MSc Public Health DO THEY KNOW THEIR LIMITS?

An exploratory study into the awareness, knowledge and exposure frequency of alcohol reduction campaigns amongst young adults, 18-24, living in South West London.

Sarah OConnor September 2012 Submitted in part fulfilment for the award of MSc in Public Health

Abstract
Background Alcohol reduction campaigns are distributed across various target populations, in relation to health and social harms, little is being achieved. Young adults have been emphasised as having risky alcohol activities. Numerous, costly, campaigns have been generated to target young adults, to promote awareness, knowledge and to reduce their risky relationship with alcohol. The current message in the United Kingdom emphasises and urges sensible and responsible alcohol consumption. Aim This study endeavours to quantify the present level of awareness, knowledge and frequency of exposure to alcohol reduction campaigns aimed specifically towards young adults living in South West London (SWL). Whilst there is national support to assist young adults, in the reduction of their alcohol consumption, there is insignificant quantity of research to indicate the desired level of awareness and knowledge, amongst this population. Methods Utilising a non-probability sample, a quantitative standardised questionnaire was used to objectively determine the level of alcohol reduction campaign awareness amongst young adults. An observation technique was implemented to examine the frequency of exposure to alcohol reduction campaigns in environments that young adults frequent. Results Of the sample population 95.56% (n=151) demonstrated no awareness of any alcohol reduction campaigns and 94.3% (n=149) displayed no knowledge of safe drinking behaviours. The field observation indicated that alcohol advertising is more prevalent than alcohol reduction campaign advertising. 19 locations demonstrated 105% (n=20) ARC advertising while alcohol advertising was 314% (n=62).

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Key words Alcohol campaigns, public health, young adults, alcohol, mass media Declaration: I, Sarah OConnor, do hereby certify and declare that the foregoing research proposal is completely prepared and written by me. Signature:

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Acknowledgments:
Thank you to all the teaching staff on the Public Health MSc pathway, as you have all helped with my learning journey. Special thanks to all the librarians who assisted me when I was floundering. Special thanks to Susan Sapseed who has been a tremendous help all the way. Special thanks to my family who have supported me all the way.

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TABLE OF CONTENTS ABSTRACT LIST OF TABLES LIST OF DIAGRAMS GLOSSARY. 1. 1.2 INTRODUCTION Background 1.2.1 1.2.2 1.2.3 1.2.4 1.3 1.4 Young Adults Alcohol Public Health Campaigns Inequalities ii 6 7 8 10

Rationale . Aims/Objectives

2 2.1 2.2

LITERATURE METHODOLGY Evaluating Study Quality Findings The Literature 2.2.1 Alcohol and Young Adults 2.2.2 Defining Binge Drinking 2.2.3 Populations 2.2.4 Gender 2.2.5 Awareness and Knowledge 2.2.6 Message 2.2.7 Effective Delivery
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TABLE OF CONTENTS 3. 3.1 RESEARCH APPROACH Methodology 3.1.2 Sample 3.1.3 Data Collection 3.1.4 Focus Groups 3.1.5 Observation 3.1.6 Data Analysis 3.1.7 Validity and Reliability 3.2 3.3 3.4 4 4.1 Time Frame Budget Ethics RESULTS Population 4.1.2 Current Alcohol Behaviours 4.1.3 Location of Drinking Alcohol 4.1.4 Incidences of Alcohol 4.1.5 Influences of Drinking Alcohol 4.1.6 Public Health Campaign Awareness 4.1.7 Message Appropriateness 4.1.8 Location of Public Health Advertising 4.1.9 Observation

4.2 4.3 4.4

Discussion of Results Limitations Recommendation

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4.5

Conclusion

Appendices
1. Hogarth Gin Lane.. 2. Dont Let the Drink Sneak up on you. 3. Literature Search.. 4. Literature Table. 5. Cover Letter.. 6. Questionnaire 7. Focus Group Information. 8. Observation Criteria. 9. Time Frame.. 10. Ethics Agreement. 11. Indemnity Letter. STATISTICS 12. Population 13. Alcohol behaviours . 14. Locations: A & B. 15. Incidences: A & B. 16. Influences: A & B 17. Reduction: A, B & C.. 18. Message Awareness: A & B. 19. Message Appropriateness: A, B. C & D.. 20. Location of Reduction Advertising: A, B & C. 21. Advertising frequency Alcohol: A. 22. Advertising Frequency Alcohol Reduction: A, B & C..

TABLES

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

PICO Inclusion/Exclusion Criteria Elimination Process Status Ages/Alcohol Frequency Chi Square Test age/alcohol Drink Choice by Gender Chi Square test Drink choice/Gender Gender and Location of Choice Incidence /Gender Increase Alcohol Consumption Unit Awareness/Gender Alcohol reduction Awareness Locations and alcohol Reduction Advertising Frequency of alcohol reduction advertising Alcohol Advertising

DIAGRAMS
1. Feeling funny? 56

2. She may be a Bag of Trouble.. 65 3. Change 4 Life 4. Drink a little less, see a little more 5. Dont turn a Night Out into a Nightmare.. 6. Dont let a Night full of Promise Turn into a Morning Full of Regret.. 7. Boozed Up. Squared Up. Locked Up. 8. Drink Less. Live More

Glossary
Accident and Emergency Alcohol Reduction Campaigns Alcohol Reduction Information Alcohol Safety Information Alcohol Unit Information Department Of Health Home Office Lesbian, Gay and Bisexual National Audit Office National Health Services Population, Intervention, Comparison and Outcome Positive Adult Development Theory Risky Single Occasion Drinking Social Norm Marketing South West London Tuberculosis United Kingdom United States Wandsworth Alcohol Harm Reduction Strategy A&E ARC ARI ASI AUI DOH HO LGB NAO NHS PICO PADT RSOD SNM SWL TB UK US WAHRS

Chapter One

Diagram 1: Feeling Funny (2007)

1 Introduction
Young adults, in the United Kingdom (UK), have been highlighted as a segment of the population, who have adopted a concerning relationship with alcohol, which has been noted with increasing concern, over the last ten years (Guise and Gill, 2007). Globally, alcohol has become a central feature in the culture of young adults and is a main contributing factor to morbidity and mortality amongst this population (Barry and Piazza-Gardener, 2012). Due to the concerning relationship that young adults have adopted towards alcohol, communities and the nation as whole, are experiencing the destructive negative consequences. Hallett et al. (2012) proposes a relationship between high levels of alcohol consumption and the occurrence of negative consequences. LaChance et al. (2009), emphasises negative These

consequences to encompass: health, social and psychological harms.

negative consequences are not only experienced by young adults but also members of communities directly and indirectly. Negative consequences, experienced by the community, as a result of risky alcohol consumption and related behaviour include the growing cost of ill health, community destruction and violence (LaChance et al. 2009). The Public Health sector has historically been commissioned to reduce the growing, alcohol related harm with the production of local and national alcohol reduction campaigns, policies, protocols and guidelines. Public health agencies, in conjunction with the Department of Health (DOH), Home Office (HO) and the National Health Service (NHS), have worked in tandem, with the aim to create effective alcohol reduction campaigns, specifically aimed towards young adults, in order to decrease harm and promote a healthier lifestyle. The current rate of alcohol related negative consequences is detrimental to the already decreasing public health expenditure (Harper, 2012). When examining the relationship between current growing cost and future projected cost, of risky alcohol consumption and negative consequences, there appears to be little gain. Though the public health sector has achieved

success, within other health domains, little success has been demonstrated to decrease alcohol consumption amongst young adults. Print media continue to report drunken debauchery occurring. The Daily Mail (2010) reported Drunken Anarchy and The Sunday Telegraph (2010) reported What Happened to our Sense of
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Shame. The current message in the UK, supported by the Government, DOH and the NHS, endorses sensible and safe drinking, not abstinence, and currently promotes safety rather than the negative health and social consequences of drinking more than the recommended limit (National Audit Office, 2008). Alcohol reduction campaigns rely heavily on young adults constructing individual choices to change their relationship with alcohol, and to take personal responsibility in obtaining a healthier relationship with alcohol (Abrams et al. 2011). Ultimately, alcohol reduction campaigns rely on individuals taking action to assist in decreasing the current climbing cost of health and social related problems. Therefore, the

current UK message places responsibility on the individual, to both, understand and practice the message of responsibility. Living in a democratic society young adults have the right to choose how and when they want to use alcohol, but it is the responsibility of the public health sector to promote healthier lifestyles both now and in the future. 1.2 Background There has been a profound, global, change in the social and cultural acceptance of alcohol and the adaptation of risky health behaviours (Pilling and Brannon, 2007). Whole populations are putting themselves at risk by choosing to participate in unhealthy lifestyle choices (Room et al. 2005). Communities up and down the country are experiencing an increase of threatening health behaviours, and growing cost, due to obesity, smoking and alcohol related ill health. These risky behaviours can have serious health implications now and in the future. A concerning area to public health is that of young adults and their relationship with alcohol. Current facts dictate that the current level of young adults ingesting risky levels of alcohol needs to change (Pilling and Brannon, 2007). Alcohol has long had a prominent stance within the social scene, in the UK, both historically and currently. According to the UK Alcohol Strategy, (DOH, 2012), fifty years ago the UK had one of the lowest alcohol consumption levels in Europe. Presently, young adults, in the UK, are reported to have one of the highest rates of alcohol consumption in Europe (HM Revenue and Customs, 2004). Hogarths Gin lane depicted a scene of drunken debauchery in 1751 (Hogarth, 1751) which, currently, is being replicated in countless communities throughout the UK (Appendix
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1). Young adults, habitually, replicate the drunken characters in this prominently cited picture. Young adults place themselves in various risky situations with no

apparent interest in their personal safety, health or wellbeing. The growing cost of alcohol related Accident and Emergency (A&E) attendances, alcohol related hospital admissions and the increased numbers of alcohol related altercations attended by police, indicates the need to examine the level of awareness, knowledge and frequency of exposure to alcohol reduction campaigns. It is estimated that 2 billion people consume alcoholic beverages and 76 million people have alcohol related disorders (Anonymous, Lancet 2009). With growing estimation of what alcohol related incidents are costing the NHS, there is mounting pressure to challenge this problem. More and more, young adults are attending primary care facilities with unwanted pregnancies, traumatic injuries, mental health issues and death (Right Time Right Place, 2009-10). two drunks. How booze is crippling the NHS. According to the Wandsworth Alcohol Harm Reduction Strategy (WAHRS, 20082011) alcohol related injury and illness accounts for 30% of all midweek A&E, rising to 70% on the weekends. The Governments Alcohol Strategy (2012) suggests that alcohol related harm is estimated to cost 21 billion annually. It has been estimated that the cost of ambulances attending alcohol related complications cost 502,920 (Right Place Right Time, 2009-2010). The overall cost of alcohol related harm to the NHS was 18,793,824 (Right Place Right Time, 2009-2010). 17 million working days are lost annually in the UK due to risky levels of alcohol consumption and related behaviours (Drinkaware, 2012). Alternatively, statistics produced locally through council organisations, such as Camden Council, have demonstrated a reduction in risky alcohol consumption amongst young adults (Camden Alcohol Reduction Strategy, 2007-2010). But this can be subjective. Conrod and The Daily Mail (2010) highlighted this growing problem by reporting 17 nurses and 15 doctors - all to treat

Castellanos-Ryan (2011) suggest that it is possible that young adults have actually decreased drinking sessions per week but the amount they drink in one session has increased. Alcohol abuse has many definitions. For the purpose of this study, risky alcohol consumption includes all unhealthy alcohol related behaviours, inclusive of binge
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drinking. Binge drinking is defined as a session of drinking alcohol to the point, and past, of intoxication (Bagnardi et al. 2011, p.102). Risky levels of alcohol

consumption have been associated with sexual health problems, unwanted pregnancies, increased injury and negative social predicaments (LaChance et al. 2009). In a large scale national survey, Reifman et al. (2006), found 37-44% of young adults report binge drinking regularly, and ultimately, putting their personal health and safety at risk. The DOH and the NHS, inclusive of the current UK Government, have developed many strategies, policies and campaigns to tackle the increasing concern of young adults and their alcohol consumption. The aim is to minimise harms related to

alcohol, including ill health and alcohol induced negative behaviours such as violence and criminality (Room et al. 2005). As little success appears to be transpiring, it is important to highlight that alcohol reduction campaigns, often, battle against liberal alcohol reforms (Room et al. 2005). The changes in licensing, alcohol price and the overall growing acceptance of alcohol, has influenced young adults in their adoption of a risky relationship with alcohol, increasing their alcohol consumption to harmful levels (Ridout et al. 2012). Whilst there are subjective indications suggesting that a decrease in alcohol consumption has occurred, there is a disturbing development of new risky alcohol behaviours that have developed in reaction to alcohol reduction campaigns (Borsari and Carey, 2012). Pre-gaming is the practice of drinking alcohol before going out to a primary setting to drink more alcohol and is a modern phenomenon (Borsari and Carey, 2012). It could be hypothesised that pre-gaming has occurred in relation to the availability of cheap supermarket deals in comparison to the cost of drinking in wine bars or pubs. Another concerning practice is drunkorexia. Drunkorexia is the term allocated to calorie conscious drinkers (Barry and Piazza-Gardener, 2012). It is the practice of limiting food calories in order to accept the calorie content of alcohol (Barry and Piazza-Gardener, 2012). It could be considered that drunkorexia developed in reaction to the campaign dont let drink sneak up on you (DOH, 2012). (Appendix 2). Both of these behaviours are relatively new and little research exists to suggest the exact development and impact on young adults. It has been suggested that these activities have occurred in direct result of alcohol reduction messages. The occurrence of new drinking behaviours is influenced by a myriad of
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factors.

These factors include community and environmental factors, economic It is these very

influences, social norms and attitudes (Pilling and Brannon, 2007).

factors that need to be involved within the development phase of alcohol reduction campaigns in the future. 1.2.1 Young Adults To understand the impact of alcohol reduction campaigns and the message delivery process, it is important to examine the physical, emotional and cognitive ability of young adults. Physical, emotional and cognitive development is a lifelong process (Hendry and Kloep, 2012). Young adults, in their late teens and early twenties, are at a time of profound change and uncertainty. During early adulthood, young adults are faced with on-going identity development and encounter the responsibility for shaping their choices and lifestyle (Arnett, 2009). This indicates that the health of young adults is dependent on their behavioural choices (Hendry and Kloep, 2012). Most young adults are capable of reasoning and cognitive tasks, indicating a reasonable level of ability to retrieve and understand societal messages (Arnett, 2009). During this stage, young adults continue to develop values and attitudes, with the hope, to enhance their self-esteem (Arnett, 2009). Young adults will encounter numerous stressors, such as employment, unemployment and studying, that can lead to anguish and tension, while attempting to sequence responsibility for their own lives (Hendy and Kloep, 2012). Levinson et al. (1978), a psychologist and developer of the Positive Adult Development Theory (PADT), incorporated social psychological concepts, to explain the developing young adult and the demands of society. Levinson et al. (1978) suggested that young adults develop personal identity, simultaneously, with the need for closeness to others. This can be seen in the experience of mounting peer pressure to belong to a group and act in the way the group does for acceptance (Jun- Hong et al. 2012). In the young adults need for acceptance, experience of precipitous changes in identity and the confronting of new experience, the young adult is at risk of increased levels of anxiety and stress (JunHong et al. 2012). Young adults vigorous exploration can lead to risk taking

behaviour, as demonstrated in the current relationship with alcohol. Drug taking and substance abuse peaks during young adulthood (McKay et al. 2012). An influencing factor in the decision making process, to take part, can be traced to the exposure of negative life events: family conflict, abusive relationships, romantic breakups and
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financial strains. These stressors will challenge development and can lead to risky decision making (McKay et al. 2012). Taking all of this into account, it is with ease, that one can perceive the simplicity in which young adults adopt risky alcohol behaviours individually and or as part of a social clique. 1.2.2 Alcohol Alcohol is a product that has provided a variety of functions for people throughout history (WHO, 2011). Historically, alcohol served as a source of nutrients and was widely used for medicinal, antiseptic, and analgesic properties (WHO, 2011). Alcohol contains ethanol and is a psychoactive substance. According to Drinkaware (2012) alcohol is a depressant. In the short term alcohol impairment encompasses: slurred speech, impaired judgment and loss of short term memory. Young adults can experience feelings of loss of inhibitions and a feeling of confidence (Drinkaware, 2012). Physically alcohol irritates the stomach, can induce nausea, vomiting and diarrhoea. In the long term, alcohol misuse, can lead to liver disease, osteoporosis, infertility and dementia (Drinkaware, 2012). Alcohol is addictive. Alcohol releases dopamine into the brain and causes the release of endorphins into the brain which affects moods (Drinkaware, 2012). The brain starts to have a reliance on alcohol for the production of endorphins. Simplistic, but these are the steps to the reliance on alcohol. Alcohol reduction campaigns convey a message of drinking safely and sensibly (NAO, 2008). Campaigns and related materials endorse behaviours that can be adopted to curtail heavy drinking sessions. Alcohol reduction strategies suggest drinking lower strength alcohol, alternate between alcohol and non-alcoholic drinks and ordering smaller glasses such as single measures or half pints (Drinkaware, 2012). The current UK guidelines, known as Sensible Drinking Guidelines suggest males 3-4 units per day and females 2-3 units per day (Drinkaware, 2012). Drinks are measured by units and it is suggested that this can cause confusion. The

amount of alcohol in a drink is measured in units. One unit is 10 ml or 8g of pure alcohol. The size and strength of your drink will determine the number of units it contains (Drinkaware, 2012). 1.2.3 Public Health Campaigns

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The use of widespread public health message delivery can be dated back to 1917 where poster campaigns were utilised to enhance the health of populations (WHO, 2009). During the First World War there was growing concern regarding the health of servicemen and migrant health, especially regarding the spread and exposure of tuberculosis (TB) and syphilis (WHO, 2009). Posters were developed using hard

hitting pictures, captions and messages. Campaign messages provided information on how to stop the spread or contract the disease, therefore, highlighting the need for a change. The aim behind public health campaigns has not changed and is very much incorporated into alcohol reduction campaigns. Emphasis is placed upon the desired outcome of behaviour change cessation, commencement or prevention (Panagopoulou et al, 2011).

Diagram 2: Syphilis (1940s)

Due to substantial risks associated with adopting risky alcohol behaviours, innovative and effective alcohol reduction campaigns need to be established. Most alcohol reduction campaigns are developed with a target population in mind (Panagopoulou et al. 2011). It has been found that audience segmentation is more effective than single campaigns attempting to appeal to the population as a whole (Scribner et al. 2011). Unfortunately this can create confusion, as there can be numerous alcohol

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reduction campaigns in existence at any one time, attempting to deliver age appropriate messages (Gill and OMay, 2007). Fundamentally, alcohol reduction campaigns are developed to deliver information and educate populations. Campaigns such as Know Your Limits (DOH, 2006) and Safe Sensible and Social (DOH, 2007) have been aimed specifically to decrease alcohol consumption and risky behaviours amongst young adults in the UK. In 20092010, the government spent 17.6 million on various public health campaigns and policy interventions to tackle the growing problem of alcohol consumption (Drinkaware, 2012). HM Government (2010) reported that allocated expenditure in 2010, for public health campaigns, was 540 million.

