codes are extremely weak in their treatment of new media which are rapidly becoming the biggest channel for alcohol promotion. The result is a regulatory system that is impossible to police and vulnerable to exploitation.

ISM Staff: Gerard Hastings, Oona Brooks (left 2010), Kathryn Angus, Martine Stead, Thomas Anker (left) and Tom Farrell (Open University)

Report: Hastings G (2010). Memorandum by Professor Gerard Hastings - "They'll drink bucket loads of the stuff". An analysis of internal alcohol industry documents. Available here

Hastings G, Brooks O, Stead M, Angus K, Anker T and Farrell T (2010). Failure of self-regulation of UK alcohol advertising (Alcohol advertising: The last chance saloon). British Medical Journal, 340: 184-186. Online

Related online articles:
Direct Traffic Media article

Prison Health Needs Assessment for Alcohol Problems
(Commissioned by NHS Health Scotland)

Alcohol problems are a major and growing public health problem in Scotland with the relationship between alcohol and crime, in particular, violent crime, increasingly being recognised. This study was part of a wider Scottish Government funded alcohol research programme in criminal justice settings which also includes a pilot of the delivery of alcohol brief interventions and a scoping study of alcohol interventions in community justice settings. It was anticipated that the study findings would inform broader health service development such as the integration of prison health care into the NHS and the update of core alcohol treatment and support services. These developments were set within a policy and practice context which acknowledges alcohol problems in the population and increasingly so the alcohol problem in offenders, along with the importance of applying a person-centred, recovery orientated approach underpinned by the NHS commitment to quality of services.

The aim of this study was to undertake a needs assessment of alcohol problems experienced by prisoners and provide recommendations for service improvement including a model of care. Key elements included:

  • a rapid review of the relevant literature on effective interventions
  • a report on the epidemiology of alcohol problems experienced by prisoners in Scotland
  • an assessment of alcohol problems among offenders within an individual prison using the AUDIT screening tool
  • mapping current models of care in the Scottish Prison Service and the interface with community care models
  • exploration of attitudes towards the delivery and effectiveness of current alcohol interventions through qualitative interviews in a prison case study
  • a gap analysis between current service provision, best practice, effective interventions and national care standards for substance misuse.

The study involved both quantitative and qualitative information being gathered through primary data collection and document retrieval and analysis.

The final report was launched at the Alcohol & Offenders Event, Edinburgh, 8th February 2011. Tessa Parkes presentation from this event can be found here. Conference presentations and paper submissions are ongoing.

ISM Staff: Susan MacAskill, Douglas Eadie and Oona Brooks (left 2010)

Collaborators: Tessa Parkes (lead), Ruth Jepson, Iain Atherton, Lawrence Doi and Stephen McGhee, Nursing, Midwifery and Health, University of Stirling

A Review of the Evidence for Effective Alcohol Education for the UK
(Commissioned by the Alcohol Education and Research Council (AERC))

The Alcohol and Education Research Council, on behalf of Drinkaware, commissioned ISM to conduct a review of reviews of the international evidence base, with special reference to its applicability and relevance to the UK. ISM was asked to recommend and develop proposals for next steps to strengthen the research agenda and evidence base. ISM developed the design and research objectives for a systematic review of most promising approaches for alcohol education-based interventions, and a longitudinal study of a community and/or family + school-based intervention.

AERC Second Stage: A Systematic Investigation of Critical Elements for Optimum Effectiveness of Promising Approaches and Delivery Methods in School and Family Linked Alcohol Education

Building on the findings of the first stage scooping study, this project systematically reviewed the evidence base on interventions intended to reduce or prevent alcohol misuse amongst young people. The review identified and interrogated the evidence base over a ten year period. Thematic analysis, case study and process and impact evidence collation methods were used. Internal and external elements of intervention programmes most frequently associated with positive behavioural outcomes were reported and strategic implications for future development were identified.

