A content analysis of tobacco and alcohol content in Netflix and Amazon Prime original programmes accessed from the UK | Research Report

Quantifying tobacco and alcohol imagery in Netflix and Amazon Prime instant video original programming accessed from the UK: a content analysis.

Alexander B BarkerJordan SmithAbby HunterJohn BrittonRachael L Murray

Exposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. Previous UK research has quantified tobacco and alcohol content in films and broadcast television but not that of video-on-demand (VOD) services such as Netflix and Amazon Prime. Furthermore, it is not clear whether regulation by Dutch (Netflix) or UK (Amazon Prime) authorities results in differences in content. We report an analysis of tobacco and alcohol content in a sample of episodes from the most popular programmes from these two VOD providers, and compare findings with earlier studies of UK prime-time television content.

Content analysis of a sample of 50 episodes from the five highest rated series released on Netflix and Amazon Prime in 2016, using 1 min interval coding of any tobacco or alcohol content, actual or implied use, paraphernalia and branding.

bmjopen-2019-February-9-2--F1.medium
Number of 1 min intervals containing tobacco and alcohol content by coding category.

Of 2704 intervals coded, any tobacco content appeared in 353 (13%) from 37 (74%) episodes. Any alcohol content appeared in 363 (13%) intervals in 47 (94%) episodes. There were no significant differences between the two services, however the proportion of episodes containing tobacco and alcohol was significantly higher in VOD original programmes than those recorded in an earlier study of prime-time UK television.

bmjopen-2019-February-9-2--F2.medium
Alcohol branding seen in Netflix and Amazon prime instant video original programming.

Audio-visual tobacco and alcohol content is common in VOD original programmes and represents a further source of exposure to imagery causing smoking uptake and alcohol use in young people. This appears to be equally true of services regulated in the UK and The Netherlands. Given that VOD services are consumed by a global audience, it appears likely that VOD content is an important global driver of tobacco and alcohol consumption.

Strengths and Limitations of this study:

  • This study is the first to explore alcohol and tobacco content in video-on-demand (VOD) programmes.
  • Established methods were used to explore the content in VOD original content.
  • This study provides a comparison of VOD alcohol and tobacco content to UK broadcast television content.
  • This study is limited to a sample of programmes and episodes on each VOD service.
  • As viewing figures are not available for VOD original content, we could not estimate exposure to tobacco and alcohol content.

Correspondence to Dr Alex Barker; alexander.barker@nottingham.ac.uk

 

 

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Are young people under the influence of alcohol content on TV? – Research Report

Alex Barker, University of Nottingham Research Fellow.

Ofcom’s 9pm watershed might not be fit for purpose, argues Alex Barker.

Alcohol use at a young age is a strong risk factor for dependence in later life, and it is important to identify avoidable causes of alcohol consumption in young people. There is strong evidence to suggest that exposure to alcohol advertising or other alcohol imagery in the media increases use in adolescents.

Whilst the Ofcom Broadcasting code protects under-18s by restricting alcohol use in TV programmes made for children and preventing the glamorisation of alcohol use in programmes broadcast before the 9pm watershed or in programmes likely to be viewed by children, a previous study from 2010 found that there is a large amount of alcohol shown on prime-time UK television. We aimed to provide contemporary data on the amount of alcohol content shown in prime-time UK television.

In our study, A content analysis of alcohol content in UK television, published in the Journal of Public Health, we investigated the amount of alcohol content shown on UK television. We recorded free-to-air prime-time TV across the five main channels (BBC1, BBC2, ITV, Channel 4 and Channel 5) between the hours of 6pm-10pm during three separate weeks in September, October and November 2015. We then recorded the amount and types of alcohol content shown using 1-minute interval coding, which involves recording any alcohol content shown in every 1-minute period in the following categories; any alcohol content, actual alcohol use, implied alcohol use, alcohol related content (such as beer pumps or bottles), and alcohol branding.

We found that alcohol content is extremely common, occurring in 14% of intervals we coded, with alcohol content being seen in 67% of programmes and 47% of advertisement/trailer periods. We found alcohol use in 2% of the total intervals, implied use in 7% of intervals and alcohol related content, such as beer pumps, in 10% of intervals. Whilst branding was uncommon, 3% of intervals, 122 brands were identified, with three brands (Heineken, Corona and Fosters) accounting for almost half of all brand occurrences. The programme genres containing the most alcohol content were ‘Cookery’ (all cookery programmes included alcohol content), ‘Soap Opera’ (99% included alcohol content) and ‘Drama’ (94% included alcohol content). The majority of alcohol content was shown before the 9pm watershed, when programmes unsuitable for children are allowed to be broadcast. The amount of alcohol content was slightly higher than in the previous study.

