Presented by Nongnuch Jaichuen Alcohol-Branded Merchandise and Alcohol Consumption in Thai Youth: a Loophole for Brand Advertising and Legislations Crisis in Thailand Nongnuch Jaichuen 1, 2, Sopit Nasueb 1,2, Surasak Chaiyasong 3, and Thaksaphon Thamarangsi 1,2 1 Health Promotion Policy Research Center (HPR) – Thailand 2 International Health Policy Program (IHPP) – Thailand 3 Facutly of Pharmacy Mahasarakham University – Thailand Good morning everyone. I am delighted to present to you Alcohol-Branded Merchandise and Alcohol Consumption in Thai Youth: a Loophole for Brand Advertising and Legislations Crisis in Thailand. Presented by Nongnuch Jaichuen

Outline Introduction Objective Conceptual framework Methodology Result Conclusion Recommendations section 32 in the Alcohol Control Act B.E. 2551 (2008) stated that any advertisement or public relation which made by manufacturers of alcoholic beverage of all kinds is able to conduct only for the purpose of giving information or creative knowledge without displaying pictures of the products or packages, except for the display of symbol of such alcoholic beverage or the symbol of the company manufacturing the alcoholic beverage. Ministerial Regulation: Criteria and Conditions for Displaying the Symbol for Advertising or Public Relations of Alcoholic Beverage B.E. 2553 (2010) [กฎกระทรวง กำหนดหลักเกณฑ์และเงื่อนไขการแสดงภาพสัญลักษณ์เพื่อประกอบการโฆษณาหรือประชาสัมพันธ์เครื่องดื่มแอลกอฮอล์ พ.ศ.2553.] Notification of the Alcohol Beverage Control Committee: Pattern and Method for the Display of Symbol of Alcoholic Beverage or Symbol of the Company Manufacturing the Alcoholic Beverage B.E. 2553 (2010). [ประกาศคณะกรรมการควบคุมเครื่องดื่มแอลกอฮอล์ ว่าด้วยรูปแบบและวิธีการแสดงข้อความคำเตือนประกอบภาพสัญลักษณ์ของเครื่องดื่มแอลกอฮอล์ หรือภาพสัญลักษณ์ของบริษัทผู้ผลิตเครื่องดื่มแอลกอฮอล์ พ.ศ.2553]

Introduction Alcohol-Branded Merchandise; ABM are the things which have the brand logo of alcohol beverages. ABM is a way to advertise alcohol. Many support the idea of legislations against promoting ABM as a means to prevent youth from health demoting behaviors. There is limited evidence indicating a relationship between ABM and alcohol consumption by Thai youth. Let start with Alcohol-Branded Merchandise or ABM. ABM are the things which have the brand logo of alcohol beverages. ABM consist of commodities sold or distributed for free or through special campaigns. Therefore, ABM includes clothing and other commodities with alcohol brands. ABM has been a marketing tool of the alcohol industry to promote their products, particularly in recent times. Moreover, the evidence suggests that there is an association between ownership of ABM and initiation of drinking as well as underage binge drinking. In Thailand, there is limited evidence pointing to ABM and alcohol consumption of Thai youth.

