Resources for finding additional information needed to support

advocacy campaigns

Part B: Module II

Good evidence makes good advocacy

• Minimum legal purchase age

• Government monopoly

• Restriction on hours or days of sale, outlet density

• Alcohol taxes• Lower alcohol

strength

• Random Breath Testing

• Lowered BAC limits• Administrative license

suspension• Graduated licensing

for novice drivers• Brief interventions for

hazardous drinkers• Treatment and detox

Data on young people and alcohol• Rates of harm:

– Mortality rates associated with alcohol

– Accident and injury rates– Rates of crime associated with

alcohol– Number of drink driving offences/

road traffic crashes related to alcohol

– Morbidity rates (e.g. liver disease, heart disease, cancer, FASD)

– Suicide rates– Poor performance at school– Sexual health problems and

unwanted pregnancies

• Consumption levels and attitudes towards drinking:– Prevalence of drinking

for different age groups– Average age of onset of

regular drinking– Rates of ‘heavy episodic’

or ‘binge’ drinking

• Current regulations and alcohol controls – e.g. age/licensing restrictions in individual countries.

Useful databases

• The World Health Organization Global School-based Student Health Survey (WHO GSHS)

• WHO Global Status Report on Alcohol Policy• The European Schools Survey Project on Alcohol and

Other Drugs report (ESPAD)• The Health Behaviour in School Children study (HBSC)• European Monitoring Centre for Drugs & Addiction

(EMCDDA)• Youth Risk Behavioral Surveillance System (YRBSS)• Behavioural Risk Factor Surveillance System (BRFSS)

Tips and Suggestions

• Use the most recent statistics available• Report trends over periods of time to help put

the data into perspective• Relate to the geographical area most relevant

to your target audience*Remember, when referencing data, the source must always be credited.

Conducting surveys/opinion polls

• Available national and regional opinion polls • Add questions to existing surveys• Collect data from general public and key

stakeholders • Coordinate school surveys with advocacy

campaigns• Use online tools– www.surveymonkey.com– www.dotsurvey.com– www.freeonlinesurveys.com

Designing survey questionnaires

• Begin with an explanation of who’s leading the research, why the data is being collected, and what is going to happen to the data after it has been submitted

• Adhere to ethical principles • Consult a survey expert• Keep it as short as possible• Use incentives• Word questions carefully (short and direct)• Use open-ended questions sparingly • Pilot the survey

Needs Assessment Exercise: Establishing the Need for Alcohol Policy

• Consult local and national resources such as school surveys, morbidity and mortality statistics, drinking-driving arrest data, alcohol-related emergency department admissions, etc.

• Use the Global Burden of Disease data base as well as WHO national statistics

• Review current concerns, existing policies, and the extent to which policy is evidence-based.

• Conduct interviews and focus groups with policymakers • Conduct attitude surveys of public support for alcohol

policies.

Part C: Dealing with “Junk Science:”

How to deal with the alcohol industry’s research and prevention

programs

Corporation-induced Diseases (+Disorders, Disability and Social Harm)

• A generic concept applied to diseases and other health conditions attributed to consumption of hazardous industrial products such as tobacco, alcohol, food, guns, and gambling machines

• Harm caused to consumers, workers, or community residents who have been exposed in the marketplace, work site or community, to disease agents that are part of the products of corporate activity

• Jahiel, R. (2008) Corporation-induced diseases, upstream epidemiologic surveillance, and urban health. Journal of Urban Health. 85, 4, 517-531.

Case Study- Finland

By 2005 alcohol-related problems were the most common cause of death among Finns of working age

In 2004, a dramatic cut in prices via taxes led within a year to an increase of 9% in consumption

Limited alcohol control policies

Government

Alcohol industry pressures; partnerships; lobbying

Cumulative Growth in Alcohol IndustrySocial Aspect/Public Relations Organizations

Sources: Witheridge (2003), Anderson (2005), ICAP (2006)

Social Aspect Organizations:Ostensible Role

•Support youth prevention activities•Support scientific research•Promote road safety and crime reduction

Actual Role of Social Aspect Organizations

•Public relations•Lobbying for industry-favorable policies•Neutralize opposing views and criticism•Promote industry-favored scientists•Oppose unpopular but effective policies•Support ineffective but popular policies

Corporate Practices that Influence Alcohol and Tobacco Use and Misuse

• Product design -- modifications of product increase sales, profits or market share

• Marketing -- advertising and product promotions increase sales and market share, attract new customers and retain customer loyalty

• Retail distribution -- activities such as convenience make alcohol and tobacco more accessible to consumers

• Pricing -- product costs increase sales, profits, and market share

• Political influence – lobbying, political contributions, and public relations activities can affect the policy environment

Areas where industry interests interact with addiction science

• industry sponsorship of research funding organizations• direct financing of university-based scientists and centers • research conducted through contract research organizations • research conducted by trade organizations and SAPROs• publication of scientific documents and support of scientific

journals• sponsorship of scientific conferences and presentations at

scientific conferences• efforts to influence public perceptions of research, research

findings and alcohol/tobacco policies

Areas where industry interests interact with practice and policy

• Industry sponsorship of prevention programs, especially alcohol and tobacco education

• Industry self-regulation of advertising• Industry “social responsibility” advertising messages• Industry positions on effective alcohol and tobacco

policies• Industry involvement in writing national alcohol

policies

History of the tobacco industry in relation to scientific research

• Misuse of science and scientific information to market their products to vulnerable populations and to make cigarettes more addictive

• Internal documents show that the tobacco industry has used university-based scientists to oppose health policies designed to prevent diseases caused by cigarette smoking

Questions for Discussion

• What is the impact of corporate practices on population health?