The majority of branding occurred through the sponsorship of programmes, such as comedy on Channel 4 (sponsored by Fosters). Advertisements are regulated by the Advertising Standards Authority (ASA) and are expected to conform to the UK Code of British Advertising (BCAP code). According to the code, alcohol ‘may not be advertised in or adjacent to children’s programmes or programmes commissioned for, principally directed at or likely to appeal particularly to audiences below the age of 18’. However, programmes popular with or watched by large numbers of young people are not necessarily made specifically for them. Branding was also commonly featured in coverage of sports events, such as Heineken, which featured predominantly during the Rugby World Cup footage. The ASA’s definition of advertising does not include sponsorship of programmes or pitch side advertisements at televised sporting events. Exemption of prime-time television and sports programmes from alcohol advertising regulations has the potential to lead to significant exposure among young people during peak viewing hours.

Television remains a major source of alcohol exposure to young people in the UK and is likely to continue to be a contributor to alcohol uptake by young people. Our results suggest that the Ofcom 9pm watershed, designed to protect children and young people from harm, is currently not fulfilling its purpose in relation to commercial advertising and alcohol content in programmes. This has the potential to lead to significant exposure among young people during peak viewing hours, when approximately 4.5 million 7–14 year olds watch television. Tighter scheduling rules from Ofcom and the ASA, such as restricting alcohol content to after the 9pm watershed, could prevent children and adolescents being exposed to alcohol content and advertising.

Written by Alex Barker, research fellow in Epidemiology and Public Health, University of Nottingham. Originally posted on ias.org.uk on 4th Feb 2019.

Electronic cigarettes: First time on a Priority Setting Partnership Group

Louise Ross – Clinical Consultant, National Centre for Smoking Cessation and Training.

When I first got the invitation to join the Priority Setting Partnership (PSP) on electronic cigarettes, I had no idea what a PSP was or did, nor had I ever heard of the James Lind Alliance (JLA), the organisation that runs the PSPs.

Electronic cigarettes for smoking cessation image Thumbnail

However, because of what I do, I’m intensely interested in e-cigarettes as a means of stopping smoking and staying stopped, so I read on…

What an opportunity it has been! It’s early days yet, but already we have formed an interactive and lively group – academics, people with lived experience, researchers and practitioners. Our task? To find out what the public want to know about e-cigarettes and vaping.

When I say ‘the public’, this includes anyone who is curious to know more through research – it could be GPs, hospital doctors, vapers, smokers, policy-makers, pregnant women, homeless people, prisoners, stop smoking practitioners – anyone who has thought ‘I really would like to see research done about xxx to do with vaping/e-cigarettes’ can respond to the survey we are sending out in January.

We haven’t got long to road-test the survey, but the team at JLA (who told us at the first meeting about some of the other PSPs they’ve been working on – who knew all this public participation was going on in research circles?) have skilfully guided us through the early steps.

So in early 2019, we will launch the survey and sit back and wait for lots of replies.

Long-term health effects? Useful for stopping smoking? Second-hand vapour? Improvements in asthma?

If you have a burning question that you’d like to see included in the list of research priorities, do fill in the survey.

Then the real work will begin, sifting through the suggestions, and deciding which are the most crucial to answer. I’m confident that we have a well-balanced, engaged and knowledgeable group to tackle this task, and I’m proud to have been included.

Original post on the James Lind Alliance website. 

Tobacco content still common on UK prime time TV, despite regulations | Research Report

Tobacco content still common on UK prime time TV, despite regulations

Likely to heavily influence young people’s take-up of smoking, say researchers

Tobacco content remains common on UK prime time TV,  cropping up in a third of all programmes, despite advertising and broadcasting regulations designed to protect children from this kind of exposure, reveals research published online in the journal Tobacco Control.

The amount of exposure has hardly changed in five years, and is likely to heavily influence young people’s take-up of smoking, say the researchers.

Tobacco content in film has been covered extensively, but relatively little attention has been paid to its inclusion on prime time TV, despite the fact that children are likely to spend more time watching TV than they are films, they point out.