Introduction The regulation of alcohol marketing, revised in 2008 and 2010, covers three aspects of advertising: time of promotion, which bans broadcast advertisements between 5 a.m. to 10 p.m. the content of promotions, which restricts any content concerning drinking persuasion and beverage properties, as well as requiring warning messages to be attached. the warning label must show on the container and advertising on mass media such as television, radio, cinema, and print media such as poster, billboard, or vehicle media. The current alcohol advertising policy prohibits an advertising of the products. The regulation of alcohol marketing, revised mainly in 2008 and 2010, covers three aspects of advertising: time of promotion, which bans broadcast advertisements between 5 a.m. to 10 p.m. the content of promotions, which restricts any content concerning drinking persuasion and beverage properties, as well as requiring warning messages to be attached. the warning label must show on the container and advertising on mass media such as television, radio, cinema, and print media such as poster, billboard, or vehicle media. section 32 in the Alcohol Control Act B.E. 2551 (2008) stated that any advertisement or public relation which made by manufacturers of alcoholic beverage of all kinds is able to conduct only for the purpose of giving information or creative knowledge without displaying pictures of the products or packages, except for the display of symbol of such alcoholic beverage or the symbol of the company manufacturing the alcoholic beverage. (i.e. its coverage of displaying names, trademarks, company logo,…) and this always lead to difficulty for legal interpretation. Indeed, this is one of legal loopholes. There is marketing control in Thailand, but it doesn’t cover ABM because the development of communication technology is dynamic and marketing strategies of the alcohol industries have changed over time. Therefore, there are always gaps within the process both channel and format, for instance, advertising on the internet, advertising brands, sponsorship, and Corporate Social Responsibility (CSR).

Introduction ABM not include Alcohol Control Act 2008, Section 32: The current alcohol advertising policy prohibits an advertising of the products. Section 3: unclear definition of alcohol advertising. The current alcohol advertising policy prohibits an advertising of the products. The regulation of alcohol marketing, revised mainly in 2008 and 2010, covers three aspects of advertising: time of promotion, which bans broadcast advertisements between 5 a.m. to 10 p.m. the content of promotions, which restricts any content concerning drinking persuasion and beverage properties, as well as requiring warning messages to be attached. the warning label must show on the container and advertising on mass media such as television, radio, cinema, and print media such as poster, billboard, or vehicle media. section 32 in the Alcohol Control Act B.E. 2551 (2008) stated that any advertisement or public relation which made by manufacturers of alcoholic beverage of all kinds is able to conduct only for the purpose of giving information or creative knowledge without displaying pictures of the products or packages, except for the display of symbol of such alcoholic beverage or the symbol of the company manufacturing the alcoholic beverage. (i.e. its coverage of displaying names, trademarks, company logo,…) and this always lead to difficulty for legal interpretation. Indeed, this is one of legal loopholes. There is marketing control in Thailand, but it doesn’t cover ABM because the development of communication technology is dynamic and marketing strategies of the alcohol industries have changed over time. Therefore, there are always gaps within the process both channel and format, for instance, advertising on the internet, advertising brands, sponsorship, and Corporate Social Responsibility (CSR). ABM not include

Objective To examine exposure, recognition, ownership and preference of ABM among Thai youth and their association with alcohol-related attitudes and alcohol consumption. The objective of this study is to examine exposure, recognition, ownership and preference of ABM among Thai youth and their associations with alcohol-related attitudes and behaviors.

Alcohol- related attitudes Conceptual framework Alcohol consumption Alcohol- related attitudes Factors Recognition of ABM Preference of ABM Exposure of ABM Ownership of ABM This is the conceptual framework for this study. On the left hand side, the four factors are exposure, recognition, ownership and preference of ABM. Then, we also explore attitude on alcohol and drinking practices.

Methodology Research design: cross-sectional study and using self-reported questionnaire Samples: high school and vocational school students Sampling: stratified 3-stage sampling approach Setting: urban and rural areas in 5 provinces across Thailand This is a cross-sectional survey, using self-reported questionnaires in 10 high schools and 10 vocational schools from thirteen hundred and fifty-one students in 5 provinces across Thailand. Content validity of the questionnaire was assessed by three experts in alcohol research. Two pilot surveys were conducted to assess reliability and applicability of the questionnaire.