ISM Staff: Georgina Cairns, Martine Stead, Kathryn Angus, Richard Purves, Jennifer McKell and Stuart Bryce (left 2011)

Cairns G, Purves R, Bryce S, McKell J, Gordon R and Angus K (2011). Investigating the Effectiveness of Education in Relation to Alcohol: A Systematic Investigation of Critical Elements for Optimum Effectiveness of Promising Approaches and Delivery Methods in School and Family Linked Alcohol Education. Stirling: Institute for Social Marketing. Report online

Reducing the Damaging Effects of Alcohol: A Technical Assistance Project for the European Alcohol and Health Forum
(Commissioned by the European Commission (DG SANCO))

In many cultures, alcohol is used to facilitate social interactions and is seen to have many other benefits. However, alcohol consumption is also associated with a broad range of health and social problems with risky drinking patterns becoming progressively more embedded in European cultures. In many member states of the EU such as France , Italy and Spain although alcohol consumption is falling there is increasing evidence of binge drinking and associated harms. In some states such as the UK overall consumption has risen by up to 20% in the last 20 years alongside a change in drinking patterns. In Sweden and the UK, drinking at the weekends in binge sessions has become the dominant alcohol consumption trend. These patterns are becoming more common in Spain whereas previously drinking was traditionally spread out over the week and involved smaller quantities per drinking episode.

Combating the damaging effects of alcohol is a public health priority in many of the Member States and at EU level. Notwithstanding the considerable health consequences of excessive alcohol consumption, there are a number of other associated harms including; lost productivity, violence, hooliganism, crime, family problems, social exclusion, problems at work and drink-driving. A review of the total tangible cost of alcohol to EU society conducted in 2003 estimated this to be €125bn (€79bn-€220bn), which is equivalent to 1.3% GDP. The intangible costs caused by indirect criminal, social and health harms caused by alcohol were estimated to be €270bn in the same review, although other reviews s produced estimates between €150bn and €760bn.

Therefore policy initiatives are required to reduce the damaging effect of alcohol in each of these areas. With its Communication of 24 October 2006 (COM (2006) 625 final), the Commission adopted a European Union strategy to help the Member States reduce the damaging effects of alcohol. Consequently, there is a need to better understand, report and evaluate the impact of policy and strategy designed to minimising the harm associated with alcohol.

ISM provides research-led technical assistance to The European Alcohol and Health Forum. The Forum is a multi-stakeholder collaboration convened and managed by the European Union Directorate-General for Health and Consumer Affairs (DG SANCO). The Forum meets regularly to review evidence for the causes and effects of alcohol misuses and to explore opportunities, policy, activities and their effectiveness in reducing alcohol-related social and health harms.

ISM provides scientific reports and briefings on various topics. During the first 18 months of this four-year project, this has included mapping reports on European social marketing interventions to reduce alcohol-related harms, European alcohol prevention and reduction interventions for young people and European self-regulation of alcohol marketing; a review of the European evidence base for effective alcohol education interventions; building a database of good practice for youth-targeted projects to reduce alcohol misuse.

ISM Staff: Georgina Cairns, Kathryn Angus, Ross Gordon (now based at the University of Wollongong), Laura Macdonald, Douglas Eadie and Richard Purves

Learning About Alcohol: Influences of the Family Context
(Commissioned by the Joseph Rowntree Foundation)

Understanding how drinking habits are learned is central to developing effective means of shifting problematic drinking patterns and cultures. Family settings are increasingly recognised as important initial reference points of individuals' socialisation and exposure to alcohol. Consequently, there is a need to examine the way alcohol is handled in a range of ‘normal' family settings and how this influences children. This study, which is funded by the Joseph Rowntree Foundation, aims to identify influences on how young children aged 7-12 years learn about alcohol and to examine differences by socio-economic status, age, family structure, geographical locality and parental drinking behaviour. The study employs qualitative modes of enquiry, combining two primary data collection methods: focus groups with children and parents to explore of social interaction within the family and beyond, norms and values re. drinking, and response to policy and practice interventions; and family case studies using in-depth interviews with children, parents and significant others to analyse influences within the family network and home context. 