Diagram 3: Change 4 Life (2012)

Campaigns utilise a myriad of tools and frameworks, in order to influence target populations. With, historically large, resources many tactics have been employed to encourage young adults to change their relationship with alcohol. These campaigns include the use of celebrities, commercials, posters and media websites. These strategies are integrated into social marketing (Mattern and Neighbors, 2004). Ross et al. (2006) suggest that social marketing incorporates the use of commercial procedures in the development of programmes designed to improve health. This is supported by DOH, (2008), as they refer to the application of social marketing as the solution of social and health problems. Social marketing is a strategy that has been used since the 1970s, and is a framework that incorporates psychology, sociology and communications (DOH, 2008). Social marketing uses commercial strategies to influence voluntary behaviour change. Social marketing does not rely on awareness or increased knowledge but aims to promote a goal of enhanced personal and
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societal prosperity (DOH, 2008).

The aim of social marketing is for the target

population to embrace a new behaviour, break a current behaviour, or avoid commencing behaviour. Social marketing campaigns want the population to talk

and discuss, with their peers, the message being delivered (Mattern and Neighbors, 2004). Alcohol reduction campaigns utilise mass media technology. Mass media

techniques reach large proportions of the population in a short period of time, but may not be suitable for all populaces (Uzunoglu and Oksuz, 2012). Message

delivery relies on effective and efficient communication through the chosen media outlet and it appears that media outlets have modernised the message delivery system (Cousins et al. 2010). Historically, message delivery relied on print and

outlets such as television and radio. But modern alcohol reduction campaigns and messages have embraced the technological revolution and are utilising mass media tools such as the internet and social network sites (Uzunoglu and Oksuz, 2012). Social networking included blogs and media messaging. More and more people are turning to the internet for health information (Uzunoglu and Oksuz, 2012). Organizations are attracted to using social media partially because of the huge potential it provides in reaching members of their target audience, especially in comparison to previous television and radio. The majority of health literature identifies motives as to why young adults drink: busy work life, socialising, relaxing and commiserating (Cousins et al. 2010). But many young adults, who partake in drinking risky levels of alcohol, report that misperception is an influential factor (Gill and OMay, 2007). According to Park et al. (2011) social norm alcohol reduction campaigns tackle misperceptions of alcohol use and it is only once the misperceptions have been tackled that the level of harm is reduced. In relation to young adults, it is suggested that they do not accurately perceive the amount of alcohol that they and their social network are drinking (Ayers and Myers, 2012). Campo and Cameron (2006) found that some campaign

messages, usually intended to correct misperceptions, actually led to the exacerbation of the behaviour, therefore, increasing negative health attitudes. If

there is a misperception of behaviour, amongst the target population, it is unlikely the message can be delivered efficiently (Mattern and Neighbors, 2004). Alcohol

reduction campaigns are only successful when young adults actually believe the
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message being delivered. This is supported by Scheier and Grenard (2010) who advise that some alcohol reduction campaigns have actually had the opposite result to the desired outcome, due to misperception of the message. Successful public health campaigns and behaviour changes can be discovered and it is possible that alcohol related campaigns are missing a key element. Successful public health campaigns, such as wearing seat-belts or mandatory car seats for infants/toddlers/children have achieved a substantial global behaviour change (WHO, 2009). Success of these campaigns can be found amongst the complete

generational behaviour change that has occurred over a long period of time. Behaviour change towards compulsory seat-belt wearing and the use of car seats for babies/infants was and is fully supported by governments with the development of statutory regulations mandated by law. Regulations mandated by law often permits members of the general public to be penalized when not abiding to the law. Essentially, this creates a national/international behaviour change that has a cause and effect. Another long standing campaign that has achieved success is

vaccinations. Though not mandated by law, the uptake of childhood vaccinations has been successful. Success can be measured against the increased health of the target population across the lifespan and the near elimination of diseases that historically killed large numbers of the target population, such as polio and diphtheria (Bloom et al, 2005). When applying these findings to alcohol reduction campaigns eliciting a generational behaviour change, it is quickly recognised that little law exists to create a cause and effect relationship. Apart from ill health and negative social consequences there is little to reinforce the importance of alcohol reduction message reception and behaviour change. According to Snyder et al. (2004, p.72) preventing behaviours can be difficult, especially amongst young adults, as the behaviour may not yet be habitual, therefore, will be susceptible to influence. 1.2.4 Inequalities Gentry et al. (2011) relates the cost of development, implementation and the expense of lengthy advertising, to economic consequence. Gentry et al. (2011)

found that in areas of severe economic deterioration, where alcohol can be an inherent problem, the frequency of alcohol advertising was more prevalent than alcohol reduction campaigns. Health inequalities are not new concepts when
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exploring alcohol behaviours. According to WHO (2004) the circumstances which people live and work will influence health negatively, by encouraging the uptake of unhealthy behaviours. Lack of income, inappropriate housing, lack of family support and deficiency of access to health care are some of the social determinants of health inequalities (WHO, 2004). This is also highlighted in the rates of access to education and access of health. It is important to highlight that even with good information it is difficult for some to take on the healthy behaviour (Bloomfield et al. 2006). Health inequalities can also be examined amongst sexual orientation, which is an important aspect amongst young adults. Young lesbian, gay and bisexual (LGB) people are vulnerable to a number of health risks often due to other peoples reactions to their identity (DOH, 2007). They can feel stigmatised, lack role models and feel that society does not approve of them (Warner et al. 2004). These psychosocial inequalities can influence the amount of alcohol consumed (DOH, 2007). Warner et al. (2004) has highlighted that lesbian and bisexual females were more likely to have ingested risky levels of alcohol in comparison to heterosexual females. Interestingly, the DOH (2007) indicates that bisexual and gay males were more likely to engage in drug use. 1.3 Rationale Understanding how young adults relate to alcohol campaigns will, and can, influence the success of future alcohol reduction campaigns for this population. Exploring the level of awareness amongst young adults offers insight to the understanding of how health and alcohol reduction can be promoted. This piece of research is essential, as it would appear that, though vast amounts of money, time and resources, are being disbursed, a substantial behaviour change has not occurred. Research

investigating the level of alcohol awareness and knowledge amongst young adults is essential, in being able to provide effective public alcohol reduction interventions that decrease risky habits; therefore, increasing health and wellbeing along the lifespan. Binge drinking, Drunkorexia and gaming are modern phenomena that have developed as a result of some national and local campaigns. Despite the reported

expenditure of the UK Government, inclusive of the DOH and the NHS, it would appear that little has been achieved in decreasing risky alcohol consumption amongst young adults. This is emphasised when exploring the upsurge of
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attendances to A&E departments with alcohol related problems. Little, UK based, research exists on the effectiveness of alcohol reduction campaigns or the awareness of safe drinking strategies, amongst young adults aged 18-24 years of age. If the cost of alcohol related incidents and ill health continues at the current rate the future consequences, of such behaviours, will have dire effects on a whole population. Alcohol reduction campaigns require further research to determine the awareness and effectiveness of message delivery and communication. 1.4 Aims/Objectives The aim of this study is to quantify the level of awareness of alcohol reduction campaigns and examine the frequency of message exposure amongst 18-24 years living in SWL. Essentially, this will gain insight to the effectiveness of alcohol

reduction campaigns that have been delivered to this target population within the last 10 years. By examining the level of awareness, it is deemed a necessity to investigate current alcohol behaviours amongst this target population as it is possible that young adults may be inadvertently practicing safe alcohol behaviours without actual knowledge of doing so. This study, also, aims to examine the frequency of exposure to alcohol reduction campaigns/messages/materials in order to develop effective recommendations for future campaign development that may achieve success in improving the health and social aspects of young adults.

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Chapter Two

Diagram 4: Drink a Little Less, See a Better You (2010)

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2 Literature Methodology
The aim of this research is to examine the level of awareness, knowledge and frequency of exposure to alcohol reduction campaigns, amongst young adults, in SWL. To begin the research process and exploration of existing literature, surrounding this subject area, is imperative. In order to locate existing research, a literature search was performed to gain understanding, and further knowledge, encompassing the background to this subject. The literature search was done with the aim of compiling relevant research to: assess existing literature, gain new perspectives and to provide a literature review. Aveyard (2011) suggests that literature reviews are important as they seek to summarise the available research. A literature review can present the whole jigsaw and analysis, of relevant literature, can lead to new discoveries (Aveyard, 2011). According to Web and Bain (2011, p.253) a literature review is the response to a clearly formulated question which involves the identification of all relevant primary research studies. A literature

review is a process in which relevant research is assembled, appraised and synthesised for a specific topic or subject (Wright et al. 2007). With the use of an exclusion and inclusion criteria literature can be found, assessed for its appropriateness and results used to validate the current study (Wright et al. 2007). The first stage of locating literature entailed the use of key words, risky, alcohol and young adult, in order to gain a general view of available grey literature. This aided the development of producing a PICO framework. Using the PICO (Table 1) a more robust search criterion was developed, to aid the search of relevant research based material. The PICO acronym stands for Population, Intervention, Comparison and Outcome. A PICO is a tool that is utilised to enhance the designing of a well-built clinical question (Dawson, 2009). Three databases were searched in order to

provide a more detailed overview of related literature. These were Medline, Embase and Psych Info. These databases broadly cover literature from disciplines appropriate to this study Nursing, Medicine and Psychology. During this search process key words included: awareness, young adult, public health and alcohol. In order to locate, appropriate primary research, steps are followed to ensure this process is meticulous (Appendix 3). Studies examining the level of awareness,

knowledge and effectiveness of UK alcohol reduction campaigns are limited. Due to

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this, all studies, including international, would be considered appropriate for this literature review. Table: 1

Population
Young adult Male and female Drink alcohol

Intervention
Alcohol reduction campaigns

Comparison
Non-alcohol drinkers

Outcome
Awareness and knowledge of recommended alcohol intake

256 titles and abstracts were examined for appropriateness of supporting the research subject area. This revealed that 104 papers were relative to the study subject. After reviewing the articles in length, 32 articles were kept. Using the inclusion exclusion criteria (Table 2) a further 26 were excluded; therefore, at the end of this process 8 papers were read in their entirety (Table 3). These were deemed supportive for the research subject and appropriate for the literature review.

Table 2

Inclusion
Young adults ages 18-24 Mixed male female population Single sex population Binge drinking Campaign awareness Alcohol reduction Awareness/effectiveness studies

Exclusion
17 years and under 25 years and older Health complications Abstinence Alcoholism Treatment interventions Non English speaking countries

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Table: 3

Papers located 256

Review of the title Papers left 104 Abstract reviewed Papers left 32 Inclusion/Exclusion Papers left 8

2.1 Evaluating Study Quality In order to analyse these studies effectively the rigor of methods of each article was assessed. This was guided by the Critical Appraisals Skills Programme (CASP) created by the Public Health Resource Unit for England (2006). This programme provides specific tools to evaluate different types of research taking into account methodological considerations. The CASP was used to evaluate all the studies This is presented in a table that

included in this literature review accordingly.

demonstrates the content of the articles (Appendix 4).

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2.2 Findings
2.2.1 The Literature: There are large amounts of studies that encompass binge drinking, especially in the US, but limited research on the effectiveness and awareness of alcohol reduction campaigns amongst young adults (Hutton 2012, Carpenter et al 2007). Of the eight located research studies, five utilised quantitative methods (Bowring et al. 2012, van Gemert 2011, Gill and OMay 2006, DeJong et al. 2006, Perkins and Craig 2006), two used mixed methods approach (Hutton 2012, Carpenter et al. 2007) and one paper used qualitative research methods (Ricciardelli and McCabe, 2008). The aims of the studies were similar in that they examined the effectiveness of an alcohol reduction campaign aimed specifically towards young adults. The research studies measured alcohol campaign message awareness in relation to achieving a behaviour change. The sample population and sampling techniques, of the relevant literature, were similar. Six studies used university/college students as their target population and two studies conducted their research using general population young adults, though students featured within the sample population of these two studies. The favoured sampling technique used in six studies was non probability purposive sampling (Hutton 2012, Bowring et al. 2012, van Gemert et al. 2011, Ricciardelli et al. 2008, Carpenter et al. 2007, Gill and OMay 2006) and two studies used a randomised sample technique (DeJong et al. 2006, Perkins and Craig 2006). Data collection tools included questionnaires and focus groups. 2.2.2 Alcohol and Young Adults The literature unanimously agrees that risky alcohol consumption, amongst young adults, is a growing public health concern (Hutton 2012, Bowring et al. 2012). van Gemert et al. (2011) suggests that risky alcohol consumption amongst this population has been an increasing challenge over the last 30 years. Carpenter et al. (2007) adds that risky alcohol consumption is a growing problem for women as well as men. This detrimental pattern has occurred globally, emphasised within this literature review is: New Zealand (Hutton, 2012) Australia (Bowring et al. 2012, van

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Gemert et al. 2011, Ricciardelli and McCabe 2008), USA (DeJong et al. 2006, Perkins and Craig 2006) and the UK (Carpenter et al. 2007, Gill and OMay, 2006). A prime aim of young adults is simply to get drunk (Gill and OMay, 2006) and risky levels of alcohol consumption have essentially become the norm (Ricciardelli and McCabe, 2008). The literature highlights the outcomes of risky alcohol consumption and these vary in nature. Risky alcohol intake is linked with accidents, injury and violence (Hutton 2012, Bowring et al. 2012). Particular to college students, the risk of academic failure, interpersonal problems and legal issues are being experienced with growing prevalence (Carpenter et al. 2007, Gill and OMay (2006). Bowring et al. (2012) found their sample population related risky drinking with pleasure, sociability and the pursuit of excitement. This is reinforced by Hutton (2012), who established that their sample of mixed gender young adults, like the taste of alcohol, use it to relieve tension and just like to get drunk. The two studies, that utilised single gender populations, offer very different reasons for their adoption of risky alcohol consumption. Gill and OMay (2006) suggest that female university students feel pressured into consuming more alcohol in a single occasion and that drinking alcohol was the student thing to do. While Carpenter et al. (2007) highlights that females use alcohol to make them more sexually attractive and recognise being out drinking is a way of networking and building their social group. Social development factors, as well as peer and family alcohol use, are influential factors amongst young adults participating in risky drinking sessions (Hutton 2012). Ricciardelli and McCabe (2008) found that alcohol played a detrimental role in 40% of students academic problems and 28% of college drop outs. This is supported by Carpenter et al. (2007), who suggest the consequences of risky alcohol consumption include loss of productivity. In regards to health and young adults, alcohol related hospital admissions are on the increase and cases of early onset alcoholic liver disease have increased in recent years among younger age groups of both sexes (van Gemert et al. 2011, Carpenter et al. 2007). Gill and OMay (2006, p.13), record female deaths due to alcohol has risen 424% during the period of 1998-2003. Perkins and Craig (2006) suggest, particular to university athletes, that risky alcohol consumption increases health and injury to athletes during training. Unfortunately, Hutton (2012) adds that most young adults take health for granted and view long term ill health as too distant and of little immediate concern. This reveals the
25

complexities amongst the various reasons as to why young adults partake in alcohol consumption. DeJong et al. (2006) and Perkins and Craig (2006) suggests that risky alcohol consumption can be due to young adults overestimating the amount of alcohol their peers consume; therefore, increasing their own amount. Perkins and Craig (2006), report that social norms alcohol reduction campaigns aims at correcting the misperception with the provision of factual information to reduce the risky behaviour. Risky alcohol intake amongst young adults needs to be taken seriously and the above findings must be incorporated into alcohol reduction campaigns in order to achieve the required outcome Young adults are frequently targeted with policies, guidelines and alcohol reduction campaigns with the aim of decreasing their alcohol consumption (Bowring et al. 2012, Hutton 2012, Ricciardelli and McCabe, 2008, Perkins and Craig 2006). All of the studies acknowledge, varying degrees, of regularly consuming more than the recommended limits during a single drinking session, (Hutton 2012, Ricciardelli and McCabe 2008, Carpenter et al. 2007, Perkins and Craig 2006). This was especially prevalent amongst students (Hutton 2012, Ricciardelli and McCabe 2008, Carpenter et al. 2007, DeJong et al. 2006, Gill and OMay 2006). Within the population characteristic description, a small portion of the sample is highlighted as nondrinkers (Hutton 2012, Ricciardelli and McCabe 2008, Gill and OMay, 2006). It is not made clear if this sub-set of the sample practice abstinence, or simply do not fit the inclusion exclusion criteria, or simply refrained from alcohol prior to the data collection time. 2.2.3 Defining Binge Drinking Consensus of definition can be difficult when examining multiple pieces of research. When examining alcohol and young adults, clarification of definitions is problematic. Researchers use terms to fit the meanings their research requires. Within the

literature multiple definitions are offered for risky alcohol behaviour which could be inhibiting the process of message recognition, retention and awareness amongst young adults. Unfortunately, the term binge drinking encompasses many definitions and can be used in distinctive ways to depict what the author desires (van Gemert

