COUNTER-MARKETING:
APPLYING LESSONS
LEARNED FROM TOBACCO
CONTROL TO ALCOHOL
AND BIG FOOD
Cheryl Healton, DrPH
APHA ANNUAL MEETING
NOVEMBER 6, 2013
PA R A L L E L TA C T I C S :
TO B A C C O , A L C O H O L A N D F O O D
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TA R G E T I N G Y O U N G W O M E N
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F O O D A N D FA S H I O N , A L C O H O L A N D
WEIGHT
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TYSONS’ CHICKEN NUGGETS AD
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THE PROBLEM IS GLOBAL
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TA R G E T I N G Y O U T H
• Extensive formative research is used to develop
products and ad campaigns that appeal to the
audience
◦ “Alcopops” and caffeinated alcoholic beverages are
new products which appeal to youth (Mart, Substance
Use and Misuse, 2011)
• Food industry can do this openly, unlike tobacco and
alcohol; Advertising and sponsorship is prevalent and
mostly unchallenged by the public (Daynard, 2002)
• Teen Attitude And Behavior Survey (TABS) of Philip
Morris is a potential example of market research.
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CRITICAL USE OF BRANDING
• Brands are a means of self-expression; youth
are particularly sensitive to the messages they
convey to peers through brand choices.
• Tobacco industry has some of the most wellknown brands in the world
◦ A study of tobacco brand awareness among youth
showed that, among 8th grade students, 95%
recognized Joe Camel and 55% recognized the
Marlboro Man. Previous research showed
kindergarteners equally recognized Mickey Mouse and
Joe Camel.
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FRAMING THE ISSUE
•The tobacco industry frames smoking as
a “personal choice”
•The food industry is following this lead,
unhampered by issues such as SHS
•This argument dampens public will to
enact policy to reduce development,
marketing and consumption of products
that contribute to poor diet and
overweight/obesity
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CO-OPTING INFLUENTIAL
O R G A N I Z AT I O N S
• Content disseminated by organizations that
seem to be neutral or protective of the
consumer (i.e.: American Dietetic Association)
is supplied by industry
• Other organizations (National Restaurant
Association) resist policy change even when
data show no negative impact
◦ Studies show that business improves when
restaurants go smoke-free, but NRA does
not embrace this research
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SHAPING POLICY
•As with tobacco, food and alcohol
industry executives are involved with
shaping relevant policy (nutrition
guidelines for example)
•Industry language is often adopted
verbatim
•For a variety of reasons, government
officials may value business interests over
public health
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INFLUENCING SCIENCE AND
PERCEPTIONS OF SCIENCE
• The tobacco industry notoriously bought a
great deal of biased science for the purpose of
creating a “debate” about the health effects of
tobacco
• Studies sponsored by the food industry are
biased in favor of the industry (Vartanian et al.,
AJPH 2007)
• The alcohol industry is pursuing this tactic now
(Babor; Miller et al. both in Addiction, 2011)
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BUYING PUBLIC TRUST
• Tobacco industry gives significant sums
to communities—particularly low-income,
minority communities—for the arts and
other programs
• These actions reduce public will for
regulation
• Is the food industry following suit?
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BUYING TRUST AMONG CONSUMERS
• Two tobacco companies disseminated national
mass media campaigns, ostensibly to prevent
youth smoking
◦ The Philip Morris campaign was found to
be counterproductive; it increased
likelihood that a young person would
smoke in the coming year (OR 0.64 (won’t
smoke), p=.05)
• What are the effects of food and alcohol
messaging?
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P R O F I TA B I L I T Y
• “If consumers’ demand for food were to reflect
what they needed to maintain a healthy weight,
the market would contract.”
◦ Brownell and Warner, 2009.
• “Every year, P. Morris gains 1.3 share points
due to their strength among YAS while RJR
loses 0.6 points annually....RJR will lose a lot of
business if its decline among YAS continues...”
◦ RJR: Bates No. 507241613/1838
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U S E M A S S M E D I A TO E D U C AT E A N D
PERSUADE CONSUMERS
• The truth® campaign: a branded, national
smoking prevention campaign designed to
reach at-risk youth, 12 to17, primarily through
edgy television advertisements with an antitobacco-industry theme.
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KEY ELEMENTS OF THE TRUTH®
C A M PA I G N
1. truth® is a brand; competes with industry
brands
2. truth® talks to teens in their own voice, and
does not talk down to them
3. Highlights the actions of the tobacco industry
in marketing cigarettes, including its failures
to be truthful about cigarettes’ addictiveness
and health effects
◦ (Columbia Marketing Panel, 1996;
McKenna et al., 2000).
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DEVELOPING AN EFFECTIVE MEDIA
C A M PA I G N
•Base the campaign on scientific evidence
•Define the target audience fairly narrowly;
you won’t be able to influence everyone
•Conduct extensive formative research with
the target audience; they drive the effort
•Pre-test messages
•Consider using new media channels
(online, mobile, gaming)
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S T R O N G , O N G O I N G E VA L U AT I O N
Awareness
• American Journal of Public Health, 2002
◦ 75% of all youth (12-17) in the U.S. can accurately describe
a truth ad
◦ Awareness is linked to attitude and belief change
Behavior Change
• American Journal of Public Health, 2005
◦ 22% of the U.S. decline in youth smoking (1999-2002)
attributed to truth
◦ About 300,000 fewer smokers as a result of truth
• American Journal of Preventive Medicine, 2009
◦ Longitudinal analysis; cumulative exposure associated with
a 20% decrease in risk of initiation
◦ 450,000 fewer smokers as a result of truth
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PUBLISH
•In peer-reviewed journals, to expand
the science base
•In news and entertainment outlets;
media coverage extends the reach of
your campaign
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E X P E C T, P R E PA R E F O R L I T I G AT I O N
• Hard-hitting campaigns: anticipate a lawsuit.
• Lorillard tried to shut down Legacy through
litigation, based on the claim that the truth
campaign “vilified” and “personally attacked”
them in violation of the MSA
• The long legal battle consumed financial and
human resources that would have been
otherwise spent on public health
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I N D U S T RY AT TA C K S O N T H E 2 0 0 9
FSPTCA
• The industry has adopted a strategy of attacks
designed to delay, weaken and burden the
agency’s ability to implement the law:
• Litigation
◦ Broad constitutional challenge to numerous provisions
◦ Lawsuits seeking to block implementation of the
graphic warning labels; challenging composition of the
tobacco products scientific advisory committee
• Administrative processes
◦ Filing voluminous comments opposing nearly
everything the FDA is proposing, with particular focus
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on derailing a menthol ban
P R E S S U R E I N D U S T RY T O D R O P
I N A P P R O P R I AT E P U B L I C R E L AT I O N S E F F O RT S
• A 2002 Legacy study showed that exposure to
Philip Morris’ “Think. Don’t Smoke” campaign
was associated with a greater likelihood of
intending to smoke within the next year (p =
0.05).
• Shortly after the publication of the study, and a
public call from Legacy for them to take the ads
off the air, Philip Morris ended the ad campaign.
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THANK YOU