The researchers therefore analysed the tobacco content of all programmes, adverts, and trailers broadcast on the five national free to air TV channels between 1800 and 2200 hours during the course of three separate weeks in September, October, and November 2015.

Their analysis included any actual or implied use, such as holding a cigarette without smoking it, or making a comment about smoking; smoking/tobacco paraphernalia; and presence of branding in 1 minute intervals. The results were then compared with those of a similar analysis carried out in 2010.

In all, 420 hours of broadcast footage, including 611 programmes, 909 adverts, and 211 trailers, were analysed.

Some 291 broadcasts (17% of all programmes) included tobacco content. The channel with the most tobacco content was Channel 5, and the one with the least was BBC2.

Tobacco content occurred in one in three TV programmes broadcast, and nearly one in 10 (8%) adverts or trailers.

Actual tobacco use occurred in one in eight (12%) programmes, while tobacco related content–primarily no smoking signs–occurred in just 2 percent of broadcasts. Implied use and branding were rare.

 

Although most tobacco content occurred after the 9 pm watershed, it still occurred on the most popular TV channels before then.  And comparison with the previous analysis in 2010 showed that the number of 1 minute intervals containing any tobacco content increased, rising from 731 to 751 in 2015.

Tobacco advertising, promotion and sponsorship, including paid product placement in TV adverts, is banned in the UK, but tobacco imagery in TV programmes and trailers is exempt, and covered instead by media regulator, OfCom’s, broadcasting code.

This code is designed to protect children by restricting depictions of tobacco use in children’s programmes, and preventing the glamorisation of smoking in programmes broadcast before 9 pm.

“Audiovisual tobacco content remains common in prime-time UK television programmes and is likely to be a significant driver of smoking uptake in young people,” emphasise the researchers.

“Guidelines on tobacco content need to be revised and more carefully enforced to protect children from exposure to tobacco imagery and the consequent risk of smoking initiation,” they added.

‘The number of smokers in the UK has fallen significantly since 2010 yet this research finds smoking is just as common on our screens. Given the proven link to childhood smoking Ofcom and the BBFC, which regulate TV and films, need to take the necessary steps to warn parents of the risks and protect our children from the harmful effects of tobacco imagery.’ 

Deborah Arnott, chief executive of Action on Smoking and Health.


Notes for editors:

Research:  Content analysis of tobacco content in UK television doi 10.1136/tobaccocontrol-2018-054427

Journal: Tobacco Control

Link to Academy of Medical Sciences press release labelling system: http://press.psprings.co.uk/AMSlabels.pdf

Author contact: Dr Alex Barker, Division of Epidemiology & Public Health, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK. Email: alexander.barker@nottingham.ac.uk

Other links:
Tobacco on TV influences children, study finds | iNews

Smoking scenes are still common in a THIRD of prime time TV programmes despite strict regulations to protect children, finds study | Daily Mail

Stubbing out the public health problem of an era | Blog piece by Tim Coleman | #myresearchlegend

Sir Richard Doll had an illustrious career. Through his efforts, the world learned much about the causes of cancer and the dangers of asbestos, radiation and, of course, smoking. Following his research into smoking and lung cancer during the 1950s, the realisation dawned that tobacco use was the public health problem of the era and not a harmless pastime. We all know what’s happened since. How many other 20th century epidemiologists have had such a transformative impact on peoples’ understanding of the determinants of disease?

myresearchlegendricharddollblog

To what extent do I consider Sir Richard Doll to be a research ‘legend’? I’m not sure I’ve earned the right to bestow that honour, so I’ve taken advice. The Cambridge English Dictionary says a ‘legend’ is “someone very famous and admired, usually because of their ability in a particular area”. Just considering the one area of Doll’s work emphasised above, this is a no-brainer; ‘legend’ threshold is clearly surpassed. Don’t take my word for this, though, Google ‘Richard Doll’ and see if you can find reason to disagree.

Am I hasty in allocating ‘legend’ status? Doll certainly changed the world’s knowledge of many illnesses; shouldn’t an NIHR research legend demonstrate clear NHS impact too? Fortunately Doll’s influence here doesn’t disappoint, even if one again only considers smoking. I am a GP. How would this be different if Sir Richard had never lived? Firstly, I’d probably smoke. A pipe would give me more gravitas than cigarettes and I’d have to either smoke in my consulting room, like some doctors did, or schedule regular ‘pipe breaks’ into my day. I would be blissfully ignorant about harms from smoking and more likely to offer patients cigarettes than help with stopping, even if they developed lung cancer or heart disease.