26

et al. 2011). Hutton (2012) emphasises that the phrase binge drinking is misleading and has essentially aided the creation of related behaviours and expectations. Bowring et al. (2012) accepts extreme drunkenness and exceeding the governments safe drinking limit to depict risky alcohol ingestion. Huttons (2012, p.230) definition utilises a session of heavy drinking while van Gemert et al. (2011) has preference in using Risky Single Occasion Drinking (RSOD). Risky alcohol consumption has created a level of social anxiety which has been actively conveyed within the media (Hutton 2012). Young adults do not consider themselves to be binge drinkers (Bowring et al. 2012, Gill and OMay, 2006). This could be due to the numerous adverse contentions committed to this phrase (Hutton 2012). Carpenter et al (2007) found a concerning area amongst definition. Intending their sample to provide a definition of risky

alcohol consumption various definitions were given and the lack of knowledge is concerning. The sample provided copious amounts of alcohol and others proposed that it depended on how many nights per week alcohol was consumed (Carpenter et al. 2007, p.9). This serves to demonstrate the wide variation and difficulty, amongst research literature, in defining risky drinking. It is this variation, in definition, that can be hindering the awareness, knowledge and message acceptance amongst target populations. 2.2.4 Populations The majority of literature, examining risky alcohol behaviours of young adults, use a college based sample/population (Hutton 2012, Ricciardelli and McCabe 2008, Carpenter et al. 2007, Gill and OMay, 2006, DeJong et al. 2006, Perkins and Craig 2006). This could reflect the ease in engaging college/university based young adults, and their willingness to participate with research and, as with DeJong et al. (2006) the participation of universities as an administration. There is limited research on general population of young adults; this review located two pieces of research that fit the exclusion inclusion criteria (Bowring et al. 2012, van Gemert et al. 2011). Though, the two, quantitative, studies utilised general population young adults, students featured heavily in both of their samples. Six studies utilised mixed gender samples (Bowring et al. 2012, Hutton 2012, van Gemert et al. 2011, Ricciardelli and McCabe 2008, DeJong et al. 2006, Perkins and Craig 2006) and two studies used
27

females only samples (Carpenter et al. 2007, Gill and OMay 2006). It should be noted that the two single gender studies complement the findings of the mixed gender studies. The findings of Carpenter et al. (2007) and McGill and OMay (2006) highlight the need to explore the use of single gender alcohol reduction campaigns. This has been attempted in the UK with the development of Binge drinking girl and Binge drinking boy (DOH, Home Office 2006), but the effectiveness of single sex alcohol reduction campaigns requires further exploration. There are limited male only effectiveness/awareness studies; none were located for this literature review. According to the literature, students entering college for the first time are at risk of heavy episodic drinking (Hutton 2012, Gill and OMay, 2006). First time college entry is recognised as a stressor, compounded with the compulsion of peer acceptance, are indicators for the increasing prevalence of risky drinking (Bowring et al. 2012, Gill and OMay, 2006). Research unanimously supports that alcohol is highly prevalent within the college/university environment which provides young adults with an array of opportunities to partake in risky alcohol consumption (Ricciardelli and McCabe, 2008). This is supported by Hutton (2012) who extracted from their focus group data that students will actively seek special deals and special events. Sporting events, drinking games and social functions offer the increased ability to engage in risky alcohol behaviours (van Gemert et al. 2011). This is supported by Perkins and Craig (2006) who conducted research specifically on university athletes. Their study

demonstrated that athletes, a sub-section of student populations, are at high risk of regular risky alcohol consumption. Perkins and Craig (2006) go onto suggest that other at risk factions of the student population, of developing risky alcohol consumption, are those that live in halls of residence and those that are members of university based associations/clubs. 2.2.5 Gender Gender related findings are interesting. A dominant finding, within the literature, was the prevalence of higher risky alcohol intake amongst male samples. Men are more likely to practice hazardous drinking behaviours (Bowring et al. 2012, Hutton 2012, van Gemert et al. 2011, Ricciardelli and McCabe 2008) in comparison to females. . Bowring et al. (2012) found male participants (65%) reported regular heavy hazardous drinking. This was replicated in Huttons (2012), mixed method study,
28

who found that 75% of male participants reported risky levels of drinking associated with an increased risk of sustaining any categorical injury. Upon examining the

pattern of gender alcohol consumption, Hutton (2012) discovered that females were more likely to decrease their alcohol consumption after seven drinks where males were more likely to increase their consumption after seven drinks, in a single session. Upon examining weekly drinking consumption, Bowring et al. (2012) discovered males were twice more likely to report weekly risky alcohol consumption in comparison to females within the same sample. Carpenter et al. (2007), through qualitative data collection methods, suggests that females feel pressured into keeping up with their male counterparts, especially within the university environment. Carpenter et al. (2007) reveals that university traditions encourage females to increase their alcohol consumption in order for them to do what everyone else is doing. Though DeJong et al. (2006) and Perkins and Craig (2006) conducted

research amongst a mixed gender population, results were not presented in a gender specific manner, findings were based on their student body sample only. . Gill and OMay (2006) found, through quantitative methods amongst a sample of women only, that females are joining in regular risky drinking sessions, which has doubled over the last four years. Hutton (2012) found that 72% of females reported recent heavy episodic drinking. Of those highlighted as partaking in recent heavy drinking, 42% were at risk of incurring any type of categorical injury. According to Carpenter et al. (2007), though females were more likely to demonstrate awareness of the negative impact of risky alcohol consumption this had little impact on decreasing their alcohol consumption. Within the college/university environment, Gill and OMay (2006) found high levels of drinking amongst young adult women especially amongst those that took part in drinking games. This is supported by Carpenter et al. (2007) whose sample suggested that the social aspects of drinking encouraged consumption. 2.2.6 Awareness and Knowledge Awareness and knowledge of alcohol reduction campaigns appears problematic. All of the literature, in this review, examined levels of awareness and knowledge amongst their sample populations, in varying degrees. Most studies examined

awareness as understanding what is deemed a safe/unsafe level of alcohol intake

29

and risky behaviours related to high levels of alcohol intake (Hutton 2012, Bowring et al. 2012, Ricciardelli and McCabe 2008). While DeJong et al. (2006) and Perkins and Craig (2006) examined the level of awareness against perceived perception of peers level of risky drinking, van Gemert et al. (2011) found that awareness and message recall was demonstrated amongst their sample population but this did not impact on their behaviour. DeJong et al. (2006) examined awareness using a comparative pre-test and post-test method, similar to Perkins and Craig (2006). Literature demonstrates pre-existing knowledge and awareness amongst the sample populations, regarding alcohol levels and occurrence of illness/injury (Hutton 2012, Bowring et al. 2012 van Gemert et al. 2011) but even with knowledge and awareness the samples continued to engage in risky alcohol consumption Young adults, within the samples, also demonstrated a level of awareness of potential negative consequences in relation to risky alcohol use (Bowring et al. 2012, Hutton 2012 and Gill and OMay, 2006). It was found that participants engaging in regular risky alcohol behaviours were less likely to have awareness and knowledge, and were less likely to be able to cite key campaigns messages (van Gemert et al. 2011, Carpenter et al. 2007, Gill and OMay 2006). In comparison to those who reported lower levels of risky alcohol consumption, which were then more likely to recall campaign messages (Bowring et al, 2012 Ricciardelli and McCabe 2008). This was particularly prevalent amongst college/university students, living within halls of residence, where frequency of exposure to alcohol reduction messages was deemed equal (Gill and OMay 2006). A qualitative study, by Ricciardelli and McCabe (2008), examined students alcohol reduction message awareness and knowledge. Of the 671 participants, most were able to recount the message and the campaign details. Ricciardelli and McCabe (2008) suggest that this demonstrates attention and acceptance of the campaign amongst the target population. This view could reflect that young adults who practice risky alcohol consumption, simply, dont want to listen to alcohol reduction messages; therefore, may not be a reflection upon the campaign. Van Gemert et al. (2011) attempted to assess the effectiveness of the campaign in reaching its target audience and in achieving a level of awareness. The findings were positive, the majority of the sample population were able to cite and recognise the key message (74.7%). Similar to other studies, those highlighted as partaking in
30

regular risky drinking behaviours, were less likely to cite the key message of the campaign (van Gemert et al. 2011). As this was a common finding throughout the literature, it is an important finding and could be a key implication that alcohol reduction campaigns need to address within future alcohol reduction developments.

Diagram 5: Dont Turn a Night Out Turn into a Nightmare (2008)

Interestingly, Bowrings et al. (2012) offers suggestions as to why some young adults, in their sample, were able to demonstrate awareness in relation to those that displayed minimal awareness. Bowring et al. (2012), established common

characteristics of young adults who demonstrated awareness of the Australian 2009 Know Your Limits campaign as: being born in Australia and having a high school education. Participants who demonstrated lower levels of awareness were less

likely to have a high school education and were less likely born in country of origin (Bowring et al. 2012). This could indicate that low educational attainment and

culture, play an important role in achieving levels of awareness and message acceptance. This concept is worthy of future research. It is important to emphasize that when understanding and awareness was indicated this did not signify that safe levels of alcohol intake were being practiced (Bowring et al. 2012). 2.2.7 Message Typically the message being delivered to young adults is one of being safe, sensible and responsible in regards to their alcohol intake (Hutton 2012, Ricciardelli and McCabe 2008, Gill and OMay, 2006, Carpenter et al. 2007). Harm reduction is the accepted philosophy associated with initiatives to minimise harms in the reduction of

31

risky alcohol behaviours (Hutton, 2012, Gill and OMay, 2006). It is an approach that favours modification not abstinence (van Gemert et al 2011). Studies have

highlighted an existent level of awareness but little has achieved a behaviour change. Six studies examined the effectiveness of an alcohol reduction campaign (Hutton 2012, van Gemert et al. 2011 Ricciardelli and McCabe 2008, Carpenter et al. 2007, Gill and OMay 2006, DeJong et al. 2006, Perkins and Craig, 2006) and one of the studies examined the use of delivering safe drinking guidelines (Bowring et al. 2012) as a means of reducing alcohol consumption. Many countries have developed guidelines regarding safe levels of drinking, but there is no international standard and guidelines vary country to country (Bowring et al. 2012). For a country, such as the UK, that has a large immigrant/migrant multicultural society this could be the reasoning behind that lack of awareness and behaviour change. Guidelines are developed to reduce health risks from risky

drinking behaviours and can be distributed amongst promotional material to raise awareness. Guidelines appear to ignore the complexities that motivate individuals to engage in risky alcohol behaviours (Bowring et al. 2012). Gill and OMay (2006) report that there is a need to develop, deliver and evaluate alcohol guidelines and campaigns in order to determine their effectiveness in behaviour change, knowledge and awareness. Using a social norms approach Carpenter et al. (2007) examined the effectiveness of a UK university based alcohol reduction campaign Unit 1421. This study

discovered that despite providing promotional merchandise there was limited awareness amongst their sample population. Data, collected through focus groups, highlighted that the message was unclear and that a more innovative approach would be needed to create more interest. This was also found by Ricciardelli and McCabe (2008), qualitative data found that though their sample liked the advertising merchandise, it was found the actual message would have only a minimal effect and would not achieve a measurable behaviour change. Both DeJong et al. (2006) and Perkins and Craig (2006) examined the effectiveness and awareness of a social norms campaign amongst university/college students. Perkins and Craig (2006) specifically examined the effectiveness and awareness amongst university athletes. Unlike Carpenter et al. (2007) and Perkins and Craig
32

(2006) DeJongs et al. study encompassed multiple universities, implementing a randomised control trial. DeJong et al. (2006) found prolonged exposure to a social norms campaign decreased, though small, alcohol consumption when compared to the control sites that were not exposed to the social norms campaign. This is

supported by Perkins and Craig (2006). Exposure to social norms campaigns reduced the number of drinks consumed per week and per session (DeJong et al. 2006, Perkins and Craig, 2006). The aim of social norms campaigns is to convey accurate information to students regarding their own alcohol consumption and that of their peers (Carpenter et al. 2007). DeJongs et al. 2006 study proposes success in using social norm campaigns to reduce college students alcohol consumption while Perkins and Craig (2006) found success amongst their sample of athletes. DeJong et al. (2006, p.877) further suggests that social norms campaigns may protect students from the social forces that drive up student alcohol consumption. . Though positive aspects were highlighted by many participants, within the various research studies, participants emphasised negativity towards the message of alcohol reduction campaigns (Hutton, 2012). Ricciardelli and McCabe (2008) found that negative views were highlighted when participants felt their personal behaviours and opinions were threatened. Carpenter et al. (2007) and Gill and OMay (2006),

highlight that the UK sensible drinking message had little effect on their samples. Bowring et al. (2012) found that despite advertising of the 2009 safe drinking guidelines, little influenced a change in consumption amongst their sample. Though DeJong et al. (2006) and Perkins and Craig (2006) report a success, the reduction in risky alcohol consumption was minimal. This highlights the problems of developing successful campaigns aimed towards young adults. 2.2.8 Effective Delivery The mass media is a powerful tool used to aid the addressing of risky alcohol consumption (Hutton 2012, van Gemert et al. 2011, Ricciardelli and McCabe 2008). Carpenter et al. (2007) suggests that there has long been a reliance on the mass media to tackle and solve social problems. Health behaviour change is influenced by multiple factors: social, environmental and public (Hutton, 2012). The ultimate goal is to elicit a behaviour change; few campaigns can be expected to gain an immediate behaviour change (Gill and OMay, 2006).
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Van Gemert et al. (2011) suggest that mass media campaigns assume that behaviour is changed by exposure. Utilising mass media as a delivery option is costly (Perkins and Craig, 2006). The Australian Government spent $53.5 million on an anti binge drinking campaign, in which, van Gemert et al. (2011) found that those who were classified as regular risky drinkers had little awareness of. This was also the finding of Gill and OMay (2006) who examined the awareness of the UKs Sensible Drinking campaign, where despite national advertising few women, within their sample, could recall the sensible drinking guidelines or unit measurement. Media campaigns, relying on gimmicky prevention efforts, do not work. This was highlighted by Ricciardelli and McCabe (2008) and Hutton (2012), who used humorous, pictures within their reduction campaigns. Though both studies portrayed a level of message and campaign awareness their participants demonstrated higher levels of awareness of the humorous aspects of their campaigns. Carpenter et al. (2007) delivered their campaign message using various merchandise which was distributed amongst the student body. This did not increase the message awareness and found, within their focus groups, that they could not recall the merchandise utilised. Marketing and advertising need to match the requirements of the target group (Perkins and Craig, 2006). Carpenter et al. (2007) found that their focus

groups highlighted the need for messages to appear on social media networks. Print media is less likely to demand attention but can be used for narrowly defined target groups. Perkins and Craig (2006) used print media within their campaign delivery but did not rely only on this method of delivery. This is supported by Carpenter et al. (2007) who found that students didnt pay attention to posters as they were often inundated with various health messages via posters. The internet and web are

becoming the popular mode of message delivery (Bowring et al. 2012). Information providing campaigns, such as social norms campaigns, can focus on negative consequences and are likely to be unsuccessful (Hutton, 2012). Though DeJong et al. (2006) and Perkins and Craig (2006) would not agree with this and have in fact demonstrated a level of success. This could highlight the international difference in tackling risky alcohol consumption amongst young adults. Ricciardelli et al. (2008) proposes that alcohol reduction messages are more likely to be effective when asking or directing the population to adopt a certain action. Young adults are more likely to respond to messages when there is a key promise that meets their
34

needs or supports their values (Bowring et al. 2012). Achieving a behaviour change can be hindered by the notion that young adults dont view their alcohol intake in a negative way. (van Gemert et al. 2011) submits that this is a problem amongst most alcohol reduction campaigns. If young adults accurately perceive how much drinking is going on, then their perception of the norm will change which in turn leads to a decrease in risky alcohol behaviours. This is supported by DeJong et al. (2006) Perkins and Craig (2006) and Carpenter et al. (2007) who believe to move ahead and achieve a behaviour change amongst young adults their perception of what is the norm needs to be the main aspect of reduction campaigns.

35

Chapter Three

Diagram 6: Rape(2012)

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3. Research Approach
This studys focus includes both people and the environment and utilises the theory of social research. Social research is defined, by Sarantakos (2005, p.10), as the exploration of social life by providing reliable valid and well documented information and the evaluation of status of social issues and their effects on society. Based upon an ontological perspective this study seeks to understand the nature of reality (Sarantakos, 2005). The objectives of social research, pertinent to this study, are that of pragmatic aims the verification and solution of social problems (Bryman, 2012). Existing research, on the awareness of alcohol reduction campaigns

amongst young adults, focuses on specific groups of young adults, mainly college/university students. Research amongst general population young adults is almost non-existent; therefore, this study, using young adults in general, identified status groups within the 18-24 age. The identified segments of the population were: student, part time employed, full time employed and unemployed. Efforts were taken to identify current alcohol behaviours and level of awareness in regards to alcohol reduction campaigns. Following this, the study attempted to identify the frequency of young adult exposure, within the environment, to alcohol reduction campaigns and alcohol advertising. The methodology aims to introduce the research method,

design, sampling technique and analysis process while demonstrating reasoning behind the choice of methods used for this study. 3.1 Methodology Research methods are the tools used to gather data (Dawson, 2009). The selection of methods is often guided by the nature of question the study is endeavouring to answer and the practicality of assembling the data (Bowling, 2009). Overall, there are two central categories of research methodology, quantitative and qualitative. Qualitative research is the process of locating rich and meaningful data, which tends to focus on narrative interviews, participant observations and focus groups (Greenhalgh, 2010). Qualitative methods are particularly useful when researching unchartered fields and hypotheses can be generated at the end of the analysis once the data has been amassed (Bowling, 2009).

37

This study was conducted using quantitative research methods, but did attempt to integrate a mixed method approach. The theoretical underpinnings of quantitative research are positivism, the practice of extracting truth (Bryman, 2012). Quantitative research is the process in which participants are asked for their opinions in a structured manner to enable the construction of firm facts and statistics (Burns and Grove, 2005). A quantitative approach was deemed suitable for this study as it permitted early identification and clarity of research aims and the construction of a hypothesis that directed the progress of the study (Dawson, 2009). It also

supported the aim of exploring the level awareness, knowledge and frequency of alcohol reduction campaigns. This study did not aim to collect personal thoughts and feelings, therefore quantitative methods were deemed appropriate for this research study. 3.1.2 Sample The research sample is the sub section of the population the study proposes to employ (Bowling, 2009). Specific criteria, geographic location and age, are often depicted in the designation of the sample (Creswell, 2008). Sampling is a significant element when undertaking quantitative research. A definition of a sample is the segment of the population that is selected for the study (Bryman, 2012, p.86). There are numerous sampling techniques that can be used when conducting quantitative research. According to Dawson (2009) the sampling technique depends upon the area of research, methodology and preference of the researcher. For the purpose of this study a non-probability sample technique was implemented. According to Bryman (2012, p.87) a non-probability sample is a sample that has not been selected using a method of randomisation. A non-probability technique

implies that some of the target population are more likely to be selected than others (Bryman and Cramer, 2011). This method can introduce bias as the selection of participants relies on the researchers judgment (Creswell, 2008). Non probability sampling is used for many quantitative studies and is often chosen when there are limitations on time and resources (Bryman, 2012). Probability sample techniques give every member of the target population the same probability of being sampled (Webb and Bain, 2011). Research on young adults and their alcohol consumption has predominantly been conducted on college students and, on occasion, amongst specific professional groups medical and military staff.
38

These groups are

commonly and historically associated with risky alcohol consumption.