Alcohol- related attitudes Methodology Measures Alcohol consumption Alcohol- related attitudes Factors Recognition of ABM Preference of ABM Exposure of ABM Ownership of ABM measured with 15 question items by using the Likert scale that consists of 5 levels How often are you expose to ABM each month? Test sample with five ABM and see if they come up with the right answer Do you own ABM? How many items of ABM do you own? What are they? Do you like ABM or dislike? For measurement ABM exposure is how often are you see ABM each month. For ABM recognition, we test sample with five ABM and see if they come up with the right answer about the alcohol beverages that link to ABM. ABM ownership is whether or not samples own ABM and how many items they own, what they are. For ABM preference, it is about do they like it or not. Then measurement about attitude and behavior. We use descriptive and analytical statistic for data analysis. 1. Alcohol consumption: drinking alcohol in the past 12 months 2.Binge drinking: drinking more than 5 standard drinks in one occasion in the past 12 months

Results Prepare for answer. ABM Exposure One item asked how often each you expose or see ABM per month. The six categories were ≥5 times per week, 3-4 times per week, 1-2 times per week, 1-3times per month, <1 times per month and never seen. [if they expose to ABM 3 or more than 3 times per week, it mean high exposure] ABM Recognition Student’s ABM recognition ability was assessed by a short quiz. The quiz consisted of 5 ABM each displaying real thing of a frequently advertised brand logo of alcohol. The students were required to write down for each ABM they believed it represent (e.g. beer, spirit, wine, etc.). ABM recognition ability of students was assessed by summing up the total number of correct answer given in the quiz, to form a score out of 5. Then researcher recoded score to three categories that were 5-4 was defined as more recognition, 3 was defined as moderate recognition, 1-2 was defined as less recognition and 0 was defined as cannot recognition. ABM Preference 1 item asked “Do you like ABM?” There are 2 choices [like or dislike] that be provided for their selection. Attitudes toward drinking Attitudes toward drinking were measured with 15 messages by using likert scale that consisted of 5 levels. The student who indicated 5 was defined as totally agree, 4 was defined as agree, 3 was defined as neutral, 2 was defined as disagree and 1 was defined as totally disagree. 15 questions of attitude towards alcohol were composite and called alcohol consumption attitudes. [if the score 4 or more than 4, it means positive attitudes toward drinking] Drinking participation A single item assessed whether or not respondents had ever finished most or all of beer, or other drink with alcohol. Response options included, “never consumed, has consumed but in the past 12 months and consumed in 12 months”. Students who indicated no alcohol consume in response to all three items were coded as lifetime abstainers. Students who indicated any alcohol consumed in 12 months were coded as current drinkers. Students who indicated any alcohol used, but not in the past 12 month were defined as former drinkers. Binge drinking A single item assessed whether or not respondents had ever drunk more than 5 standard drinks all of beer, or other drink with alcohol in 12 months. Response options included, yes or no.

Characteristic data Characteristics N Percent Gender 1,314 100.0 female 693 52.7 male 621 47.3 Age [mean=16.6] 1,316 100.0  15 38 2.9 16 624 47.4 17 546 41.5 18 71 5.4 19 30 2.3 20 7 0.5 School type 1,317 high school 872 66.2 vocational school 445 33.8 Location urban 815 61.9 rural 502 38.1 GPA 1,220 3.01-4.00 [good academic performance] 565 46.3 2.01-3.00 558 45.7 ≤2.00 97 8.0 The most adolescents are 16 years old. Majority of students educated in high school. They get GPA between 3.01 and 4.00.

Alcohol Consumption Alcohol consumption N Percent Drinking status 1,298 100.0 lifetime abstainer [never consumed] 475 36.7 former drinker [has consumed but not in the past 12 months] 399 30.7 current drinker [consumed in the last 12 months] 424 32.7  Binge drinking yes 168 39.6 no 256 60.4 At follow-up, 424 young people reported having drunk alcohol in 12 months 39.6% of students binged on alcohol while 60.4 of youth did not.

ABM Exposure Drinkers VS non drinkers Overall Among Drinkers 32.1% of young drinkers exposed to ABM everyday or almost everyday 32.7% of youth saw ABM at local and open-air barbecue restaurants Among Drinkers 42.4% of Thai youth exposed to ABM everyday or almost everyday 79.6% of youth saw ABM at local, open-air barbecue restaurants Overall, around one third of sample sees ABM everyday or almost every day and local and open-air barbecue restaurants are the common place for them to see. Interestingly, drinker have a higher rate of exposure to ABM with 42% and/ BBQ restaurants are the most common point for 80% of drinkers. U won’t be surprise that these BBQ restaurants have become the most popular drinking place among Thai kids in recent times.