Smoking Kills

Thankfully, Sir Richard did exist. Although I tried smoking as a teenager, a friend’s mum made me think again and I didn’t ever fully adopt the habit. Immature, teenage me was saved from smoking because Doll had shown how harmful smoking is. Fast forward to my GP work in 2018; again due to Doll, I fully realise that smoking kills my patients and wrecks their lives.

crop.jpgAlso, due to research which was only possible because of his early work, I can offer smokers numerous types of cessation support. It’s even possible to refer on to Stop Smoking Services (SSS) for specialist help, though a major cloud on the horizon is that these vital services are no longer universal; they are endangered.

Through their work at the Statistical research Unit of the MRC, Doll and Hill demonstrated that smoking causes lung cancer; before this smoking was ubiquitous across social classes and many doctors smoked. By 1954, the government accepted the link and the middle classes started quitting in droves. When he died in 2005, Doll would very likely have been delighted that UK smoking rates were falling fast. However, improvements were chiefly amongst the better off, so smoking had become disproportionately concentrated amongst society’s poorest. Given his well-documented non-conformist views, my bet is that he would have been saddened that those with most to gain benefited least from such massive social change. Nevertheless, he might have been heartened by the government’s national and vigorous action against smoking. Back then, although SSS were a very new NHS entity, it was mandatory for Primary Care Trusts to deliver them and SSS were closely performance-managed by the then Department of Health. Any smoker could access services’ evidenced-based support to increase their chances of permanent cessation.

Smoking Prevention

Worldwide, legions of researchers, including me, have followed Doll by trying to find ways of treating or preventing smoking. Few epidemiologists have caused such a seismic shift in the international research agenda. Take a look at the thousands of randomised controlled trials (RCTs) reviewed in the tobacco section of the Cochrane Library. All of these studies test interventions against smoking. This necessary work continues today and NIHR is a leading supporter funding, for example, the largest ever RCTs of Nicotine Replacement Therapy used in pregnancy* or for ‘preloading’.

The NHS is 70. Celebrating research legends is a great idea but it’s important we remember what they did and why they are lauded. It took almost half a century after Doll and Hill’s landmark paper for the NHS to implement national treatment services for smokers, and sadly less than 20 years later these have become an optional extra with patchy coverage across the country. Smoking is less prevalent than in the past but there are still millions of UK citizens who want to stop and can’t manage this alone. Smoking is still a national problem and requires a national NHS response. A crucial component of this response should be to help quitters by giving them the very best support.

Sir Richard’s work has had a great impact, as all research should. The demise of SSS suggests we risk forgetting this when instead we should continue to build on his significant achievements.

*More information on the trial: Double-blind, randomised, placebo-controlled trial of nicotine replacement therapy (NRT) in pregnancy – SNAP is available on the NIHR Journals Library website.

Tim Coleman, Professor of Primary Care, Faculty of Medicine & Health Sciences
University of Nottingham and NIHR Senior Investigator

The NIHR is highlighting seven research legends whose work has shaped the NHS, as part of its celebrations for the NHS’s 70th birthday and the NIHR’s I Am Research campaign.

Original post on NIHR website. – Posted: 04 May 2018

Alcohol Policy in Practice | Continuing Professional Development Course | 11th-13th September 2018

Following the successful Alcohol CPD courses held in 2014-2017; we are delighted to announce the line-up for our 2018 course, featuring some exciting new inputs!

This year’s course will feature inputs from Prof. Anna Gilmore and colleagues from the University of Bath, Dr Carol Emslie from Glasgow Caledonian University, Dr James Nicholls from Alcohol Research UK, and Professor Karine Gallopel-Morvan from the EHESP School of Public Health, France. We also welcome the return of highly-rated inputs from leading experts such as Katherine Brown from the Institute of Alcohol Studies and Colin Shevills of Balance North East.

What previous participants said:

“Great range of content and world-class speakers. Organisers did an amazing job including looking after us all while we were here. The mix of lectures / Q & As / panel discussions was great. Really worth taking time away from work/home to attend this.”
“Extremely informative course and relevant to current alcohol policy challenges. Good venue, convenient location and lovely setting. Module well organised and brilliant range of speakers.”
“Thank you very much. It was a great privilege to listen and attend this course. Lectures and lecturers were outstanding.”
“Very informative useful training, well worth my time and travel.”
“Wonderful networking opportunity.”
“Thank you for such a brilliant training event – the content was spot on, all the presentations and sessions were really, really good and I came away feeling that I had learned masses: a rich diet of fact and opinion. I can honestly say that I have rarely – if ever – enjoyed such an event quite as much as this one.”