Very little

research has been conducted on general population young adults. As this study is aimed towards the general population of young adults in SWL it was impossible to put together a list of the target population to elicit probability sampling. Therefore, it was deemed appropriate to use a non-probability sample technique. This is

supported by Dawson (2009) who suggests that non-probability sampling may be the convenient choice when attempting to determine whether a problem exists or not. The target population for this study was young adults, aged 18-24, and living in SWL. This population was chosen due to the growing concern of their current relationship with alcohol, the risk of future health problems, high risk anti-social behaviours and the lack of existing research on general population young adults. Research dictates that young adults tend to have a more social attitude towards alcohol, playing a large part in their rest and relaxation (Scribner et al. 2011). This population was also

chosen as the government has targeted numerous campaigns over the last ten years with an effort to imbue this group with responsible behaviour, knowledge of alcohol consumption and increase awareness regarding its negative effects. A specific geographical location was chosen due to the recent opening, of morning to afternoon drinking venues usually attached with a theme, within SWL. One such establishment, The Church, is frequented by young adults. To gain entry, a person must dress in a costume or comical outfit. Young adults appear to get drunk from early on in the day until late at night. Due to this, there has been an increase of police presence, rowdy behaviour and local bars/pubs have advertised special deals to attract business after the venue has closed, encouraging further risky alcohol consumption. The sampling technique, for this study, did indeed rely on the researchers aptitude to detect young adults aged 18-24 years. Clarification was achieved when the

participant agreed that they were within target age group. Proof was not requested. The accessibility of this target group was deemed attainable by targeting various choke points, such as train stations and shopping precincts throughout SWL. The sampling plan was decided by financial constraints and time allotment. Therefore, this impedes the size of the sample group. It was deemed appropriate for the sample size to consist of a minimum of 150 participants.
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3.1.3 Data Collection A quantitative research approach was chosen for this study as numerical data needed to be accomplished in order to gauge the level of awareness, knowledge and frequency of message exposure, amongst young adult participants. According to

Sarantakos (2005), surveys are frequently used within social research. To obtain numerical data a questionnaire was formulated and was used as the primary data collection source. Generally, questionnaires tend to be quick and easy to gain data, potentially can reach a large number of the target population (Parahoo, 2006) and are a popular quantitative data collection method (Nayab, 2011). A positive motive for employing a survey technique is that the majority of the population are aware of how questionnaires work and would likely have had previous experience (Sarantokas, 2005). Questionnaires have many positive and negative features that need to be considered when deciding the appropriateness of data collection. Parahoo (2006) suggests that questionnaires incur less cost, can provide quick results and offer a greater anonymity. A perceived weakness of questionnaires is the inability to probe further than the actual question (Creswell, 2008). Quantitative questionnaires are commonly comprised of standardised questions, meaning all participants will answer the same questions in the same order (Bryman, 2012). Standardisation, aids the process of tabulation and comparison (Nayab, 2011). The standardisation of a questionnaire increases the elimination of bias and allows the impartial collection of responses (Sarantakos, 2005). A further positive aspect for the use of a questionnaire was the autonomy in the design of the questions that reflected the aims needed to develop data for the research. Alongside the questionnaire, a cover letter was designed (Appendix 5). As

suggested by Dawson (2009) this enriches the response rate. The aim of the cover letter is to distribute information to the participant in regards to: why this research is being done, description of main objectives and guarantee anonymity and confidentiality (Creswell, 2008). The covering letter should also provide instruction as to how the questionnaire should be completed. The questionnaire (Appendix 6) implemented for this research contained 21 standardised closed questions. The use of close ended questions was deemed appropriate as closed questions permit participants to provide finite answers such as
40

yes or no (Bowling, 2009). Closed questions can be described as a dichotomous; construed as audacious, probing or leading (Sarantakos, 2005). Closed questions can result in incomplete responses and offers less spontaneity in answers (Bryman, 2012). Participants may not be able to answer the question in the way that they would want as their true answer may not be an option. Despite this, survey

researchers typically prefer to use closed questions (Dawson, 2009). Questions, often used within qualitative methods, are open ended which are known to enhance trust as participants have the opportunity to answer in their own terms (Silverman, 2010). Open questions are time consuming and costly as they usually require an interviewer, sometimes more than one, and can be difficult to code (Silverman, 2010). For the purpose of the questionnaire used in this study the opportunity was provided in several questions for participants to expand or add to the question. This allowed participants to express feelings and thoughts should they wish to do so. It was found that this method did indeed elicit further information, though from only a few participants Prior to implementation, the questionnaire was subject to change. The questionnaire was put through a pre-test in order to ensure that the information being collected was suitable, and reliable (Webb and Bain, 2011). According to Sarantakos (2005) pretesting is employed by quantitative researchers and is a positive feature of questionnaire data collection. A pre-test is a small test used to check the

mechanical structure of the tool (Bryman, 2012). The pre-test stage, consisting of 15 people, emphasised that some of the questions were ambiguous and that the data collected was not pertinent to the hypothesis. As design flaws were located, they were corrected appropriately. The pre-test provided the opportunity to re-word the questions and the format further developed. According to Parahoo (2006), reviewing the questionnaire prior to administration is an important stage. Structural parts of the questionnaire such as: tone, clarity and lay-out can be highlighted and improved. In order to implement the questionnaire, it was decided that the researcher would approach potential participants on the street to gain their participation.

Questionnaires can be delivered to the target population in various modes. Questionnaires posted to addresses can be costly and the response rate poor (Bryman, 2012). If questions are misunderstood participants may not answer them fully, rendering the questionnaire incomplete (Dawson, 2009). A positive feature of
41

the researcher being present during the questionnaire administration is the enablement of participants to clarify any potential misunderstandings (Munn and Drever, 2004). It also permits the assistance with any encountered literacy problems amongst participants (Munn and Drever, 2004). One disadvantage, of researcher presence, is the possibility of researcher influence. Participants could potentially be influenced to answer questions in a perceived expected manner, therefore increasing the possibility of bias (Nayab, 2011). During questionnaire

implementation, privacy was given to participants, with the provision of a clipboard, pen and questionnaire. Nayab (2011) suggests that when the participant is able to answer their questions individually and on their own, influences the participants ability to think more independently, resulting in a higher quality answer. Unfortunately not all people take questionnaires seriously and may be reluctant to spend time filling them out this was the experience during the pre-test. 3.1.4 Focus Groups Focus groups were planned, for this study, in order to gain additional data. Creswell (2008) suggests that focus groups are a popular data collection method within health promotion research. Though this is a qualitative data collection method, Creswell (2008) suggests that focus groups can enhance quantitative data. people who interact with each other and the group leader. According to Bowling (2009, p.424) focus groups are unstructured interviews with small groups of The aim of conducting

focus groups, for this study, was to allow further investigation of the data collected through the survey. Bowling (2009) suggests this is the process of sense making. Participants were highlighted through the questionnaire and those that agreed to take part in the focus group were provided with the details of when and where the focus groups would take place (Appendix 7). No incentives were offered. Morias (2010) suggests that incentives can encourage participants to attend as focus groups can be lengthy. On the allocated day no one attended the focus group and was, therefore, unable to gain further data. 3.1.5 Observation Observation is one of the oldest methods of social research, but can be challenging and complex (Simpson and Tuson, 2003). Observation entails the gathering of data through vision (Sarantakos, 2005), and is commonly used in tandem with other data
42

collection methods (Parahoo, 2006). The observation of objects refers to the visual stimulant that has a significant impact on peoples lives (Simpson and Tuson, 2003). Benefits, from the use of observation, is the ability to collect data when respondents are unable to or dont want to provide the required information (Creswell, 2008). Unfortunately observation is at risk of bias and dependent upon the researchers perception (Simpson and Tuson, 2003). It is possible that the researcher can miss important information leaving it unrecorded. According to Simpson and Tuson (2003) the researcher decides on the unit of the observation, and particular to this study, was the observation of advertising frequency of alcohol reduction material in comparison to alcohol advertising within public places young adults frequent. The aim of the observation was to investigate the environment in which young adults are known to inhabit and to note the frequency of alcohol reduction advertising promoting safe and sensible drinking message. Specific categories pertinent to the observation were developed. An

observation criterion was designed to produce numerical data in regards to the frequency of exposure (Appendix 8). A timeframe of one week was allocated to

carry out the observation. Recording times and days were deemed not important as it was understood that the advertising of alcohol reduction messages would not frequently change within public establishments. The places of observation were

determined and attended by the researcher. This was conducted in five areas throughout SWL. Establishments used were: GP office, public library, further

education common rooms, wine bar, pub, supermarket, sports centre and job centres. To record the data a field note check list was designed and a pre-test was completed outside of SWL. By using the technique of observation further information was gathered that may or may not support the data gathered by the questionnaire. Though primarily observations are a common qualitative method it is possible to build numerical data and exclude any weaknesses from the questionnaire. It would be possible to compare what was observed with the survey data. 3.1.6 Data Analysis The research method will guide the form of analysis to be carried out. Qualitative data analysis can be a personal and objective process (Dawson, 2009), and often takes place in tandem with the data collection process. Qualitative data analysis can
43

be thematic, guided by themes, or comparative which entails the drilling down of data until no new information is found (Bryman, 2012). Qualitative analysis can be

time consuming as large amounts of data is produced (Dawson, 2009) Qualitative research is not guided, in the same manner as quantitative research, but similarly can be done using computer software packages, but according to Bryman and Cramer (2011) this has not been universally embraced. For quantitative analysis, there are set procedures and guidelines (Sarantakos, 2005). The process of quantitative analysis can be descriptive or inferential

(Dawson, 2009). The method of analysis needs to be considered early on in, quantitative research, but typically does not occur until the end of the data collection process (Creswell, 2008). Considerations must be made regarding the size and nature of the sample and the types of variables that are being created (Walker and Almond, 2010). The key of quantitative data collection and analysis is to test the hypothesis. There are several steps to be completed when testing a hypothesis. Ultimately the researcher starts with the development of a hypothesis, ensuing steps are then followed to indicate if the hypothesis is proven or unproven (Walker and Almond, 2010). This study undertook the process of non-parametric descriptive analysis with the development of categorical data and nominal variables. Nonparametric data is an analysis method where the data is not required to fit a normal distribution (Bryman and Cramer, 2011). Non-parametric statistics uses data that is often nominal,

meaning it does not rely on numbers, but rather a categorical ranking, representing the objects of what the coded numbers represent (Hinton et al. 2004). Descriptive analysis is the presentation of numerical results for the target population (Walker and Almond, 2010). Therefore, descriptive non parametric analysis was deemed

appropriate for this study as the sample size was small and nominal variables were utilised. Commonly quantitative data analysis is done by using the statistical package, SPSS, and this is universally accepted. Though this appears to be quick and the easiest method of data analysis (Dawson, 2009), this can be labour intensive and time consuming. Uni-variate analysis demonstrates frequency; this is a basic concept within quantitative analysis and can be done without the SPSS software, but the
44

researcher is at risk of missing answers and, thereby, introducing a bias into the results (Hinton et al. 2004). This study, therefore, implemented the use of the SPSS statistical package during the analysis stage. In order to create numerical data to input into SPSS software, numerical values must be allocated to each response within the multiple response questionnaires (Griffith, 2010). SPSS is not suitable for text base responses. When creating multiple

response questionnaires, analysis requirements must be considered as variables and must be identified (Bryman and Cramer, 2011). Variables are the thing the data represents (Hinton et al. 2004). The need to code the questionnaire indicates the use of nominal variables. Nominal variables are items that are converted into numerical data and can be identified early on in the data collection process (Griffith, 2010). Variables can be dependent and independent; this indicates the influence of one variable to another (Sarantakos, 2005). For example, in this study, a dependent variable is alcohol and an independent variable is age. The alcohol variable was subject to change while the age variable would not change but could influence the alcohol variable. When selecting the appropriate statistical procedure for the study a confidence interval must be determined. The confidence interval will establish how confident the statistical result is, ensuring that it did not occur simply by chance or an error in sampling (Bowling, 2009). According to Walker and Almond (2010) statistical significance is what researchers are willing to accept as probably true and not due to chance. The common statistical significance is 0.05 which indicates 95%

significance (Hinton et al. 2004). The 0.05 is the statistical allowance of something not being true. This study set the confidence level at 0.05 (CI 95%). Following the development of variables, the relationship and the introduction of the statistical significance, frequency counts can be determined. Frequency counts refer to the number of occurrences repeating over time (Walker and Almond 2010). According to Griffith (2010) frequency counts simply count the number of occurrences of each response which can be generated using SPSS. A useful

method for summarising data is cross tabulations. This allows the analysis of frequency patterns of sub sets, within the population, and is done on SPSS (Bryman and Cramer, 2011). It is possible to cross tabulate all categorical data but much of
45

the result will be useless (Hinton et al. 2004). Therefore, only variables that will produce results should be cross tabulated. For example, age with views on alcohol campaigns can be cross tabulated, aiming to find out if age has any relevance on views of alcohol campaigns. Once the data has been summarised it is then possible to introduce further statistical techniques to reveal more information (Griffith, 2010). One such test, employed within the analysis, was the Pearson chi square test. This test is useful when two categorical variables have been cross tabulated and a judgment can be made (Hinton et al. 2004). The Pearson chi square test can be used to examine the likelihood of statistical evidence of a relationship between two variables (Bryman and Crammer, 2011). This study also utilised the Spearmans rho (two tailed test). This is used when implementing non parametric tests of correlation (Walker and Almond, 2010). All correlation coefficients produce a number between -1 and +1 (Hinton et al. 2004). The Mann Whitney test was also implemented in the statistical analysis. This is the non-parametric test that is the equivalent of the t-test; this test compares ranked scores between groups (Walker and Almond, 2010). 3.1.7 Validity and Reliability Reliability and validity are both quality measures of research instruments and although are different in nature, always have to be considered together (Sarantakos, 2005). Validity is considered to be the strength of the final results (Webb and Bain, 2011), determining whether the results can be seen as accurately describing the real world. Reliability is an important part of validity but on its own is an insufficient measure (Parahoo, 2006). Reliability is the account of repeatability, the consistency of a test and quality indication of instruments utilised (Walker and Almond, 2010). This study worked at ensuring both reliability and validity were key components. Both data collection methods were put through a pre-test test trial. Pre-test participants were asked for their opinions regarding the content and design of the questionnaire. It is correct to engage in systematic development of questionnaires to enable reduction in potential measurement errors. By not engaging in systematic

development, may lead to the validity and reliability of the data to be undermined.

46

3.2 Time Frame

February 2012 September 2012 The time frame was very specific (Appendix 9). February and March was utilised for background reading and research with the aim to develop a better understanding for the subject area. April was used for the development of the questionnaire and The

observation field check list. May was utilised for the literature review.

preliminary data collection took place throughout the month of May and first two week in June. This was deemed appropriate to complete the pre-test of the

questionnaire, amend any problems and complete the data collection process using the questionnaire. The focus groups were planned for 23rd June. Had participants turned up for the focus groups this would have provided enough time for analysis. Questions used in the interview were generated from the data collected in the survey stage. The Observation took place simultaneously as the questionnaire and interviews were being done throughout May and June. This allowed July for data analysis; August and September for writing the research process and requirements for the dissertation.

3.3 Budget
Budget is an important area to consider when preparing to plan, undertake and complete a piece of research. Often budget will guide the researcher in their choices of methodology (Dawson, 2009). This study did not receive any sponsorship, grants or financial assistance. The occurrence of any cost was carried by the researcher. The financial cost involved in this study was minimal and was incurred by the cost of paper, pens, photocopying and printing. The researcher was aware that there would be a large amount of man-hours incurred and was completed in the researchers own time. No incentives were offered to participants at any time due to cost

implications. The researcher was aware that extra costs may be incurred but, as there was no agreed budget, the researcher endeavoured to keep all the costs to a minimum.

47

3.4 Ethics
Ethical considerations must be taken into account when executing a research project. One of the tools used to ensure that ethical considerations of the study are compliant was to review the university ethics check list (Appendix 10). Prior to

conducting research on human beings a study protocol was approved (Appendix 10). In the case of this research study a research proposal was developed and approved by the researchers university. An indemnity letter was provided after the research proposal was approved (Appendix 11). Approval ensures that the rights of the

participants are protected at all times (Webb and Bain, 2011). Due to the nature of this study, risks, or harm, to participants were deemed minimal. Bryman (2012) records that harm can entail a number of facets, and in relation to this study, include: loss of self-esteem and stress. It would be possible that the researcher may come into contact with participants who potentially have high risk issues with alcohol such as dependency, long term abuse or historical personal exposure to alcohol related diseases/problems. Therefore, ethical principles were integrated. The ethical

principle of Beneficence is to ensure that good is done (Web and Bain, 2011). Should a participant highlight any emotional or physical problems related to the questioning of alcohol, the researcher would be able to sign post participants to local organisations that would assist the participant with their distress. The ethical

principle of non-maleficence is related to doing no harm (Webb and Bain, 2011). This principle is often weighed against the principle of beneficence. It is perceived that no harm will come to participants due to the subject nature of the study but should emotional harm occur the researcher would support the participant in receiving the needed assistance and help. Under the principle of respect for autonomy the researcher is able to recognise and respect the rights of the participants. This is inclusive of the right to privacy and the right to make informed decisions and the right to refuse to participate. All

participants were fully informed and the benefits of the research are highlighted to them both verbally and written. This was completed in the use of the cover letter provided to all participants prior to answering the questionnaire. According to the Nuremberg Code (1947) the voluntary consent of human subjects is absolutely essential. Verbal/informed consent was achieved by each participant once they had

48

read the covering letter and upon the completion of the questionnaire their consent was implied.

49

Chapter Four

Diagram 7: Violence (2011)

50

4. Results
4.1 Population 250 potential participants were approached to take part in the survey, 63.2% (N=158) consented and completed the questionnaire. 36.8% (n=92) Refused to participate, which was the main reason for non-participation. The gender of the participants was female 56.3% (n=89) and male 43.7% (n=69). The largest age group represented from the participants was age 20-22 which consisted of 50.6% (n=80), of the total participant. 42.4% (n=67) of the participants surveyed, lived in Lambeth. Table 4 demonstrates the status of the participants was broken down into sub groups, which were students (48.73%, n=77), fulltime (21.52% n=34), part time workers (10.13% n=16), and unemployed (19.62% n=31) (Appendix 12).
Table 4: Status

4.1.2 Current Alcohol Behaviours When examining the current alcohol behaviours of the participants the frequency of drinking and age was examined. Using a cross tabulation table, it was discovered that 53.8% (n= 14) of 18-19 year olds, 51.3% (n=40) of 20-22 year olds and 52.1% (n=25) of 23-24 year olds drank alcohol 2-7 times per week (Table 5). Overall, 52%

51

(n=79) of the 152 participants, who in the survey, stated that they drank. This indicates that the largest percentage of frequency for drinking, can lead to risky drinking and increased health risks. Using a Pearsons chi square formulae comparing age groups and the frequency of drinking, the result was p=0.830 (Table 6) which indicates that there is no significant relationship between age of the participants and the frequency of their drinking. When examining the choice of alcoholic drink amongst the sample, it was found that Beer/lager was the most popular choice throughout the whole population (27% n=41). It was found that gender affected choice with 50% (n=34) of males choose beer/lager while 8.3% (n=7) of females chose beer/lager (Table 7). This is a highly significant finding as p=0.000 (Table 8). Comparisons were then made with age and status (Appendix 13).
Table 5: Ages and Alcohol Frequency

Frequency 2-3 times 2-7 days Daily Ages 18-19 1 3.8% 20-22 7 9.0% 23-24 7 14.6% Total 15 9.9% per week 14 53.8% 40 51.3% 25 52.1% 79 52.0% per month 9 34.6% 27 34.6% 14 29.2% 50 32.9% 3-4 times per year 2 7.7% 4 5.1% 2 4.2% 8 5.3% Total 26 100.0% 78 100.0% 48 100.0% 152 100.0%

52

Table 6: Chi-Square Tests, age/frequency

Asymp. Sig. (2Value Pearson ChiSquare Likelihood Ratio Linear-byLinear Association N of Valid Cases 152 1.875 1 .171 2.957 6 .814 2.825
a

df 6

sided) .830

TABLE 7: Drink choice by Gender

Drink choice by gender

Beer/lager Gender_18_24 Male 34 50.0% Female 7 8.3% Total 41 27.0%

Beverage Alco-pops 13 19.1% 15 17.9% 28 18.4% Wine 6 8.8% 30 35.7% 36 23.7% Spirits 9 13.2% 21 25.0% 30 19.7% Other 6 8.8% 11 13.1% 17 11.2% Total 68 100.0% 84 100.0% 152 100.0%

TABLE 8: Chi-Square Tests choice of Beverage/Gender

Asymp. Sig. (2Value Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases 152 38.941
a

df 4 4 1

sided) .000 .000 .000

41.712 22.618

53

4.1.3 Location of Drinking Alcohol Upon examining where participants prefer to consume their alcohol, it was found that 32.4% (n=22) of 68 males indicated that drinking at a friends house was the most popular choice. 32.1% (n=27) of 89 females also indicated this as a popular choice. There is no significant relationship between gender and where people consume alcohol (Table 9). Location of choice was also examined with age and status (Appendix 14)
Table 9: Gender and location

Gender and location of choice

Home Gender_18_24 Male 6 8.8% Female 15 17.9% Total 21 13.8%

Where Friends House 22 32.4% 27 32.1% 49 32.2% Parties 20 29.4% 14 16.7% 34 22.4% Pubs/Clubs Restaurant 20 29.4% 25 29.8% 45 29.6% 0 .0% 3 3.6% 3 2.0% Total 68 100.0% 84 100.0% 152 100.0%

4.1.4 Incidences and Alcohol When examining the experience of alcohol related incidences, 25% (n=17) of the male drinking participants (n=68) indicated hangover and 23.5% (n=16) indicated getting into trouble with the police. 42.9% (n=36) of females, who drink alcohol (n=84), indicated the most common incident experienced was a hangover. This was followed by 21.4% (n=18) feeling ill and vomiting (Table 10). When looking for

relationships on how gender impacts the experience of drinking a significant relationship was located p=0.001. Relationships between experience and status and age were also examined (Appendix 15).