ABM Recognition Overall: 39.5% of youth recognized ABM Among drinkers: 42.3% of youth recognized ABM The difference in ABM recognition between drinker and non-owner is not much. One third of samples recognized ABM very well and drinkers have better recognition.

ABM Ownership 71.1% 56% 46.4% 36.8% 36.2% Overall: Among drinkers: 88.5% of Thai youth own ABM average 4 items Among drinkers: 93% of Thai youth own ABM average 6 items Popular items: glasses, sport clothing, key rings, calendars and hats 71.1% 56% 46.4% 36.8% For ownership, Around 89% of Thai kids own at least one and/ on average have 4 items. Beer mug is the most common item/ followed by sport clothing, key rings, calendars and hats. As you may expect, drinkers have higher number of ABM, on average of 6 items/ compared with 1 to two among non drinkers. 36.2%

ABM Preference Overall: 71% of youth liked ABM Among drinkers: 81.1% of youth recognized ABM Preference means like or dislike. The difference in ABM preference between drinker and non-owner is large. Almost one third of students liked ABM and drinkers have better preference.

Result Factors associated with attitudes towards drinking, alcohol consumption and binge drinking Note: reference group were not having ABM, no exposure, be not able to recognize, dislike and negative attitude toward drinking CI stands for confidence interval. adjusted by gender, age, GPA score , high school, number of ABM and attitudes towards drinking This table shows analytical statistic by using the logistic regression test. The result confirms that exposure, recognition, owner, preference of ABM all have association with attitude toward drinking. While ownership and preference of ABM have association with drinker status of Thai kids. These are not associated with exposure, recognition, owner, preference and binge drinking.

Conclusion Thai youth have high a exposure to, ownership and preference of ABM. ABM exposure, recognition, ownership, preference have association with attitudes towards drinking. ABM exposure, ownership and preference have a clear association with alcohol consumption among Thai youth. Drinkers have higher exposure [1.91 times] , ownership [1.07 times] and preference [2.04 times] compared to non-drinkers. Young people have a high exposure to and recognition of ABM. When compare to non-drinkers, drinkers have higher exposure, higher possession and higher preference of ABM compared to non-drinkers. ABM ownership and preference have a clear association to drinking practice among Thai students.

Policy recommendations 1. The definition in the legislature is unclear with regards of ABM. New regulations should require that “No person shall advertise or display names or trademarks of alcoholic beverage deemed to exaggerate their qualifications or induce people to drink such alcoholic beverage either directly or indirectly”. Therefore, the ABM should be included as an integral component of the alcohol marketing regulatory framework. 2. Consider prohibiting distribution or sale of ABM to youth We would recommend that ABM should be included in the alcohol marketing regulation framework. We should translate the study into policy formulation, better regulate the ABM, either free distribution or for sale and consider prohibiting distribution or sale of ABM to young people.

In 2006, Coup d'état as a result overthrow a government in Thailand. In 2008, We have alcohol control act. Code 32 indicate that “any advertisement or public relation which made by manufacturers of alcoholic beverage of all kinds is able to conduct only for the purpose of giving information or creative knowledge without displaying pictures of the products or packages, except for the display of symbol of such alcoholic beverage or the symbol of the company manufacturing the alcoholic beverage”. But alcohol industry can advertise their products by using brand logo and Corporate Social Responsibility: CSR. Why don’t we impose total ban? One committee of the National legislative Assembly is from. The News broadcasting council of Thailand, they are against a total ban and negotiate with parliament asking that u don’t impose total ban.

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Prepare for answer % of total respondents (n=1314) % of drinkers   % of total respondents (n=1314) % of drinkers (n=424) Exposure 32.1% 42.4% Recognition (high level) 39.5% 42.3% Ownership 88.5% 93% Preference (like) 71% 81.1%