Report and summary available from Joseph Rowntree Foundation website

ISM Staff: Douglas Eadie, Susan MacAskill and Oona Brooks (left 2010)

Changing Attitudes, Knowledge and Behaviour: A Review of Successful Initiatives
(Commissioned by the Joseph Rowntree Foundation)

The aim of the study was to draw on the lessons learnt from successful initiatives in other fields to identify approaches likely to be effective in influencing trends in drinking in the UK. Seven case studies were presented of initiatives conducted to tackle HIV/AIDS (Switzerland's STOP AIDS campaign), smoking in public places (Smokefree Scotland), sustainable transport use (InMotion campaign), youth smoking prevention (Florida ‘Truth' tobacco counter-marketing campaign), gambling (Australian responsibility in gambling campaign), speeding (Foolsspeed and ‘Pinkie') and mental health issues in lesbian and gay youth (Trevor Project). Initiatives sought to bring about attitudinal, behavioural or policy changes. The initiatives adopted a range of approaches, including advocacy, campaigning, counter-marketing, theory-based communications, policy formation and legislation, social marketing and positive role models. For each case study, transferable lessons for alcohol were identified. Finally, learning from the case studies was synthesised to present an account of how harmful drinking patterns in the UK may be reduced through the application of new thinking.

ISM Staff: Martine Stead, Ross Gordon (now based at the University of Wollongong), Ingrid Holme (left 2009), Crawford Moodie, Gerard Hastings, Kathryn Angus and Susan MacAskill (advisory group member)

Advisory Group: Evelyn Gillon, Scottish Health Action on Alcohol Problems; Rowdy Yates, Department of Applied Social Science, University of Stirling; and Alex Crawford, RCA Trust

Study of Drinking Cultures
(Commissioned by NHS Health Scotland)

A steady increase in alcohol consumption in Scotland over the past two decades has been associated with a growing number of health and social problems. However, drinking is recognised as having an important role in Scottish culture. The ISM in collaboration with the University of Central Lancashire was commissioned by NHS Health Scotland to undertake two complementary studies; a review of drinking cultures in different countries and primary research in Scotland. The review examined drinking patterns and cultures and discusses explanations of recent changes in the following countries: Australia, Canada, France, Germany, Spain and Sweden and UK/Scotland. Key themes were; drinking behaviours and typologies; policy, regulation and marketing issues; and social and cultural aspects of alcohol consumption.

The primary research was a qualitative study designed to improve understanding of drinking behaviours and different drinking cultures in Scotland. Respondents were recruited in four study areas as drinkers in home settings and/or were ‘regulars' in local pubs or were employed in pubs. Data collection comprised focus groups and in-depth interviews. The study found that drinking alcohol is an integral part of Scottish culture, with many benefits as a relaxant and social lubricant but with considerable variation in individual consumption styles. The study identified a large group of adult drinkers who regularly consume above recommended drinking limits across socio-economic groups, but who neither experience immediate adverse effects nor anticipate experiencing any future harm. Amounts consumed were largely influenced by the experience of the body's response rather than counting drinks or units. Reported consumption in the previous week was also recorded and a separate report produced. It is intended that the findings will contribute to the further development of a Scottish strategy to reduce alcohol-related harm.

ISM Staff: Susan MacAskill, Ross Gordon (now based at the University of Wollongong) and Douglas Eadie

Collaborator: Derek Heim, University of Central Lancashire

Gordon R, Heim D and MacAskill S (2012). Rethinking drinking cultures: A review of drinking cultures and a reconstructed dimensional approach. Public Health, 126(1): 3-11.

MacAskill S, Heim D, Eadie D and Gordon R (2007). Analysis of Drinking Diaries and Self-poured Drinks - Technical Report. Stirling: Institute for Social Marketing. Online

Gordon R, Heim D, MacAskill S, Angus K, Dooley J, Merlot R and Thomson S (2008). Snapshots of Drinking - A Rapid Review of Drinking Cultures and Influencing Factors: Australia, Canada, France, Germany, Spain, Sweden and the United Kingdom and Scotland (Revised from 2007). Prepared for NHS Health Scotland. Stirling: Institute for Social Marketing. Online

MacAskill S, Eadie D, Gordon R and Heim D (2008). Drinking in Scotland: Qualitative Insights into Influences, Attitudes and Behaviours - Final Report. Prepared for NHS Health Scotland. Stirling: Institute for Social Marketing. Online

Assessing the Cumulative Impact of Alcohol Marketing Communications on Youth Drinking
(Commissioned by the National Prevention Research Initiative (NPRI))

The last decade saw a significant increase in alcohol consumption in the UK and a growth in binge drinking amongst young people. These trends were responsible for raising particular health concerns as there is now clear evidence of a link between regular recreational alcohol use in adolescence and alcohol dependence in early adulthood. This study aimed to examine the marketing communication techniques used by the UK alcohol industry to assess its impact on youth drinking and risk taking during the period when most young people start experimenting with alcohol, from ages 13-15.