4.1.5 Influences of Drinking Alcohol Examining what influences, the sample of drinking participants, to increase their drinking 27.9% (n=19) of 68 males, indicated that friends are influential in encouraging higher intake of alcohol. 28.6% (n=24) of 84 females, drinking sample, indicated that the availability of special offers in supermarkets was the largest influence of increasing their alcohol intake. P=.040, indicating a significant
54

relationship between males and females and their influences of drinking (Appendix 16). When comparing influences and status, 30.1% (n=22) of students and 29% (n=9) unemployed, indicated friends were influential. 31.3% (n=10) of full time
TABLE 10: Incidence and Gender
Gender_18_24

Incidence and gender

Male Incidents Ill vomited 9 33.3% Gaps in memory 4 36.4% Hangover next day 17 32.1% Unprotected sex 12 54.5% Got into argument/fight 8 47.1% Been victim of crime 2 40.0% Trouble with police 16 94.1% Total 68 44.7% Female 18 66.7% 7 63.6% 36 67.9% 10 45.5% 9 52.9% 3 60.0% 1 5.9% 84 55.3% Total 27 100.0% 11 100.0% 53 100.0% 22 100.0% 17 100.0% 5 100.0% 17 100.0% 152 100.0%

workers and 50% (n=8) part-time workers indicated that nothing influenced their drinking. Indicating this is personal choice (Table 11). In overall comparison of status and influence the largest response 25.7% (n=39) indicated that special offers in supermarkets was a key driver in influencing alcohol consumption. There is a significant relationship indicated, p=0.000, between status and their influences of drinking.

55

TABLE 11: Influences to increase alcohol consumption

Status Influences and increased alcohol Student F/T work P/T work Unemployed Total

Family

66.7%

33.3%

.0%

.0%

100.0%

Employment

.0%

.0%

.0%

100.0%

100.0%

Friends

22

32

68.8%

3.1%

.0%

28.1%

100.0%

Life event

25.0%

37.5%

12.5%

25.0%

100.0%

Product advertising

14

21

66.7%

14.3%

.0%

19.0%

100.0%

Special offers in supermarket

22

39

56.4%

15.4%

12.8%

15.4%

100.0%

Happy Hour

15

26.7%

53.3%

13.3%

6.7%

100.0%

Extended Open Hours

75.0%

.0%

.0%

25.0%

100.0%

Nothing

10

29

13.8% Total 73

34.5% 32

27.6% 16

24.1% 31

100.0% 152

48.0%

21.1%

10.5%

20.4%

100.0%

56

When analysing the total drinking population and reasons for reducing alcohol consumption, 42.8% (n=65) indicated finances. This was also the finding when comparing gender; 45.6% (n=31) of males and 40.5% (n=34) of females (Appendix 17). Age and status can be found in Appendix 17. 4.1.6 Alcohol Reduction Campaign Awareness When examining the entire sample knowledge on recommended unit intake per day 18% (n=16) of 89 females and 24.6% (n=17) of 69 males demonstrated knowledge. This indicates that the majority of the total sample lacked unit awareness. 34.8% (n=24) of 69 males stated Dont Know and 28.1% (n=25) of 89 females stated Dont Know (Table 12).
TABLE 12: Unit Awareness by Gender
Gender and unit awareness per day Male 1-2 units per day 5 35.7% 2-3 units per day 4 20% 3-4 units 17 37% 5-6 units per 14 63.6% 7-8 units per 5 71.4% Dont know 24 49% Gender Female 9 64.3% 16 80% 29 63% 8 36.4% 2 28.6% 25 51% Total 14 100% 20 100% 46 100% 22 100% 7 100% 49 100%

Total

Count Alcohol Units Day

69 43.7%

89 56.3%

158 100%

Awareness regarding safe drinking strategies demonstrated that 94.3% (n=149) of the total sample were unaware of any safe drinking behaviours.
57

When examining

drinking strategies with age, gender and status no significant relationship was found. Awareness regarding alcohol reduction campaigns, 98.6% (n=68) of males and 93.3% (n=83) females were unable to name a campaign (Table 13). Status,

demonstrated 11.8% (n=4) full time employees, 12.5% (n=2) of part time employees and 1.3% (n=1) of students demonstrated awareness of alcohol reduction campaigns (Appendix 18). P=0.019 which indicates that status is significant in their ability to name a campaign.
TABLE 13: Name an Alcohol Reduction Campaign

Name_campaign Yes Gender_18_24 Male Count Expected Count % within Gender_18_24 Female Count Expected Count % within Gender_18_24 Total Count Expected Count % within Gender_18_24 1 3.1 1.4% 6 3.9 6.7% 7 7.0 4.4% No 68 65.9 98.6% 83 85.1 93.3% 151 151.0 95.6% Total 69 69.0 100.0% 89 89.0 100.0% 158 158.0 100.0%

4.1.7 Message Appropriateness 55.1% (n=38) of males claim that alcohol reducation campaigns do not promote age appropriate campaigns. 56.2% (n=50) of females indicate that they dont know if campaigns are age appropriate (Appendix 19). p=0.024 indicating that there is a significance between gender and the age appropriateness of alcohol reduction campaigns. When examining status, 53.2% (n=41) students, 41.2% (n=14) full time employees 12.5% (n=2) part time employees and 38.7% (n=12) unemployed stated that campaigns were not age appropriate (Appendix 19). The data, in relation to status, indicates a combined No or Dont Know response of 93.7% (n=148). There is a relationship of significance between status and the age appropriateness of campaigns which is indicated by p=0.003.

58

4.1.8 Location of Alcohol Reduction Advertising When asking where alcohol reduction advertising should take place 23.2% (n=16) of males suggested public places. 23.6% (n=21) females suggested everywhere.

p=0.033 indicates that gender is significant on the feelings where campaigns should be advertised (Appendix 20). Age indicated 26.9% (n=7) of 18-19 year olds stated that advertising should be done through social media outlets (Appendix 20). Status indicated 23.4% (n= 18) of students indicated public places, 26.5% (n=9) of full time workers indicated public place, 37.5% (n=6) part time workers suggest public transport and 32.3% (n=10) unemployed suggest everywhere (Table 14). P=0.001 significantly indicates that status has a relationship with where alcohol reduction campaigns should be advertised. 4.1.9 Observation 42 observations were analysed and in 45.2% (n=19) locations there was found to be Alcohol Reduction Campaign (ARC) messages. Alcohol campaign message consisted of: 52.4% (n=11) Alcohol Unit Information (AUI), 33.3% (n=7) Alcohol Safety Information (ASI) and 14.3% (n=3) Alcohol Reduction Information (ARI). The message most observed as being promoted was AUI which was noted in 57.9% (n=11) of the locations (Table 15).

59

TABLE 14: Locations where reduction advertising should be

Where should adverts be Public Transport

Status Student 3 13.6% Fulltime work 8 36.4% 9 25.7% 5 41.7% 0 .0% 1 7.7% 0 .0% 2 40.0% 0 .0% 2 100.0% 7 19.4% 0 .0% 34 21.5% Part time work 6 27.3% 0 .0% 0 .0% 3 16.7% 1 7.7% 0 .0% 1 20.0% 1 25.0% 0 .0% 3 8.3% 1 25.0% 16 10.1% Unemployed 5 22.7% 8 22.9% 3 25.0% 0 .0% 3 23.1% 0 .0% 1 20.0% 0 .0% 0 .0% 10 27.8% 1 25.0% 31 19.6% Total 22 100.0% 35 100.0% 12 100.0% 18 100.0% 13 100.0% 7 100.0% 5 100.0% 4 100.0% 2 100.0% 36 100.0% 4 100.0% 158 100.0%

Public Place

18 51.4%

Pubs/clubs

4 33.3%

Social Media

15 83.3%

Billboards

8 61.5%

TV/Radio

7 100.0%

Magazines/New spapers

1 20.0%

University/Work place

3 75.0%

Hospital/GP

0 .0%

Everywhere

16 44.4%

Nowhere

2 50.0%

Total

77 48.7%

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TABLE 15: Frequency of alcohol reduction advertising

Message Environment and Message Promotion Mess_Prom_ AUI Enviro_GP Count % within $Enviro % within $Message Enviro_Library Count % within $Enviro % within $Message Enviro_Restaurant Count % within $Enviro % within $Message Enviro_Pub Count % within $Enviro % within $Message Enviro_Wine_Bar Count % within $Enviro % within $Message Enviro_Comm_Ctr Count % within $Enviro % within $Message Enviro_College Count % within $Enviro % within $Message Enviro_University Count % within $Enviro % within $Message Enviro_Nightclub Count % within $Enviro % within $Message Total Count 0 .0% .0% 1 50.0% 9.1% 3 100.0% 27.3% 1 100.0% 9.1% 2 100.0% 18.2% 1 33.3% 9.1% 1 100.0% 9.1% 1 100.0% 9.1% 1 100.0% 9.1% 11 Mess_Prom_ ARI 2 40.0% 66.7% 0 .0% .0% 0 .0% .0% 0 .0% .0% 0 .0% .0% 0 .0% .0% 0 .0% .0% 1 100.0% 33.3% 0 .0% .0% 3 Mess_Prom_ ASI 3 60.0% 42.9% 1 50.0% 14.3% 0 .0% .0% 0 .0% .0% 0 .0% .0% 2 66.7% 28.6% 0 .0% .0% 1 100.0% 14.3% 0 .0% .0% 7 19 1 1 1 3 2 1 3 2 Total 5

Percentages and totals are based on respondents. a. Dichotomy group tabulated at value 1.

In comparison, observation of alcohol advertising 47.6% (n=20), of valid observation sheets, observed Alcohol Promotion. The largest promotion observed was the
61

promotion of Special Deals which were noted at 50% (n=10). Alcohol Brand Promotion was noted in 45% (n=9). Event Promotion was noted in 35% (n=7) of the locations. The promotion of Sponsored Events and Theme Nights were both the same with them being noted in 20% (n=4) (Table 16)

TABLE 16: What alcohol adverts are promoting

Type of Alcohol promotion

Alcohol Ads Yes Count % within Alcohol Ads Total Count 9 9 45.0%

Alcohol Promotion Brand Sponsored Event Evening Theme Night Special Deal Total 4 20.0% 7 35.0% 4 20.0% 10 50.0% 20

10

20

Percentages and totals are based on respondents. a. Dichotomy group tabulated at value 1.

Promotional advertising of alcohol and alcohol reduction messages varied.

The

most prominent alcohol advertising was 85% (n=17) using posters to promote alcohol. This was closely followed by 75% (n=15) advertising banners and 35% (n=7) offered free promotional merchandise (Appendix 21). In comparison, alcohol reduction messages were observed to be less frequent. No promotional merchandise was on offer, no banners were noted. Alcohol reduction advertising was found, through the use of posters, 63.2% (n=12) on information boards, 15.8% of toilets and 26.3% (n=5) was promoted on menus. (Appendix 21) 4.2 Discussion of Results This study examined the current alcohol behaviours, level of alcohol awareness and frequency of exposure to alcohol reduction campaigns, amongst young adults, 1824, living in SWL. Alcohol Reduction Campaigns aim to elicit behaviour change amongst young adults in regards to their alcohol consumption. This study

discovered that alcohol reduction campaigns have little influence amongst young adults. Current alcohol consumption is being practiced at risky levels; there is a lack of awareness and limited level of exposure.
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This study discovered that males and females continue to ingest worrying levels of alcohol. The majority of the sample population regularly drink more than the recommended limit. This study found that the sample population were likely to report feeling ill and having a hangover after drinking sessions. But it also discovered that males were also likely to get into trouble with the police. This is a concern as numerous campaigns have targeted young men and alcohol related violence. When examining the choice of favourite drink beer was indicated for the total sample. When examining this within the location frequently used to purchase alcohol it is easily discovered that beer/lager have many special deals and cheap prices. It was also discovered that many of the sample, regardless of gender, choose to drink at a friends house. This could indicate the practice of pre gaming which has received little attention thus far with alcohol reduction campaigns. It was also found that alcohol pricing is influential in increasing the amount of alcohol in any one session supermarket special offers is the main indicator here. Amongst those that were classified as in full time employment findings suggest that nothing influenced this group to drink more. Therefore, this suggests that if alcohol reduction campaigns offered an alternative behaviour this could well elicit a behaviour change amongst this sub group. Interestingly, amongst young adults, friends continue to carry weight amongst their decision making process. This supports current literature where it is suggested that peer pressure and or the need to be accepted by group continues to be a influencing factor amongst alcohol consumption. Though this study has produced some valuable findings, it can be assumed that the sample population were able to justify their choice to drink and have some understanding, therefore, appearing unwilling to receive messages that are in conflict with their wants and needs. The majority of the sample identified that finances was the most influencing factor in decreasing the amount of alcohol intake. This is an important finding as this

suggests alcohol reduction messages could incorporate the same message as smoking. This entailed alerting the public as to how much money could be saved if smoking was stopped and what could be purchased with that saving at the end of a year.

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There was a general lack of awareness, of Alcohol Reduction Campaigns, amongst the studys population. It was discovered that, while the results indicate a lack of awareness, it is indicated that young adults have higher levels of awareness when in employment, full time and part time. Therefore, this study found that status has an influence on knowledge of awareness. This level of awareness included being able to name an Alcohol Reduction Campaign and having awareness of recommended safe drinking strategies. This could support studies that suggest risky alcohol consumption is the norm amongst students and highlights the poverty health gap amongst the unemployed Health messages have little impact on 18-24 year olds though interestingly those classified as students, in this study, suggested that the notion of health would influence them to drink less; though this finding was minimal. A conclusion drawn from this could be that alcohol reduction messages are having an indirect effect on student population. Alcohol reduction campaigns could incorporate the notion found in this study that males and females are more likely to drink at friends houses. There are three points worthy to discuss. Firstly, a lack of knowledge around alcohol reduction awareness campaigns as there are current messages about the dangers of drinking at home. This also demonstrates the likeliness of a lack of knowledge of alcohol campaigns such as Know your Limits/Units. Though alternatively, females are less likely to drink at house parties in comparison to males. This could indicate that the safety

messages regarding alcohol are having an effect on women staying safe at parties where alcohol is being drunk. Generally young adults are getting drunk and are experiencing hangovers and general illness the following day. Males 18-24 are more likely to get into trouble with the police; this indicates that alcohol reduction campaigns delivering safety messages are not reaching this target population. Though, it was found that when classified by status, those termed as unemployed were at high risk of unsafe sex as compared to other status groups. Alcohol Reduction Campaign knowledge is poor and this is common amongst males and females. Very few of the studys population were able to name a campaign and those that could often described the commercial and were not able to talk about neither the title nor the message component of the campaign. Very few were able to
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name any recommended behaviours. Gender has no specific significance on the level of knowledge of safe drinking behaviours, this is mirrored in the idea that majority of the sample suggests that alcohol related public health campaigns should be publicised everywhere. It was during the observation It is fair to suggest that even though there is some advertising occurring within the community of SWL it is in direct contrast to the alcohol advertising. 4.3 Limitations This study has particular strengths and weaknesses which may affect the validity and reliability. This study used a non-probability sampling technique, though this was deemed appropriate, due to the allocated time frame and lack of any funding, it can be presumed that the findings of this study cannot be generalised to all young adults. As this study was carried out in SWL, and did not examine ethnicity, this further reduces the generalizability. However, as the majority of the literature has utilised student sample populations, this study does provide new and valuable findings. A limitation can be located in the questionnaire; it could appear that some of the questions are misleading. This is a problem when using a questionnaire for the first time. Despite a pre-test, it was found that one of the questions did not produce the data expected. response bias. A further limitation was the failure of the focus groups, which would have provided further information to support both the survey and frequency observation. As this study had no budget, incentives were not offered for participants to attend. This study would have greatly benefited from the findings of focus groups. 4.4 Recommendation This study examined current alcohol behaviours, level of awareness and exposure frequency of alcohol reduction campaigns amongst young adults in SWL. Upon completion of the data collection and the analysis of the data, recommendation can be made for future research on this topic. Recommendations, according to NICE guidelines (2012), are unanswered questions that emerge from the conducted study. Firstly, recommendations can be made on the research process and methods used
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As with all self-report measures, these findings were subject to

in this study. It is recommended that this subject area could benefit from the use of a probability randomised sampling technique. The use of this type of sampling would allow the findings of the data to be more generalised amongst the targeted population. The observation of exposure frequency, to Alcohol Reduction

Campaigns, should be furthered explored in the future as little research exists to support frequency versus improved awareness. An additional recommendation

would be to involve and work closely with young adults. Limited effectiveness studies, especially in the UK, exist and this requires further research. It is advised that, due to the numerous Alcohol Reduction Campaigns, both national and local, available at any one time, further research should be attempted to examine the effectiveness of a particular campaign amongst young adults. As there are limited single gender studies, this could also be a very important area to examine. This study found that there are some gender differences amongst current alcohol consumption. Therefore, by examining and comparing single gender related data could be beneficial in creating a behaviour change and decreasing alcohol consumption. It is conceivable that any of the findings of these recommendations would support the findings within this study. This study has been able to highlight concerning risky alcohol behaviours that future campaigns need to encompass. The discovery that young adults like to drink at home is worthy of campaign attention. Drinking at home is high risk of drinking more than the recommended limits as people tend to free pour, therefore, putting them at risk. A further campaign suggestion is one that encompasses the cost of alcohol and how much a young person can save when not spending money on alcohol. Young adults are consumers and by advertising decreasing alcohol, and the gain of money, could be influential as the campaign would not be in contrast with their current alcohol beliefs; therefore, increasing message believability. 4.5 Conclusion Young adults are highlighted as having a risky relationship with alcohol. Risky alcohol consumption and related behaviours are occurring at a concerning level and young adults appear to have little interest in the growing health problems this is causing. Alcohol Reduction Campaigns have been developed to decrease alcohol consumption and to create awareness with the aim of eliciting a behaviour change.
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This study examined the level of awareness, knowledge and exposure frequency of alcohol reduction campaigns amongst young adults, living in SWL. The findings of this study have highlighted that little awareness of alcohol reduction campaigns and knowledge of safe drinking strategies exists amongst this population. This study has presented strong evidence that alcohol reduction campaigns are currently not influencing young adults and or changing their risky alcohol consumption. This study has also highlighted that the level of message exposure, of Alcohol Reduction Campaigns, is minimal and this can seriously impact the need of behaviour change. There is a lack of effectiveness studies regarding Alcohol Reduction Campaigns, especially within the UK. Though, the results demonstrate that status appears to have an effect on alcohol, the risk experienced by the entire sample is concerning. The UK has spent large amounts of expenditure on Alcohol Reduction Campaigns aimed specifically towards young adults. But the actual exposure to the message is infrequent in comparison to alcohol advertising. If a behaviour change is the required outcome, then Public

Health professionals need to take the findings of this study on board.