Anyone wishing to gain an in-depth understanding and up to date insight into evidence and innovative practice in alcohol policy in the UK and internationally.
Previous participants have included people working in public health, local and national alcohol policy, or alcohol research; from Iceland to New Zealand.
Places are filling up fast and the early-bird rate applies until Friday 15th June 2018! 

Apply Here!

New Systematic Review: Effectiveness of Mass Media Campaigns to Reduce Alcohol Consumption and Harm

This systematic review, published in Alcohol and Alcoholism, assessed the effectiveness of mass media messages to reduce alcohol consumption and related harms. Eight databases were searched along with reference lists of eligible studies. Studies of any design in any country were included, provided that they evaluated a mass media intervention targeting alcohol consumption or related behavioural, social cognitive or clinical outcomes. This was the first comprehensive systematic review of evidence of the effectiveness of mass media to reduce alcohol consumption, allowing those who make decisions about whether and how to develop and implement such campaigns to do so informed by a synthesis of the evidence base.
a&a1The search produced 10,212 results and 24 studies were included in the review. Most of the campaigns used TV or radio in combination with other media channels. There was little evidence of reduction in alcohol consumption associated with exposure to campaigns based on 13 studies which measured consumption, although most did not state this as a specific aim of the campaign. There were some increases in treatment seeking and information seeking and mixed evidence of changes in intentions, motivation, beliefs and attitudes about alcohol. Campaigns were associated with increases in knowledge about alcohol consumption, especially where levels had initially been low.The evidence suggests mass media health campaigns about alcohol can be recalled by individuals and can achieve changes in knowledge, attitudes and beliefs about alcohol, based mainly on weak quality studies. Findings of studies that measured alcohol consumption suggest campaigns have not reduced consumption, although most did not state that they directly aim to do so.

The finding that campaigns can be recalled suggests appropriate media channels, targeting strategies, durations and intensities have been utilized to reach target audiences. These campaign characteristics were not always reported by studies so it is not possible to draw a link between types of campaign strategies and levels of recall or exposure. Recall of tobacco mass media campaigns has been shown to be positively associated with smoking cessation (Jepson et al., 2007) so the outcome may be an important first step towards subsequent behaviour change in populations.

Most campaigns that aimed to improve knowledge were shown to be effective. This was particularly evident in areas where knowledge was initially low, for example, knowledge of unit consumption guidelines and of the link between alcohol and cancer. Mass media can yield sustained knowledge, which may lay the groundwork for reductions in consumption that are achieved using other public health measures.

There was evidence of increases in information seeking and treatment seeking. However, alcohol campaigns have not presented the simple call to action of tobacco messages (‘quit’) or provided offers of tangible help such as ‘quitlines’. Furthermore, as alcohol support services have historically been aimed at very heavy drinkers there may be a perception that current services do not cater for those who drink less. Mass media might therefore have limited utility in promoting service uptake.

Most studies found no impact on alcohol consumption, consistent with the conclusion of a previous review that there should be modest expectations of behaviour change from such campaigns (Snyder et al., 2004). Longer term evaluations conducted following sustained and repeated exposure to campaigns might be expected to be better able to detect effects on behaviour. However, the relationship between tobacco mass media campaign duration and effectiveness has been difficult to gauge due to confounding influences and trends over time (Durkin et al., 2012). The context in which alcohol health promotion campaigns operate is particularly challenging because of the ubiquity and power of alcohol marketing (de Bruijn et al., 2016) and pro-alcohol cultural norms (Gordon et al., 2012). This is another key difference to tobacco, where health campaigns in recent years have run in a context where most tobacco marketing has been banned or strictly regulated and social norms have become increasingly anti-smoking. The current review found evidence of impact on short term intermediate outcomes, suggesting mass media can play a supportive role for other actions which are more likely to have an impact on behaviour. These might include price-based measures (Babor et al., 2010), advertising restrictions (Siegfried et al., 2014), limiting availability and access to alcohol (Anderson et al., 2009) with the targeting of high risk groups (Foxcroft et al., 2015).

Alcohol and Alcoholismhttps://doi.org/10.1093/alcalc/agx094
Published: 10 January 2018