It addressed four deficiencies in the current evidence base. Firstly, whilst the evidence indicated that alcohol promotion had a reinforcing effect on young people's drinking, there was a paucity of research to establish whether or not it was implicated in the onset of drinking and harmful drinking patterns. Secondly, the evidence focused almost exclusively on traditional 'above-the-line' advertising (television, billboards, magazine advertising etc) and failed to take account of new, largely unregulated interactive media such as the web and the mobile phone. Thirdly, no attempt was made to examine the cumulative impact of marketing communications in establishing evocative alcohol brands. Finally, no one had checked for any differential effect on gender and by affluence and deprivation.

The study addressed these gaps and played a proactive role in developing an evidence-based policy to respond with countervailing social marketing and smarter regulation.

ISM Staff: Ross Gordon (now based at the University of Wollongong), Gerard Hastings, Douglas Eadie and Anne Marie MacKintosh

Co-Investigators: Dr Fiona Harris, Open University; Professor Avril Taylor, University of Paisley; Dr Amanda Amos, University of Edinburgh; Sally Haw and Mary Allison, NHS Health Scotland

Gordon R, Harris F, Moodie C and MacKintosh AM (2011). Assessing the cumulative impact of alcohol marketing on young people’s drinking: Cross-sectional data findings. Addiction Research and Theory, 19(1): 66-75.

Hastings G and Sheron N (2011). Editorial: Alcohol marketing to children. British Medical Journal, 342: d1767.

Hastings G (2011). Letter to Editor – Impact of alcohol marketing on youth drinking. Alcohol and Alcoholism, 46(4): 506.

Gordon R, Hastings GB and Moodie C (2010). Alcohol marketing and young people’s drinking: What the evidence base suggests for policy. Journal of Public Affairs, 10: 88-101.

Gordon R, Moodie C, Eadie D and Hastings GB (2010). Critical social marketing - The impact of alcohol marketing on youth drinking: Qualitative findings. International Journal of Nonprofit and Voluntary Sector Marketing, 15(3): 265-275.

Gordon R, MacKintosh AM and Moodie C (2010). The impact of alcohol marketing on youth drinking behaviour: A two-stage cohort study. Alcohol & Alcoholism, 45(5): 470-480.

Alcohol Marketing: Influence on Young People's Alcohol Consumption

(Commissioned by the World Health Organization)

At the 2001 World Health Organization Ministerial Conference on Young People and Alcohol considerable concern was expressed about the nature and pervasiveness of marketing and advertising by the alcohol industry. Explicit examples were shown of alcohol promotion exploiting the themes of sexual, sporting and lifetime success and achievement, often in direct violation of advertising codes. Furthermore, many of the advertising examples displayed images of excessive consumption. In addition, marketing stretches beyond the realms of billboards, magazine pages and television screens. The retail outlet, the price charged, packaging and even the alcoholic product itself are all open to marketing manipulation. The purpose of this review was to examine what evidence (if any) exists to demonstrate that marketing and advertising by the alcohol industry may influence young people's consumption of alcohol. It had the following objectives:

  • To identify the ways in which the alcohol industry markets its products to young people.
  • To examine the influence of alcohol marketing on young people's consumption of alcohol.
  • To include evidence from non-English sources, in particular, evidence from developing and transitional countries.

The results of the study were published in the WHO Monograph series.

ISM Staff: Emma Cooke (left 2002), Gerard Hastings and Susan Anderson (left 2005)

Hastings G, Anderson S, Cooke E and Gordon R (2005). Alcohol marketing and young people's drinking: A review of the research. Journal of Public Health Policy, 26: 296-311.