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Chapter Five

Diagram 8: Drink Less Live More (2009)

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5. Plans for Dissemination

Dissemination of research is the process of sharing information and knowledge (Dawson, 2009), and is an important stage in the research process (Gerrish and Lacey, 2010). The most important aspect of dissemination is making the results available which also need to include the target population as well as other professionals. Dissemination of results, this needs to include the negative and the positive findings. It is imperative to highlight that budget must be considered within the process of disseminating research. In regards to this piece of research, any costs within the dissemination phase will be incurred by the researcher (Gerrish and Lacey, 2010). A time line of 6 months has been allocated to carry out the dissemination process. Dissemination of the research results will occur in different settings. It is normal practice, for post graduate students that their research will be made available to the university library (Dawson, 2009). The dissertation will be kept for other students to make use of the findings and the process of obtaining the findings. As this study provides valuable information that is locally relevant, this dissertation will be made available to councils in SWL who produce local alcohol reduction campaigns. Also, relevant to local councils and representing young adults in the borough, the researcher will organise a presentation as it is important to include the target population. With the dissemination process, therefore, this piece of research will be made available to young adults, by holding workshops to not only convey the findings but also to create awareness of Alcohol Reduction Campaigns. The findings of this study will also be delivered, in the form of a presentation, across SWL within community settings, such as GP consortiums and urgent care centre staff. Within the researchers workplace, a presentation will be done for colleagues. Though this will reach only a limited amount of people (Gerrish and Lacey, 2010), the findings will be valuable to public health colleagues. This allows the dissemination of results in the hope that it will encourage colleagues to understand the complexities of working with young adults and alcohol. This dissertation will be adapted to enable the production of data into the form of an acceptable article for publication. Appropriate journals, regarding the focus of the study would be:

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Community Practice Nurse or Journal of Human Behaviour in the Social Environment. (387/500) 5.1 Reflection on Learning Reflection is analysing how we learn. Reflection is the ability to reflect honestly on one's own practice in a manner that allows multiple perspectives and approaches to inform practice (Noble et al. 2005, p.14). It is suggested that effective learning

cannot take place without being reflective and is an essential element of learning. Using a reflective cycle, highlighted by Howatson-Jones (2012), the process of systematic reflection can take place using a framework. Personal notes were kept in the form of a diary, as suggested by the University, to assist in summarising learning, problems encountered and areas that went well. I have found completing this research, an academic challenge. As suggested by the module leaders I kept a reflective diary. I used the diary to record thoughts, feelings and ideas along the development of this piece of research. Examining the reflective diary, I experienced many emotions in relation to conducting this piece of research. I have felt overwhelmed with the amount of preparation and stages of planning that were required. As this was the first piece of research I have undertaken I found preparing and sticking to a time table a test of my academic ability. It was a challenging experience to abide by the time constraints while attempting to develop a fuller understanding of the material in relation to the requirements of the research. This at times made me feel that I was unable to complete what was expected. At other times, I struggled with parts of the research, persevering with areas, until understanding took place. This research has provided me the opportunity to put into action research methods that I have learnt through the completion of modules within this MSc pathway. Having undertaken previous research modules, at BSc level, I thought that completing the dissertation would simply be a review of previous knowledge. I

quickly realised that though previous modules had been completed that extensive knowledge is required. Therefore to increase my knowledge to the level of

undertaking research, a lot of time was spent examining and reading research text and material. While in the development stage of my proposal, I have at times been confused with the information that is required.
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Locating and interpreting the

evidence has been difficult, but by completing this has allowed me to see the development of a piece of research that will benefit the target population. Noble et al. (2005) suggests the ability to reflect upon ones own practice engages the learner with the construction of knowledge rather than the reproduction of knowledge. Reflection throughout the development of the research proposal has also provided the opportunity to highlight not only the knowledge gaps and areas that were troublesome but allowed the recognition of areas that went well. I have thoroughly enjoyed designing, implementing and evaluating this research. Though this has been incredibly hard work, I feel lucky to have had the opportunity to build and increase my knowledge on research methods. Most importantly, I feel able to carry out research, that would enable me to develop evidenced based practice, of which would benefit the NHS Trust, the community and young adults of whom have a risky behaviour with alcohol.

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REFERENCES
Abrams, G. B., Kolligian, Jr. J., Mills, D. L. and DeJong, W. (2011) Failure of college students to complete an online alcohol education course as a predictor of high-risk drinking that requires medical attention, American Journal of Drug and Alcohol Abuse, 37(6), pp.515-519. Anonymous, (2009) Alcohol Misuse needs a Global Response, The Lancet, 373(9662), p.433. Arnett, J. J. (2009) Adolescence and Emerging Adulthood: A Cultural Approach. 5th edn. Cambridge: Pearson Publishing. Australian Government Department for Health and Aging (2008) Dont Turn a Night out into a Nightmare. Available at: http://www.drinkingnightmare.gov.au/internet/DrinkingNightmare/publishing.nsf (Accessed 10 August 2012). Aveyard, H. (2011) Doing a literature review in Health and Social Care. 2nd edn. Maidenhead: Open University Press Ayers B. and Myers, L. B. (2012) Do media messages change peoples risk perceptions for binge-drinking? Alcohol & Alcoholism, 47(1), pp.52-56. Bagnardi, V., Sorini, E., Disalvatore, D., Assi, V., Corrao, G., De Stefani, R. and Collaborative Alcohol, Less is Better Group (2011) Alcohol, less is better project: Outcomes of an Italian community-based prevention programme on reducing percapita alcohol consumption, Addiction, 106(1), pp.102-110. Barry, A. E. and Piazza-Gardner, A. K. (2012) Drunkorexia: understanding the cooccurrence of alcohol consumption and eating/exercise weight management behaviors, Journal American College Health, 60(3), pp.236-243.

72

Bloom, D. E., Canning, D. and Weston M. (2005) Value of Vaccination, World Economics, 6(3), pp.15-39 [Online]. Available at: http://www.who.int/immunization_supply/financing/value_vaccination_bloom_canning _weston.pdf (Accessed 1 September 2012). Bloomfield, K., Grittner, U., Kramer, S. and Gmel, G. (2006) Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action Gender, Culture and Alcohol Problems: a Multi-national Study', Oxford Journals: Alcohol and Alcoholism Supplement, 41(1), pp.26-36. Borsari, B. and Carey, K. B. (2012) Overestimation of Peer Substance Use: Additional Perspectives, Addiction, 107(5), pp.886-888. Bowling, A. (2009) Research Methods in Health. 3rd edn. Maidenhead: Open University Press. Bowring, A. L., Gold, J., Dietze, P., Gouillou, M., Van Gemert, C. and Hellard, M. E. (2012) Know your Limits: Awareness of the 2009 Australian alcohol guidelines among young people, Drug and Alcohol Review, 31, pp.213-223. Bryman, A. (2012) Social Research Methods. 4th edn. Oxford: Oxford University Press Burns, N. and Grove, S. (2005). The practice of nursing research: Conduct, critique, & utilization. 5th edn. St Louis: Elsevier/Saunders. Camden NHS Primary Care Trust (2007-2010) Camdens Alcohol Harm Reduction Strategy 2007-10. Available at: http://www.camden.nhs.uk/Camden%20Alcohol%20harm%20Reduction%20Strategy %202007-10.pdf (Accessed 15 April 2012). Campo, S. and Cameron, K. A. (2006) Differential Effects of Exposure to Social Norms Campaigns: A Cause for Concern, Health Communication, 19(3), pp.209219.

73

Carpenter, R., Fishlock, A., Mulroy, A., Oxley, B., Russell, K., Salter, C., Williams, N. and Heffernan, C. (2007) After Unit 1421: an exploratory study into female students attitudes and behaviours towards binge drinking at Leeds University, Journal of Public Health, 30(1), pp.8-13. Change4Life (2012). [Online]. Available at: http://www.playproviders.org.uk/change4life (Accessed 30 June 2012). Cheshire & Merseysides Public Health Network (CHAMPS) 2009 Drink a little less, see a little more: Your hair looks fine, how about the belly?, [Online]. Available at: : http://www.how-do.co.uk/node/9148 (Accessed 30 June 2012). Christian (1940s) She may be a bag of Trouble. Syphilis-Gonorrhea. [Iconograph] Available at: http://www.nlm.nih.gov/news/posters_pub_health.html (Accessed 30 June 2012). Conrod, P. J., Castellanos-Ryan, N. and Mackie, C. (2011) Long-term effects of personality-targeted intervention to reduce alcohol use in adolescents, Journal of Consulting and Clinical Psychology, 79(3), pp.296-306. Cousins, K., Connor, J. L. and Kypri, K. (2010) Reducing alcohol-related harm and social disorder in a university community: A framework for evaluation, Injury Prevention, 16(5), pp.1-6, BMJhost Plus with Full Text [Online]. Available at: http://injuryprevention.bmj.com/content/16/5/e1.full.html (Accessed 15 June 2012). Creswell, J. W. (2008) Research Design: Qualitative, Quantitative and Mixed Methods Approaches. 3rd edn. London: Sage Publications Dawson, C. (2009) Introduction to Research Methods. 4th edn. Oxford: How to Books Ltd. DeJong W., Schneider, S. K., Towvim, L. G., Murphy, M. J., Doerr, E. E., Simonsen, N. R., Mason, K. E. and Scribner, R. A. (2006) A Multisite Randomized Trial of Social Norms Marketing Campaigns to Reduce College Student Drinking, Journal of Studies on Alcohol and Drugs, 67(6), pp.868-879 Department of Health (2012) Governments Alcohol Strategy. Available at: http://www.dh.gov.uk/health/2012/03/alcohol-strategy-published/ (Accessed 10 June 2012).
74

Department of Health (2008) Social Marketing Available at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publichealth/Choosin ghealth/DH_066342 (Accessed 1 July 2012). Department of Health, Home Office, Department of Education and Skills and Department for Culture, Media and Sport (2007) Safe. Sensible. Social. The next step in the National Alcohol Strategy. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/document s/digitalasset/dh_075219.pdf (Accessed 15 February 2012). Department of Health (2007) Young lesbian, gay and bisexual (LGB) people. Available at: http://www.schools-out.org.uk/policy/docs/DH_078355.pdf (Accessed 1 September 2012). Department of Health, Home Office (2006) Know Your Limits Alcohol Campaign launched by Government. Available at: http://www.alcoholpolicy.net/2006/10/know_your_limit.html (Accessed 1 February 2012). DrinkAware (2012) Available at: http://www.drinkaware.co.uk/media/pressreleases/2012-press-releases/drinkaware-response-to-department-of-healthchange4life-campaign-launch (Accessed 20 June 2012). Edwards, N. (2010) From a Despairing A&E Doctor, 17 Nurses, 15 Doctors to treat 2 Drunks. How Booze is crippling the NHS, Daily Mail, 8 June [Online]. Available at: http://www.dailymail.co.uk/health/article-1284771/From-despairing-A-E-doctorfurious-broadside--17-nurses-15-doctors--treat-drunks-How-booze-cripplingNHS.html (Accessed 12 June 2012). Gentry, E., Poirier, K., Wilkinson, T., Nhean, S., Nyborn, J. and Siegel, M. (2011) Alcohol Advertising at Boston Subway Stations: An assessment of exposure by race and socioeconomic status, American Journal of Public Health, 101(10), pp.19361941. Gerrish, K. and Lacey, A. (2010) The Research Process in Nursing. 6th edn. London: Blackwell Publishing Ltd.

75

Gill, J. and OMay, F. (2007) Practical Demonstration of Daily Consumption Limits: A useful intervention tool to promote responsible drinking among UK adults?, Alcohol and Alcoholism, 42(5), pp.436-441. Available at: http://alcalc.oxfordjournals.org/content/42/5/436.full.pdf (Accessed 10 June 2012). Gill, J. and OMay, F. (2006) How Sensible is the UK Sensible Drinking Message? Preliminary findings amongst newly matriculated female university students in Scotland, Journal of Public Health, 29(1), pp.13-16, Oxford Journals host Plus with Full Text [Online]. Available at: http://intl-

jpubhealth.oxfordjournals.org/content/29/1/13.full (Accessed 15 March 2012). Greenhalgh, T. (2010) How to read a paper: The basis of evidence based medicine. 3rd edn. London: BMJ Press. Griffith, A. (2010) SPSS for Dummies. 2nd edn. Indianapolis: Wiley Publishing Inc. Guise, J. M. F. and Gill, J. S. (2007) Binge drinking? It's good, it's harmless fun: a discourse analysis of accounts of female undergraduate drinking in Scotland, Health Education Research, 22(6), pp.895-906. Hallett, J., Howat, P., Maycock, B. R., McManus, A., Kypri, K. and Dhaliwal, S. S. (2012) Undergraduate Student Drinking and Related Harms at an Australian University: web-based survey of a large random sample, Biomed Central Public Health, 12(37), pp.1471-2458. Harper, S. (2012) Public Health: Saving Lives and Spending Less, The Guardian, 11 March [Online]. Available at: http://www.guardian.co.uk/commentisfree/2012/mar/11/public-health-saving-livesspending-less (Accessed 18 August 2012). Hendry, L. and Kloep, M. (2012) Adolescence and Adulthood: Transitions and Transformations. Basingstoke: Palgrave Macmillan HM Government (2010) Change 4 Life. Available at: http://www.physicalactivityandnutritionwales.org.uk/Documents/740/DH_summaryof_ change4lifeoneyearon.pdf (Accessed 2 September 2012).

76

HM Revenue and Customs (2004) Fact Sheet. Available at: http://www.ias.org.uk/resources/factsheets/consumption-uk.pdf (Accessed 10 July 2012). Hinton, P. R., Brownlow, C., McMurray, I. and Cozens, B. (2004) SPSS Explained: London: Routledge Taylor & Francis Group. Hogarth, W. (1751) Available at: http://www.artble.com/artists/william_hogarth/drawings/beer_street_and_gin_lane (Accessed 10 September 2012). Home Office (2012) The Governments Alcohol Strategy. Cm.8336. London: The Stationery Office Howatson-Jones, L. (2010) Reflective Practice in Nursing (Transforming Nursing Practice. Exeter: Learning Matters Ltd. Humphrys, J. (2010) Binge-Drinking: What happened to our sense of shame, Sunday Telegraph, 17 April [Online]. Available at: http://www.telegraph.co.uk/news/uknews/crime/7601915/Binge-drinking-Whathappened-to-our-sense-of-shame.html (Accessed 24 June 2012). Humphrys, J. (2010) Drunken Anarchy, Daily Mail, 15 April. Highbeam [Online] Available at: http://www.highbeam.com/doc/1G1-223886963.html (Accessed 30 July 2012). Hutton, F. (2012) Harm reduction, students and pleasure: An examination of student responses to a binge drinking campaign, International Journal of Drug Policy, 23, pp.229-235. Jun-Hong, K. and Kwang, S. K. (2012) The role of sensation seeking, perceived peer pressure, and harmful alcohol use in riding with an alcohol-impaired driver, Accident Analysis & Prevention, 48, pp.326-334.

77

LaChance, H., Feldstein Ewing, S. W., Bryan, A. D. and Hutchison, K. E. (2009) What makes group MET work? A randomized controlled trial of college student drinkers in mandated alcohol diversion, Psychology of Addictive Behaviors, 23(4), pp.598-612. Levinson, D. J., Darrow, C. N., Klein, E. B. Levinson, M. H. and McKee, B. (1978) Seasons of a Mans Life. New York: Knopf Publishing Group. Mattern, J. L. and Neighbors, C. (2004) Social norms campaigns: Examining the relationship between changes in drinking levels, Journal of Studies on Alcohol, 65(4), pp.489-493 McKay, M. T., Percy, A., Goudie, A. J., Sumnall, H. R. and Cole, J. C. (2012) The Temporal Focus Scale: Factor Structure and Association with alcohol use in a sample of Northern Irish school children, Journal of Adolescence, 35(5), pp.13611368. Morias, R. J. (2010) Refocusing Focus Groups: A Practical Guide. Ithaca: Paramount Market Publishing Inc. Munn, P. and Drever, E. (2004) Using Questionnaires in Small-Scale Research: A Beginners Guide. Rev. edn. Glasgow: Scottish Centre for Research in Education. National Audit Office (2008) Reducing Alcohol Harm: Health services in England for alcohol misuse. Available at: http://www.nao.org.uk/publications/0708/reducing_alcohol_harm.aspx (Accessed 10 July 2012). National Health Service South of Tyne and Wear (2009) Drink Less. Live More. Available at: http://www.cehi.org.uk/2009/10/new_alcohol_treatment_services.html (Accessed 31 July 2012). National Institute for Health and Clinical Excellence (2012) Guidelines. Available at: http://guidance.nice.org.uk/CG/Published (Accessed 30 August 2012).

78

Nayab, N. and Bowen, R. (ed) (2011) How to Gather Data for Business Research, Host Bright Hub PM. With full text [Online]. Available at: http://www.brighthubpm.com/methods-strategies/118176-how-to-gather-data-forbusiness-research/ (Accessed 1 September 2012). Noble, K., Macfarlane, K. and Cartmel, J. (eds.) (2005) Circles of Change. Challenging orthodoxy in practitioner supervision. Melbourne: Pearson Education. Panagopoulou, E., Montgomery, A. and Benos, A. (2011) Health promotion as a behavioural challenge: Are we missing attitudes?, Global Health Promotion, 18(2), pp.54-57. Parahoo, K., (2006) Nursing Research. Principles, Process and Issues. 2nd edn. Basingstoke: Palgrave MacMillan. Park, H. S., Smith S. W., Klein, K. A. and Martell, D. (2011) College Students Estimation and Accuracy of Other Students Drinking and Believability of Advertisements Featured in a Social Norms Campaign, Journal of Health Communication, 16, pp.504-518. Perkins, H. W. and Craig, D. W. (2006) A Successful Social Norms Campaign to reduce Alcohol-Misuse among College Student-Athletes, Journal of Studies on Alcohol and Drugs, 67(6), pp.880-889. Available at: http://alcohol.hws.edu/jsaperkins-craig-nov-06.pdf (Accessed 25 August 2012). Pilling, V. K. and Brannon, L. A. (2007) Assessing College Students' Attitudes Toward Responsible Drinking Messages to Identify Promising Binge Drinking Intervention Strategies, Health Communication, 22(3), pp.265-276 [Online]. Available at: http://www.tandfonline.com/doi/abs/10.1080/10410230701708121 (Accessed 10 August 2012). Public Health Resource Unit (2006) Critical Appraisal Skills Programme. Available at: http://www.sph.nhs.uk/sph-files/casp-appraisaltools/Qualitative%20Appraisal%20Tool.pdf (Accessed 1 July 2012).

