Authors: Kate Robaina, MPH, Thomas Babor, PhD, MPH & Jonathan Noel, MPH (2016).
Title: Evaluating compliance with alcohol industry self-regulation in seven countries in Africa. An external evaluation of the MAMPA (Monitoring Alcohol Marketing Practices in Africa) project.
The Monitoring Alcohol Marketing Practices in Africa (MAMPA) Project was a public health surveillance program devoted to monitoring alcohol marketing activities in the African region as well as youth exposure to these marketing activities. The first project report was the subject of a World Health Organization (WHO) technical meeting in Brazzaville in 2012, where it was recognized that MAMPA had methodological limitations that precluded definitive conclusions about the extent to which alcohol marketing in four countries within Africa violated international guidelines regarding the exposure of young persons to potentially harmful advertising content. It was recommended that content of advertisements should be analyzed using a coding scheme developed by a panel of experts.
Following the meeting, the WHO Regional Office for Africa asked researchers from the University of Connecticut School of Medicine to systematically evaluate the marketing materials collected as part of the MAMPA project, and to expand the study to include the second wave of data collected from three other sub-Saharan African countries: Kenya, Malawi, and Namibia.
The purpose of this report is to describe the results of an independent analysis of the MAMPA data. The specific aims of the re-analysis of the MAMPA marketing data were: 1) to provide estimates of the prevalence of code violations in alcohol advertisements within and across these seven African nations, 2) to determine which sections of the Code were violated most often; 3) to determine if different producers and media had more violations than others; and 4) to test the feasibility of a new standardized rating procedure to evaluate code violations in alcohol marketing materials (Babor, Xuan & Damon, 2013a). Developed initially for television and print media, the procedure is applied for the first time in this study to radio ads and outdoor advertisements.
Ethnographic field methods were used to collect marketing materials from rural and urban areas of seven countries: Ghana, Nigeria, Uganda, the Gambia, Kenya, Malawi and Namibia. These countries were selected to provide a range of social availability climates (according to religion and culture) and regulatory environments (ranging from a ban on alcohol advertising to only partial restriction).
Examples of unique marketing materials (N=282) used by both domestic and foreign alcohol producers were obtained by trained observers recruited from public health NGOs and research NGOs working on alcohol prevention and operating at the national level within each country. Observers were trained to collect digital recordings of visual stimuli across four types of media: TV, radio, print and outdoor advertising. In order to conduct this secondary analysis of the data collected in the original four MAMPA countries and in the three additional countries, all unique alcohol ads from each country were identified from the available recordings and abstracted into individual video, audio, or image files.
Because of between-country variation in alcohol marketing regulations, a set of guidelines developed by the alcohol industry (ICAP’s Guiding Principles: Self-Regulation of Marketing Communications for Beverage Alcohol) were chosen as the standard code to compare all advertisements. Using an objective Delphi rating procedure developed and validated in prior alcohol marketing research (Babor, Xuan & Proctor,
2008; Babor et al., 2013a), the ads were subjected to an evaluation by 9 trained raters across two rounds, the second of which allowed the raters to see the average ratings of the group. Each rater had experience in public health, substance use, or public health, and was considered to have the necessary expertise to protect vulnerable populations. Raters were from Kenya, Malawi, Nigeria and the US. Interrater reliability between the raters was assessed using violation level and item-level data and was found to be high.
In total, 282 unique examples of alcohol advertising were analyzed. Observers collected the largest number of marketing examples in Uganda (25.2% of all examples) and Nigeria (24.8%). The Gambia, where there is a ban on alcohol advertising, contributed only 1.4% of the total ads collected. Over seventy percent (70.6%) of ads collected from all countries were obtained from outdoor media (billboards, posters, signage, etc.).
Overall, 78 advertisements (27.7%) were found to contain at least one violation, representing an industry compliance rate of 72.3%. Advertisements collected from Kenya were the most likely to contain a violation. Guiding Principle 5, which refers to “the effects of alcohol,” accounted for the largest number of violations (77 ads). This guideline was most often scored as a violation because of the suggestion that alcoholic beverages can enhance attractiveness and/ or remove social or sexual inhibitions (n=51) and/ or presenting alcohol as necessary for social success or acceptance (n=63). The second most frequently violated guideline was Guiding Principle 3 (69 ads), which speaks to health and safety aspects in marketing communications. This principle was most often violated for presenting alcohol as a stimulant, sedative or tranquilizer (50 ads), and suggesting that alcohol can “prevent, treat or cure illness or resolve personal problems” (29 ads).
Violation rates significantly differed between media (p = <.001), with television ads having the highest proportion of violations (72.2%) and outdoor ads having the lowest (21.6%). Certain types of outdoor ads, however (e.g. billboards and posters), contained higher violation rates (37.3% and 30.8%, respectively).
The findings suggest that code violations of the ICAP Guiding Principles were prevalent in the four types of media sampled during the MAMPA project in the seven countries. It is interesting to note that the country with the fewest marketing materials recorded (n = 4) was The Gambia, which is a Muslim country with a ban on most forms of advertising. Despite the limitations of the prior MAMPA project and the current re-analysis, this research establishes a basis for a monitoring and regulating alcohol advertising in African countries. The methodology offers a systematic way to evaluate media advertisements of alcoholic beverages to determine whether their contents comply with generally accepted guidelines for responsible advertising practices.
Based on the evidence described above, governments and policymakers should give serious consideration to the key messages emerging from the Consultative meeting on addressing alcohol marketing in the African Region (WHO, 2012) and from the PAHO Expert Meeting on Alcohol Marketing Regulation (PAHO,
2016), which are consistent with the well-documented premise that alcohol is not an ordinary commodity (Babor et al., 2010) and should not be marketed as such.
These findings provide evidence of violations in the seven countries studied and the need for systematic surveillance of alcoholic beverage marketing to protect vulnerable populations such as youth, who may already be experiencing problems related to their alcohol use.
Our secondary analysis of the original MAMPA marketing data confirms the conclusions of the original MAMPA report, in that it provides strong evidence of code violations in all media evaluated, and suggests that exposure to potentially harmful alcohol marketing content is widespread in six of the seven countries studied. These reports also raise questions about the effectiveness of current industry efforts to regulate alcohol marketing.