• Is industry collaboration (“partnerships”) with the scientific community, public health advocates and prevention professionals mainly designed to achieve their business objectives?

• What should be done about corporate intrusions into science and practice?

• Is there an opportunity to channel corporate responsibility into needed funding for research, prevention and treatment?

ICAP Survey of Health Authorities

• An international survey of 114 national health authorities

• Solicited views about alcohol policies and partnerships with the alcohol industry

• 42% response rate• Concluded that alcohol education was a

priority areas for partnerships, especially in developing countries

Efforts to influence public perceptions of research

• California Wine Institute publications and its website: 1) made exaggerated claims about the health benefits of alcohol and wine; 2) regularly omitted the cautionary statements made by scientists whose studies it cited; and 3) failed to mention the health risks of alcohol consumption (Steinhardt and Hacker, 1997).

• Representatives of Portman Group nominated to sit on governmental advisory counsels charged with research funding and policy (Alcohol Education and Research Council)

• Portman Group invited criticism of the book, Alcohol Policy and the Public Good (Edwards et al., 1994)

• Representatives of Portman Group contribute to drafting of "A Harm Reduction Strategy for England"

• Critique of Swiss tax study (Gmel, et al., 2005) by economist paid by Groupement Suise des Spirituex de Marque

• Distilled Spirits Council of United States supports letters to the editor questioning the methodology of an NIH study concluding that alcohol advertising is associated with increased alcohol use by youth

Does industry funding affect alcohol policy and program effectiveness?

• One study reported that industry funding of programs to prevent underage drinking was associated with an abandonment of a less expensive compliance check program

• Alcohol industry opposition to advertising bans in favour of self-regulation exposes millions of youth to alcohol marketing

• Industry opposition to alcohol taxes and availability restrictions leads to the adoption of less effective or ineffective policies (e.g., alcohol education campaigns, designated driver programs) in many countries.

Can industry funding bias research findings?

• In a comparison of the conclusions of 24 published review papers, Jorgensen et al. (2008) found that industry supported reviews of drug medications had more favourable conclusions than corresponding Cochrane reviews of the same drugs, and were also rated as being of lower methodological quality.

• Studies of anti-hypertensive drugs funded by a single drug company have a 55% rate of favourable results, compared with 18% if they are not funded by an industry source (Yank et al. (2008).

• In a review of breast cancer clinical trials, it was found that pharmaceutical industry involvement may affect study design, focus and results (Peppercorn et al., 2007). Studies that reported drug company sponsorship were more likely to be positive than non-sponsored studies (Bekelman et al., 2003).

Can industry funding bias research findings?

• A growing number of studies have shown that conflicts of interests in health research are associated with biased research findings that favor commercial interests at the expense of patient health

• It is 3.5 times more likely a study will yield a positive result about a product if that study is funded by industry (DeAngelis, 2007)

• In several integrative reviews of the evidence it has been argued that not only does this compromise scientific integrity, it also decreases public trust in research. (FASED, 2007; Brennen et al., 2007; Kassirer, 2005; Krimsky, 2003).

What is the extent of industry involvement in alcohol research and prevention?

• Despite claims that the industry devotes millions to health-related alcohol research and prevention, the evidence suggests a rather small direct contribution, one that is unlikely to contribute to alcohol science, lead to prevention breakthroughs, or reduce the burden of alcohol-related illness.

What is the proper role of scientists and prevention professionals?

• Alcohol scientists should be very wary about accepting research funding directly from the industry, its trade associations or SAPROs.

• Consulting arrangements wherein scientists are paid to critique the work of other scientists constitute a serious financial conflict of interest

• Acceptance of fees for book chapters, background reports, attending conferences and prevention activities should be prefaced by the following questions: 1) To what extent is the activity designed to promote the commercial interests of the alcohol or tobacco industries? 2) Will the funding source be acknowledged?

• Funding from independent organizations (e.g., ABMRF and ERAB) may be consistent with scientific and public health aims if the grant review process is independent, transparent and peer reviewed. But scientists and prevention professionals need to be careful that their objectivity and independence are not compromised by fraternizing with industry executives, paid travel to meeting sites, and consulting fees.

What about industry-sponsored dialogues and "partnerships" in relation to public health issues?

• The “hands-off” position: refuse to engage in communication or collaboration with industry representatives, based on the assumption that the industry’s commercial interests are incompatible with the values and aims of public health and with scientific research.

• The “hands-on” approach: engage in dialogue with industry representatives, accept industry funding, and participate as “partners” in industry-funded scientific activities as long as independent judgment is maintained

A third way – Engage with the industry only when it promotes the interests of science and public health

• Insist on industry support for evidence-based policies, and cessation of anti-scientific lobbying activities, as a precondition for dialogue about partnerships with scientists and prevention professionals

• Encourage monitoring of industry activities using advanced social science methods

• Be attentive to organizational legitimacy issues• Conduct ethical hazard inventories before engaging in any

partnerships, prevention initiatives, or mutual scientific activities• Engage professional scientific organizations and NGOs in a critical

review of industry-science relationships• Insist on rigorous adherence to Conflict of Interest principles

Should the alcohol and tobacco industries pay for the societal costs of research, prevention and policy?

• The attributable burden can be estimated• The costs can be estimated• It is agreed that alcohol and tobacco are no

ordinary commodities• General and dedicated taxation are

accepted by governments and industry