79

Reifman, A., Watson, W. and McCourt, A. (2006) Social networks and college drinking: Probing processes of social influence and reflection, Personality and Social Psychology Bulletin, 32, pp.820-832. Ricciardelli, L. A. and McCabe, M. P. (2008) University Students Perceptions of the alcoholic campaign: Is getting Pissed Getting Pathetic? (Just ask your friends), Addictive Behaviours, 33, pp.366-372. Ridout, B., Campbell, A. and Ellis, L. (2012) Off your Face(book): alcohol in online social identify construction and its relation to problem drinking in university students, Drug and Alcohol Review, 31(1), pp.20-26. Right Place at the Right Time (2009-2010) Written submissions received for the London Assemblys investigation into the future of the London Ambulance Service. Available at: http://www.london.gov.uk/sites/default/files/Written%20submissionsLAS.pdf (Accessed 1 June 2012) Room, R., Babor, T. and Rehm, J. (2005) Alcohol and Public Health. The Lancet, 365, pp.519530. Ross, G., McDermott, L., Stead, M. and Angus, K. (2006). The effectiveness of social marketing interventions for health improvement: whats the evidence?Public Health, 120(12), pp.11331139. Sarantakos, S. (2005) Social Research. 3rd edn. New York: Palgrave MacMillan. Scheier, L. M. and Grenard, J. L. (2010) Influence of a Nationwide Social Marketing Campaign on Adolescent Drug Use, Journal of Health Communication, 15, pp.240271. Scribner, R. A., Theall, K. P., Mason, K., Simonsen, N., Schneider, S. K., Towvim, L. G. and DeJong W. (2011) Alcohol prevention on college campuses: the moderating effect of the alcohol environment on the effectiveness of social norms marketing campaigns, Journal of Studies on Alcohol and Drugs, 72(2), pp.232-239.

80

Silverman, D. (2010) Qualitative Research. 3rd edn. London: Sage Publications. Simpson, M. and Tuson, J. (2003) Using Observations in Small-Scale Research: A Beginners Guide. 2nd edn. Glasgow: The SCRE Centre. Snyder, L. B., Hamilton, M. A., Mitchell, E. W., Kiwanuka-Tondo, J.,, Fleming, F. and Proctor, M. D. (2004) A Meta-Analysis of the Effect of Mediated Health Communications Campaigns on Behaviour Change in the United States, Journal of Health Communication, 9, pp.71-96. The Nuremberg Code (1947) British Medical Journal (1996) Available at: http://www.bmj.com/content/313/7070/1448.1 (Accessed 14 August 2012). Unknown (2007) Feeling Funny? Lets face it: excessive drinking isnt a joke. [Electronic Print] Available at: http://fsd.lincolnshire.gov.uk/section.asp?catid=15277 (Accessed 15 June 2012). Uzunoglu, E.and Oksuz, B. (2012) New opportunities in social media for adrestricted alcohol products: The case of Yeni Raki, Journal of Marketing Communications, July, pp. 1-21 Van Gemert, C., Dietze, P., Gold, J., Sacks-Davis, R., Stoove, M., Vally, H. and Hellard, M. (2011) The Australian national binge drinking campaign: campaign recognition among young people at a music festival who report risky drinking, Biomed Central Public Health, 11(482), pp.1471-2458. Violence Reduction Unit. Safer Scotland (2011) Boozed Up. Squared Up. Locked Up. [Online]. Available at: http://www.actiononviolence.org.uk/sites/default/files/images/Boozed%20up%20post er%20--3mm_Over.pdf (Accessed 1 September 2012). Walker, J. and Almond, P. (2010) Interpreting Statistical Findings. Maidenhead: Open University Press.

81

Wandsworth Alcohol Harm Reduction Strategy (WAHRS, 2008-2011) Wandsworth NHS Teaching Primary Care Trust (2008-2011) Alcohol Related Harm: A strategy enabling positive choices in Wandsworth. Available at: http://www.avaproject.org.uk/media/25258/wandsworth%20crime%20and%20disord er%20reduction%20partnership.pdf (Accessed 5 July 2012). Warner, J., McKeown, E., Griffin, M., Johnson, K., Ramsay, A., Cort, C. and King, M. (2004) Rates and predictors of mental illness in gay men, lesbians and bisexual men and women: Results from a survey based in England and Wales, The British Journal of Psychiatry, (185), pp.479-485 Web, P. and Bain, C. (2011) Essential Epidemiology: An introduction for students and health professionals. Cambridge: Cambridge University Press. West Mercia Police (2012) Rape: Dont let a night full of promise turn into a morning full of regret. [Online]. Available at: http://www.womensviewsonnews.org/wpcontent/uploads/2012/08/poster-2-419x595.jpg (Accessed 1 September 2012). World Health Organization (2011) Global Status Report on Alcohol and Health. Available at: http://www.who.int/substance_abuse/publications/global_alcohol_report/en/index.ht ml (Accessed 5 July 2012).

World Health Organization (2009) Public Health Campaigns: Getting the Message Across. Geneva: World Health Organization Press

World Health Organization (2004) Commission on the Social Determinants of Health (CSDH): note by the Secretariat, Document number EB115/35. Available at: http://apps.who.int/gb/archive/pdf_files/EB115/B115_35-en.pdf (Accessed 10 September 2012). Wright, R. W., Brand, R. A., Dunn, W. and Spindler, K. P. (2007) How to Write a Systematic Review, Clinical Orthopaedics and Related Research, 455, pp.23-29.

82

Bibliography
Ames, G. and Cunradi, C. (2004) Alcohol use preventing alcohol-related problems among young adults in the military, Alcohol Research and Health, 28(4), pp.252257. Annas, G. J. and Grodin, M. A. (eds.) (1995) The Nazi Doctors and the Nuremberg Code: Human Rights in Human Experimentation. New York: Oxford University Press. Arbour-Nicitopoulos, K. P., Kwan, Y. W., Lowe, D., Taman, S. and Faulkner, G. E. J. (2010) Social Norms of Alcohol, Smoking and Marijuana Use Within a Canadian University Setting, Journal of American College Health, 59(3), pp.191-196. Barry, A. E. and Goodson, P. (2011) How college students conceptualize and practice responsible drinking, Journal of American College Health, 59(4), pp.304312, NCBIhost Plus with Full Text [Online]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21308591 (Accessed 12 August 2012).

Bendtsen, P., Karlsson, N., Dalal, K. and Nilsen, P. (2011) Hazardous Drinking Concepts, Limits and Methods: Low levels of awareness, knowledge and use in the Swedish population, Alcohol and Alcoholism, 46(5), pp.638-645. Bryman, A. & Cramer, D. (2011). Quantitative data analysis with IBM SPSS Statistics 17, 18 and 19: A guide for social scientists. Hove: Psychology Press. DeJong, W. (2010) Social Norms Marketing Campaigns to reduce Campus Alcohol Problems. Health Communication, 25(6), pp.615-616. DeJong, W., Schneider, S. K., Towvim, L. G., Murphy, M. J., Doerr, E. E., Simonsen, N. R., Mason, K. E. and Scribner, R. A. (2009) A multisite randomized trial of social Norms marketing campaigns to reduce college students drinking: A replication failure, Substance Abuse, 30(2), pp.127-140. DeJong, W. (2002) The role of mass media Campaigns in reducing High-Risk Drinking among college students, Journal of Studies on Alcohol, 14, pp.182-192.

83

Hackley, C., Griffin, C., Szmigin, I., Mistral, W. and Bengry-Howell, A. (2008) The Discursive Constitution of the UK Alcohol Problem in Safe, Sensible, Social: a discussion of policy implications, Drugs: Education, Prevention and Policy, 15(S1), pp.65-78. Litwin, M. (1995) How to Measure Survey Reliability and Validity. London: Sage Publications Marmot Review (2010) Fair Society, Healthy Lives. Strategic Review of Health Inequalities in England Post-2010. Available at: http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmotreview/fair-society-healthy-lives-full-report (Accessed 1 September 2012).

Meyer, A. (2010) Too Drunk to say No Binge drinking, rape and the Daily Mail, Feminist Media Studies, 10(1), pp.19-34. Misch, D. A. (2010) Changing the Culture of Alcohol Abuse on Campus: Lessons Learned From Secondhand Smoke, Journal of American College Health, 59(3), pp.232-234. Mouilso, E. R., Fischer, S. and Calhoun, K. S. (2012) A Prospective Study of Sexual Assault and Alcohol Use Among First-Year College Women, Violence and Victims, 27, pp.78-93. Mulgan, G. (2010) Influencing public behaviour to improve health and wellbeing. [Online]. Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/doc uments/digitalasset/dh_111694.pdf (Accessed 31 August 2012).

Neuman, W. L. (2003) Social Research Methods. 5th edn. Boston: Pearson Education Inc. Newman, I. M., Shell, D. F., Major, L. J. and Workman, T. A. (2006) Use of policy, education and enforcement to reduce binge drinking among university students: The NU Directions project, International Journal of Drug Policy, 17, pp.339-349.

84

OConnor, N., OConnor, M. and Bradley, C. P. (2008) Alcohol how much is too much? Irish Medical Journal, 101(7), pp.200-202. Russell, C. A., Clapp, J. D. and DeJong, W. (2005) Done 4: Analysis of a Failed Social Norms Marketing Campaign, Health Communication, 17(1), pp.57-65. Saunders, J. B., Kypri, K., Walters, S. T., Laforge, R. G. and Larimer, M. E. (2004) Approaches to Brief Intervention for Hazardous Drinking in Young People, Alcoholism: Clinical and Experimental Research, 28(2), pp.322-329. Sugarman, D. E. and Carey, K. B. (2009) Drink Less or Drink Slower: The effects of instruction on alcohol consumption and drinking control strategy use, Psychology of Addictive Behaviours, 23(4), pp.577-585. Sugarman, D. E. and Carey, K. B. (2007) The Relationship between drinking control strategies and college student alcohol use, Psychology of Addictive Behaviours, 21(3), pp.338-345. Van de Luitgaarden, J., Thush, C., Wiers, R. W., and Knibbe, R. A. (2012) Prevention of Alcohol Problems in Dutch Youth, Evaluation & the Health Professions, 31(2), pp.167-181. White, A. M., Courtney L. K., Flom, J. D., Kestenbaum, L. A., Mitchell, J. R., Shah, K., and Swartzwelder, H. S. (2005) College Students Lack Knowledge of Standard Drink Volumes: Implications for Definitions of Risky Drinking Based on Survey Data, Alcoholism: Clinical and Experimental Research, 29(4), pp.631638.

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APPENDIX ONE Hogarths GIN LANE

86

APPENDIX TWO Dont let drink sneak up on you (2012)

87

APPENDIX THREE - Detail of literature search

Population Young Adults Intervention Alcohol reduction campaign Comparison safe alcohol consumption Outcome Awareness, knowledge

Young adult (MeSH) OR Young adult& OR Early adulthood

Public health (MeSH) OR Public health OR Health promotion OR

Improved awareness

Behaviour change

Risk reduction Health education OR Social marketing OR Awareness OR Mass media

AND
AND safety (MeSH) OR behaviour (MeSH) OR prevention OR reduction OR Knowledge OR Risk reduction

AND alcohol (MeSH) OR booze OR liquor OR Binge (MeSH) OR Binge drinking

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APPENDIX 4 Literature Table

Author/Date/Title Bowring et al 2012 Know Your Limits: Awareness of the 2009 Australian Alcohol guidelines amongst young people Aims of the Study Examine the awareness of 2009 guidelines amongst young adults and their understanding of safe number of drinks Type of Study/Methods Quantitative, questionnaire Statistical analysis using Stata version 10 Dependent and independent Variables identified Chi sq, multivariable logistic regression Mixed methods study, questionnaire and semi structured interviews Sample Convenience sample of 1381, 18-29 year olds. 66% were females 92% born in Australia 72% lived/close to a city 67% lived with parents Findings A lack of awareness of 2009 safe drinking guidelines, but accurate knowledge of safe number of drinks to avoid immediate alcohol related injury and long term ill health Strengths/Limitations
Limitation: Convenience

sample Self-reporting bias Lack of drinking definitions Strength: use of appropriate statistical analysis

Hutton 2012 Harm reduction, students and pleasure: an examination of student responses to a binge drinking campaign

Examine the effectiveness of a alcohol reduction campaign in making students think about their alcohol consumption

105 males, 183 females, average age 18. Four students took part in the interview, 3 female and 1 male

43% of questionnaire respondents agreed the campaign would reduce alcohol consumption

Limitations: Low

response rate, small number of interview participants, Findings may be gender specific Strength: use of appropriate analysis methods
Limitations:

Van Gemert et al 2011 the Australian national binge drinking campaign: campaign recognition among young people at a music festival who report risky drinking

To gain a measure of the recognition of the binge drinking campaign If participants recognised the message of the campaign

Quantitative, Cross sectional behavioural study Questionnaire survey Statistical analysis using Stata version 9.1 Logistic regression Reverse stepwise selection procedures

Convenience sample 16-29 years. 1072 in total. 62.6% female, 55.4% between the age 16-19,60.9% lived in a city, 59.7% lived with family/parents

Those that demonstrated more frequency of risky alcohol consumption were less likely to recognise the campaign message

convenience sample, unable to calculate overall participant rate Strength: the first independent evaluation assessing recognition of reduction message

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Author/Date/Title Ricciardelli and McCabe 2008 university students perceptions of the alcohol campaign is getting pissed getting pathetic? (Just ask your friends) Carpenter et al 2007 After Unit 1421: an exploratory study into female students attitudes and behaviours towards binge drinking at Leeds university

Aims of the Study To assess students understanding and opinion of alcohol reduction campaign

Type of Study/Methods Mixed methods approach questionnaire with interview

Sample 671 university students, equally male and female, aged 18-25. connivance sample

Findings Suggest there is value in continuing with this campaign though negative aspects were highlighted, students demonstrated campaign message awareness That women can feel pressured into risky alcohol, alcohol central to student life, and that UK sensible drinking guidelines did not influence alcohol consumption

Strengths/Limitations
Limitation: Methods not

clearly indicated Connivance sample Analysis technique not clearly stated

Strength: the findings add to the limited effectiveness research Limitation: financial and

Explore female perspectives and awareness on binge drinking and the Unit 1421 reduction campaign

Qualitative 2, 2 hour, focus groups Thematic analysis Validated results with observer triangulation And by theory triangulation Incentive given

Purposive sample Females only 24 in total Aged 18-23 University students Recruited by email and advertising in student union

time constraints and small participant number Strengths: peer led discussion helped participants share experiences

DeJong et al 2006 A Multisite randomised trial of social norms marketing campaigns to reduce college student drinking

To determine the effectiveness of a social norms marketing campaign in reducing college students alcohol consumption

An 18 site Randomised control trial with cross sectional data Postal survey Statistical analysis using PROC MIXED

A random sample of 300 students per institution, stratified to produce a representation per institution

Analysis revealed that students attending a university with a social norms campaign demonstrated a significant lower risk of alcohol consumption

Limitation: reporting

bias due to selfreporting survey technique Strength: analysis and comparison across different universities

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Author/Date/Title Gill and OMay 2006 How sensible is the UK sensible drinking message? Preliminary findings amongst newly matriculated female university students in Scotland

Aims of the Study To measure the effectiveness of the UK sensible drinking message

Type of Study/Methods Quantitative non standardised questionnaire, anonymised coding system using SPSS and Excel

Sample Connivance sample of 180 first year female undergraduate students, Response rate 94%

Findings 58% unable to record sensible drinking message, lacked unit awareness of their favourite drink and claimed that the message did not change their alcohol consumption

Strengths/Limitations
Limitation: Sample not

representative of the population Connivance sample

Strength: limited

research on female only samples and alcohol

Perkins and Craig 2006 A successful social norms campaign to reduce alcohol misuse among college studentAthletes

To examine the effectiveness of a social norms alcohol reduction campaign amongst university athletes

Qualitative, pre and post survey administered on university computer

Undergraduate athletes, not randomised volunteers who assigned themselves to schedule for completion of survey pre and post

Students with high levels of exposure to the social norms campaign demonstrated 50% less alcohol consumption

Limitations: Self-

reported survey subject to errors Unable to match unexposed group to exposed group Strengths: limited research on college athletes and alcohol

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APPENDIX FIVE: Questionnaire letter

Dear Participant: Thank you for taking part in this research by completing this questionnaire. The purpose of this research is to investigate the level of awareness, knowledge and exposure frequency of alcohol reduction campaigns. This research is important as it affects young people and the alcohol reduction campaigns aimed towards them. The more information we can gather the more affective the campaigns can be. This questionnaire is anonymous; nothing can be traced back to you. All answers will be confidential. This questionnaire will be kept safely in a locked cupboard and then destroyed appropriately when the research is complete. When this piece of research is complete it will be possible to share the results with you. If you would be interested in this please speak with the research after

completion. The researcher will also be conducting focus groups to gather further information from participants. If you would like to take part please speak to the researcher. All information, regarding the focus groups, can be given to you today. To complete the questionnaire today please answer each question. Do not add any personal details and if you have any queries please ask the researcher who will be able to help Thank you for your time in completing this questionnaire Yours sincerely

Sarah OConnor

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APPENDIX SIX: Questionnaire

We would like to know what young adults, living in South West London, know about alcohol. We would like to invite you to complete this short survey. All questionnaires are anonymous. You do not have to take part, by doing so I will understand that as your consent to participate. The aim of this survey is to examine the effectiveness of public health campaigns in reducing risky alcohol behaviour amongst 18-24 year olds. Please tick only one answer 1. Are you male or female and 18-24 years? Male Female

18-19 years 20-22 years 23-24 years 2. What is your status: Student Full-time working P/time working Unemployed 3) Do you live in South West London? Yes No Croydon Wandsworth Sutton/Merton Kingston Lambeth Richmond 4) Do you drink alcohol? Yes No If No go to question 14

5) How frequently do you drink alcohol? Daily 2-7 days per week 2-3 times per month 3-4 times per year i.e. holidays 6) How often have you been drunk? Daily 4-6 days a week 2 or 3 days a week Once a week 2 or 3 times a month Once a month Less than once a month Never 7) Have you experienced any of the following due to alcohol? Felt ill/vomited Gaps in memory Hangover the next day Had unprotected sex Got into an argument/fight Been a victim of Crime Got into trouble with the police 8) What do you drink? Beer/lager Alco-pops Wine Spirits Other