Young People and Alcohol
(Commissioned by the Health Education Board for Scotland)

Alcohol consumption among young people and young adults is an area of increasing concern, with regular drinking and drinking above the recommended limit being common in this age group. This study explored young people's perceptions of what constitutes safe drinking and factors that promote and protect against alcohol misuse. The findings were presented to The Scottish Advisory Council on Alcohol Misuse (SACAM) and contributed to the development of a Scottish strategy on alcohol misuse.

The report can be found on the Scottish Executive website.

ISM Staff: Susan MacAskill and Emma Cooke (left 2002)

Binge Drinking and Young People
(Commissioned by Gateshead and South Tyneside Health Authority)

This eight-month qualitative study explored young people's experiences of and attitudes towards binge drinking in the north-east of England and was design to inform local harm minimisation strategy and policy. The research employed a focus group design and an inductive approach to ensure that the emerging guidance was firmly grounded in the needs and values of the people for whom the programme was intended to benefit.

ISM Staff: Emma Cooke (left 2002) and Douglas Eadie

Cooke E, Eadie DR, Lowry R and Newbury-Birch D (2001). Research in progress: binge drinking and harm minimisation in the Tyne and Wear Health Action Zone. Alcohol Concern Information and Research Bulletin, 31(Winter): 5-6.

Management of Alcohol Misuse in Scottish Accident and Emergency Departments
(Commissioned by the Health Education Board for Scotland)

This study investigated the role of Accident and Emergency staff in the management of alcohol-related attendances, the prevalence and nature of alcohol-related attendances in A&E, current intervention procedures and A&E staff attitudes towards identifying and responding to alcohol-related attendances. The survey was conducted by means of a postal questionnaire, which was distributed to every A&E department and minor injury unit in Scotland. The results of the survey have been published in the journal 'Accident and Emergency Nursing'.

ISM Staff: Susan Anderson (left 2005) and Douglas Eadie

Anderson S, Eadie DR, MacKintosh AM and Haw A (2001). Management of alcohol misuse in Scotland: The role of A&E nurses. Accident and Emergency Nursing, 9: 92-100.

Designer Drinks and Young People
(Commissioned by the Health Education Board for Scotland)

The emergence, in the mid-1990's of a new range of fortified wines and strong white ciders (so called 'designer drinks') and the appeal of these drinks to under 18's was the focus of mounting public concern. This study, conducted on behalf of HEBS, was the first major primary research study to test claims about the appeal of designer drinks to under 18's.

Both qualitative and quantitative research was conducted with young people aged 12-17 in the West of Scotland. The qualitative research comprised eight focus group discussions while the survey was conducted with over 800 young people aged 12-17. The survey sample was drawn from the Community Health Index for Argyll and Clyde Health Board area using a multi-stage random procedure and a response rate of 78% was achieved.

The study found that adolescent drinking varied considerably between the ages of 12 and 17. Fourteen and fifteen-year-olds, in particular, were found to be keen to test their limits with alcohol and drink to intoxication although they did not necessarily like the taste of alcohol or enjoy the process of drinking. Designer drinks were seen to have particular characteristics that met the needs of this group by minimising the costs and maximising the effects of drinking. They appealed to young people, often more so than conventional drinks, and popularity peaked between the ages of 13 and 16. The brand imagery - in contrast with that of more mainstream drinks - matched many 14 and 15-year-olds' perceptions and expectations for drinking. Furthermore, consumption of designer drinks was found to be associated with drinking in less controlled environments, heavier drinking and greater drunkenness.

The study concluded that designer drinks were a cause for concern and highlighted the need for policy debate, assessing the desirability of these drinks and the extent to which further controls on marketing were required.

ISM Staff: Anne Marie MacKintosh and Gerard Hastings

MacKintosh AM, Hastings GB, Hughes K, Wheeler C, Watson J and Inglis J (1997). Young people, alcohol and designer drinks - conventional drinks are a much greater threat to health than designer drinks. British Medical Journal, 314: 1623. Letter

Hughes K, MacKintosh AM, Hastings GB, Wheeler C, Watson J and Inglis J (1997). Young people, alcohol and designer drinks: quantitative and qualitative study. British Medical Journal, 314: 414-418. Article

MacKintosh AM, Hastings GB, Hughes K, Wheeler C, Watson J and Inglis J (1997). Adolescent drinking: The role of designer drinks. Health Education,6: 213-224.


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