9) Why do you drink alcohol? To be social I like it Because my friends do Because its cheap To relax Dont know 10) Where do you mainly consume alcohol? Home At a Friends house Parties Pubs/Clubs Restaurant 11) Where do you mainly purchase your alcohol from?
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 Off Licence Supermarket Local Shop Pubs/clubs Restaurants 12) Has anything/anyone influenced you to reduce your alcohol intake? Family Partner Employment Finances Friends Health Life event Alcohol campaigns NHS/GP Government Advertising 13) Has anything/anyone influenced you to increase your alcohol intake? Family Partner Employment Friends Life event Product advertising Special offers in supermarket Happy hour Extended open hours Nothing 14) Are you aware of the recommended alcohol units for your gender per day? 1-2 units 2-3 units 3-4 units 5-6 units 7-8units dont know 15) If you are aware, where did you get the information from? Television Newspaper/Magazine Internet Public place Public transport Bar/club Radio You Tube Word of mouth Family/Friends NHS/GP Government 16) Are you aware of any recommended safer drinking behaviours? Yes No If yes can you add here:

17) Have you heard or seen any public health campaigns regarding recommended safe drinking behaviour? Television Newspaper/Magazine Internet Public place Public transport Bar/club Radio You Tube Word of mouth Family/Friends NHS/GP Government None 18) Do you feel that they appropriately target your age group (18-24)? Yes No Dont know 19) Can you name any campaigns aimed at 18-24 regarding alcohol safety? Yes No If yes can you include it here:

20) Where do you think alcohol safety campaigns should be advertised? Public Transport Public place Pubs/Clubs Social media Billboards TV/Radio Magazines/Newspapers University/workplace Hospital/GP Everywhere Nowhere 21) Would you like to take part in an interview/focus group regarding the effectiveness of alcohol campaigns, in the near future? Yes No
If you wish to read the final results please leave your contact details with the researcher. Thank you for taking part in this questionnaire

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APPENDIX SEVEN: Focus group information

Dear Participant: Thank you for agreeing to take part in a focus group. The aim of the focus group is to gain your opinion on alcohol reduction campaigns. The focus group will include other young adults and will be led by the researcher. This focus group is part of a research study for a MSc public health course. The focus group will take place on Saturday June 23rd 2012. It will take place at Ethelburga community centre at 13:00 and is expected to run for 2 hours. The address can be found below. Please provide contact details to the researcher so that a reminder can be sent via text to remind you closer the date. Focus groups are a group of people who are asked about their perceptions, opinions, beliefs, and attitudes towards a product, service, concept, advertisement, idea, or packaging. Questions are asked in an interactive group setting where

participants are free to talk with other group members. In regards to this focus group it will be regarding alcohol reduction campaigns and message exposure Thank you for your time and agreeing to partake in the focus group. Yours sincerely

Sarah OConnor

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APPENDIX EIGHT: Observation check list

FIELD NOTE CHECK LIST AND INFORMATION GATHERING Frequency of exposure Circle as appropriate AREA: Wandsworth Lambeth Kingston Richmond Merton Sutton

EXACT AREA LOCATION:

ENVIRONMENT: GP Library Restaurant College Pub Wine Bar Supermarket Hospital Train/tube/bus

Community Centre

University

Night club

ALCOHOL REDUCTION ADVERTISING

yes

no

IF YES, WHAT WERE THEY PROMOTING? Alcohol unit information information Alcohol reduction information Alcohol safety

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WHAT MATERIALS AVAILABLE: Posters leaflets banners promotional merchandise

TARGET POPULATION: <18 18-24 25-64 > 65

ADVERTISING LOCATION: Information board Toilets menus bar public transport enter/exit door

Electronic message board

TV/Video feed

ALCOHOL ADVERTISING:

yes

no

IF YES, WHAT WERE THEY PROMOTING? Brand sponsored event promotional even theme night special deal

WHAT MATERIALS ARE AVAILABLE Posters leaflets promotional merchandise banners

ADVERTISING LOCATION: Information board Toilets menus bar public transport enter/exit door

Electronic message board TARGET POPULATION: <18 18-24 25-64

TV/Video feed

> 65

POTENTIAL FOR ADVERTISING ALCOHOL REDUCTION CAMPAIGNS 1 2 3 4 5

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APPENDIX NINE: Time Frame Guidelines

TIME FRAME MONTH:

FEB-MARCH12

ACTIVITY:
Background reading Grey Literature search Discuss with mentor

APRIL12

Questionnaire development Discuss with mentor

MAY12

Finalise literature review

MAY-JUNE12

Data collection

JUNE 23rd 2012

Focus Group

JULY12

Data Analysis Discuss with mentor

AUG-SEPT12

Write up dissertation Discuss with mentor

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APPENDIX TEN ADD in Ethics Check List I have this in a photocopy Study Protocol I have this to add in as photo copy this is two pages

99

100

101

APPENDIX ELEVEN

102

ADD in Indemnity Letter HERE

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APPENDIX Twelve Sample Population Characteristics Gender

Frequency Valid Male Female Total 69 89 158 Percent 43.7 56.3 100.0 Valid Percent 43.7 56.3 100.0 Cumulative Percent 43.7 100.0

Ages
Frequency Valid 18-19 yrs 20-22 yrs 23-24 yrs Total 26 80 52 158 Percent 16.5 50.6 32.9 100.0 Valid Percent 16.5 50.6 32.9 100.0

Cumulative Percent 16.5 67.1 100.0

Location
Frequency Valid Croydon Wandsworth Sutton/Merton Kingston Lambeth Richmond Total 4 53 17 12 67 5 158 Percent 2.5 33.5 10.8 7.6 42.4 3.2 100.0 Valid Percent 2.5 33.5 10.8 7.6 42.4 3.2 100.0

Cumulative Percent 2.5 36.1 46.8 54.4 96.8 100.0

Status
Frequency Valid Student Fulltime work Part time work Unemployed Total 77 34 16 31 158 Percent 48.7 21.5 10.1 19.6 100.0 Valid Percent 48.7 21.5 10.1 19.6 100.0

Cumulative Percent 48.7 70.3 80.4 100.0

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APPENDIX Thirteen Alcohol Behaviours Age and Status

13A AGE COMPARED TO CHOICE OF ALCOHOLIC DRINK

Age and choice of alcoholic drink

Beer/lager Ages 18-19 yrs Count % within Ages 20-22 yrs Count % within Ages 23-24 yrs Count % within Ages Total Count % within Ages 8 30.8% 16 20.5% 17 35.4% 41 27.0% Alco-pops 4 15.4% 18 23.1% 6 12.5% 28 18.4%

Beverage Wine 5 19.2% 18 23.1% 13 27.1% 36 23.7% Spirits 8 30.8% 13 16.7% 9 18.8% 30 19.7% Other 1 3.8% 13 16.7% 3 6.3% 17 11.2% Total 26 100.0% 78 100.0% 48 100.0% 152 100.0%

13B SIGNIFICANCE

age/alcoholic choice
Value Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases 152 11.432
a

Asymp. Sig. (2df 8 8 1 sided) .178 .169 .463

11.621 .537

13C STATUS & WHAT THEY DRINK

Status and choice of alcoholic drink

Beer/lager Status Student Count % within Status Fulltime work Count % within Status Part time work Count % within Status Unemployed Count % within Status Total Count % within Status 20 27.4% 9 28.1% 2 12.5% 10 32.3% 41 27.0% Alco-pops 17 23.3% 5 15.6% 4 25.0% 2 6.5% 28 18.4%

Beverage Wine 18 24.7% 8 25.0% 5 31.3% 5 16.1% 36 23.7% Spirits 13 17.8% 7 21.9% 1 6.3% 9 29.0% 30 19.7% Other 5 6.8% 3 9.4% 4 25.0% 5 16.1% 17 11.2% Total 73 100.0% 32 100.0% 16 100.0% 31 100.0% 152 100.0%

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13D SIGNIFICANCE

Tests status and choice of drink

Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases

Asymp. Sig. (2Value 14.404

a

df 12 12 1

sided) .276 .229 .122

15.240 2.393

152

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APPENDIX Fourteen Location of Drinking Alcohol- Status and Age

14A LOCATION COMPARED TO STATUS FOR DRINKING LOCATIONS Status

Location and status

Student Where Home Friends House Parties Pubs/Clubs Restaurant Total 2 29 21 21 0 73 Fulltime work 8 4 6 14 0 32 Part time work 4 7 3 1 1 16 Unemployed 7 9 4 9 2 31 Total 21 49 34 45 3 152

14B WHERE THEY DRINK Ages

Location and Age

18-19 yrs Where Home Friends House Parties Pubs/Clubs Restaurant Total 3 10 4 9 0 26 20-22 yrs 9 28 24 16 1 78 23-24 yrs 9 11 6 20 2 48 Total 21 49 34 45 3 152

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APPENDIX FIFTEEN Incidences and alcohol in relation to status and ages

15A INCIDENCE COMPARED TO STATUS Status

Incidence and Status

Fulltime Student Incidents Ill/vomitted Count % within Incidents Gaps in memory Count % within Incidents Hangover next day Count % within Incidents Unprotected sex Count % within Incidents Got into argument/fight % within Incidents Been victim of crime % within Incidents Trouble with police Count % within Incidents Total Count % within Incidents 80.0% 8 47.1% 73 48.0% 20.0% 2 11.8% 32 21.1% .0% 1 5.9% 16 10.5% .0% 6 35.3% 31 20.4% 100.0% 17 100.0% 152 100.0% Count 58.8% 4 17.6% 1 5.9% 0 17.6% 0 100.0% 5 Count 10 37.0% 3 27.3% 29 54.7% 9 40.9% 10 work 5 18.5% 5 45.5% 13 24.5% 3 13.6% 3 Part time work 8 29.6% 1 9.1% 3 5.7% 2 9.1% 1 Unemployed 4 14.8% 2 18.2% 8 15.1% 8 36.4% 3 Total 27 100.0% 11 100.0% 53 100.0% 22 100.0% 17

108

15B INCIDENCE COMPARED TO AGE Ages

Incidence and Age

18-19 yrs Incidents Ill/vomitted Count % within Incidents Gaps in memory Count % within Incidents Hangover next day Count % within Incidents Unprotected sex Count % within Incidents Got into argument/fight Count % within Incidents Been victim of crime Count % within Incidents Trouble with police Count % within Incidents Total Count % within Incidents 5 18.5% 0 .0% 10 18.9% 3 13.6% 4 23.5% 1 20.0% 3 17.6% 26 17.1% 20-22 yrs 12 44.4% 5 45.5% 29 54.7% 11 50.0% 9 52.9% 4 80.0% 8 47.1% 78 51.3% 23-24 yrs 10 37.0% 6 54.5% 14 26.4% 8 36.4% 4 23.5% 0 .0% 6 35.3% 48 31.6% Total 27 100.0% 11 100.0% 53 100.0% 22 100.0% 17 100.0% 5 100.0% 17 100.0% 152 100.0%

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APPENDIX SIXTEEN Influences on Increasing Alcohol Intake in Gender

16A INFLUENCE TO INCREASE DRINKING COMPARED TO GENDER Gender_18_24 Influences to increase alcohol and Gender Male Family Count % within Infl_increase_drinking Employment Count % within Infl_increase_drinking Friends Count % within Infl_increase_drinking Life event Count % within Infl_increase_drinking Product advertising % within Infl_increase_drinking Special offers in supermarket % within Infl_increase_drinking Happy Hour Count % within Infl_increase_drinking Extended Open Hours % within Infl_increase_drinking Nothing Count % within Infl_increase_drinking Total Count % within Infl_increase_drinking 75.0% 17 58.6% 68 44.7% 25.0% 12 41.4% 84 55.3% 100.0% 29 100.0% 152 100.0% Count 38.5% 3 20.0% 3 61.5% 12 80.0% 1 100.0% 15 100.0% 4 Count 38.1% 15 61.9% 24 100.0% 39 Count 0 .0% 1 100.0% 19 59.4% 2 25.0% 8 Female 3 100.0% 0 .0% 13 40.6% 6 75.0% 13 Total 3 100.0% 1 100.0% 32 100.0% 8 100.0% 21

110

16B SIGNIFICANCE Chi-Square Tests Asymp. Sig. (2Value Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases 152 16.149
a

df 8 8 1

sided) .040 .021 .600

18.076 .275

a. 8 cells (44.4%) have expected count less than 5. The minimum expected count is .45.

111

APPENDIX SEVENTEEN Influences in Reducing Alcohol

17A INFLUENCES IN REDUCING DRINKING AND GENDER Influences in Reducing alcohol and Gender Family Count % within Infl_reduce_drinking Partner Count % within Infl_reduce_drinking Employment Count % within Infl_reduce_drinking Finances Count % within Infl_reduce_drinking Friends Count % within Infl_reduce_drinking Health Count % within Infl_reduce_drinking Life event Count % within Infl_reduce_drinking Alcohol campaign Count % within Infl_reduce_drinking NHS/GP Count % within Infl_reduce_drinking Government Count % within Infl_reduce_drinking Advertising Count % within Infl_reduce_drinking Question Ignored Count % within Infl_reduce_drinking 13 Count % within Infl_reduce_drinking Total Count % within Infl_reduce_drinking Gender_18_24 Male 11 55.0% 5 35.7% 1 25.0% 31 47.7% 5 45.5% 5 45.5% 3 50.0% 0 .0% 0 .0% 1 100.0% 5 71.4% 1 12.5% 0 .0% 68 44.7% Female 9 45.0% 9 64.3% 3 75.0% 34 52.3% 6 54.5% 6 54.5% 3 50.0% 2 100.0% 1 100.0% 0 .0% 2 28.6% 7 87.5% 2 100.0% 84 55.3% Total 20 100.0% 14 100.0% 4 100.0% 65 100.0% 11 100.0% 11 100.0% 6 100.0% 2 100.0% 1 100.0% 1 100.0% 7 100.0% 8 100.0% 2 100.0% 152 100.0%

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17B INFLUENCES TO DECREASE DRINKING ALCOHOL COMPARED WITH AGES

Influences to decrease alcohol and Age Family Count % within Infl_reduce_drinking Partner Count % within Infl_reduce_drinking Employment Count % within Infl_reduce_drinking Finances Count % within Infl_reduce_drinking Friends Count % within Infl_reduce_drinking Health Count % within Infl_reduce_drinking Life event Count % within Infl_reduce_drinking Alcohol campaign NHS/GP Count % within Infl_reduce_drinking Count % within Infl_reduce_drinking Government Count % within Infl_reduce_drinking Advertising Count % within Infl_reduce_drinking Question Ignored 13 Count % within Infl_reduce_drinking Count % within Infl_reduce_drinking Total Count % within Infl_reduce_drinking 5 25.0% 0 .0% 0 .0% 13 20.0% 3 27.3% 2 18.2% 0 .0% 0 .0% 0 .0% 1 100.0% 1 14.3% 1 12.5% 0 .0% 26 17.1%

Ages 18-19 yrs 20-22 yrs 23-24 yrs 8 40.0% 7 50.0% 3 75.0% 33 50.8% 4 36.4% 7 63.6% 3 50.0% 1 50.0% 1 100.0% 0 .0% 5 71.4% 5 62.5% 1 50.0% 78 51.3% 7 Total 20

35.0% 100.0% 7 14

50.0% 100.0% 1 4

25.0% 100.0% 19 65

29.2% 100.0% 4 11

36.4% 100.0% 2 11

18.2% 100.0% 3 6

50.0% 100.0% 1 2

50.0% 100.0% 0 1

.0% 100.0% 0 1

.0% 100.0% 1 7

14.3% 100.0% 2 8

25.0% 100.0% 1 2

50.0% 100.0% 48 152

31.6% 100.0%

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17C INFLUENCE TO REDUCE DRINKING ALCOHOL COMPARED WITH STATUS Status Influence to reduce alcohol and status Student Family Count % within Infl_reduce_drinking Partner Count % within Infl_reduce_drinking Employment Count % within Infl_reduce_drinking Finances Count % within Infl_reduce_drinking Friends Count % within Infl_reduce_drinking Health Count % within Infl_reduce_drinking Life event Count % within Infl_reduce_drinking Alcohol campaign NHS/GP Count % within Infl_reduce_drinking Count % within Infl_reduce_drinking Government Count % within Infl_reduce_drinking Advertising Count % within Infl_reduce_drinking Question Ignored 13 Count % within Infl_reduce_drinking Count % within Infl_reduce_drinking Total Count % within Infl_reduce_drinking 6 30.0% 3 21.4% 2 50.0% 31 47.7% 5 45.5% 8 72.7% 4 66.7% 1 50.0% 1 100.0% 1 100.0% 4 57.1% 6 75.0% 1 50.0% 73 48.0% Fulltime work 3 15.0% 8 57.1% 2 50.0% 13 20.0% 1 9.1% 1 9.1% 2 33.3% 1 50.0% 0 .0% 0 .0% 0 .0% 1 12.5% 0 .0% 32 21.1% Part time work 5 25.0% 1 7.1% 0 .0% 9 13.8% 0 .0% 0 .0% 0 .0% 0 .0% 0 .0% 0 .0% 1 14.3% 0 .0% 0 .0% 16 10.5% Unemployed 6 Total 20

30.0% 100.0% 2 14

14.3% 100.0% 0 4

.0% 100.0% 12 65

18.5% 100.0% 5 11

45.5% 100.0% 2 11

18.2% 100.0% 0 6

.0% 100.0% 0 2

.0% 100.0% 0 1

.0% 100.0% 0 1

.0% 100.0% 2 7

28.6% 100.0% 1 8

12.5% 100.0% 1 2

50.0% 100.0% 31 152

20.4% 100.0%

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APPENDIX EIGHTEEN Name a Campaign

18A STATUS COMPARED TO NAMING A CAMPAIGN

Ability to name a campaign and status

Status Student Count Expected Count % within Status Fulltime work Count Expected Count % within Status Part time work Count Expected Count % within Status Unemployed Count Expected Count % within Status Total Count Expected Count % within Status

Name_campaign Yes 1 3.4 1.3% 4 1.5 11.8% 2 .7 12.5% 0 1.4 .0% 7 7.0 4.4% No 76 73.6 98.7% 30 32.5 88.2% 14 15.3 87.5% 31 29.6 100.0% 151 151.0 95.6% Total 77 77.0 100.0% 34 34.0 100.0% 16 16.0 100.0% 31 31.0 100.0% 158 158.0 100.0%

18B SIGNIFICANCE Chi-Square Tests

Status and naming a campaign

Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases

Asymp. Sig. (2Value 10.001

a

df 3 3 1

sided) .019 .019 .753

9.957 .099

158

a. 4 cells (50.0%) have expected count less than 5. The minimum expected count is .71.

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APPENDIX NINETEEN Public Health Campaign Message Appropriateness

19A GENDER COMPARED TO AGE APPROPRIATE ADVERTS

GENDER
Yes Gender_18_24 Male Count Expected Count % within Gender_18_24 Female Count Expected Count % within Gender_18_24 Total Count Expected Count % within Gender_18_24

Age_app_adverts No 2 4.4 2.9% 8 5.6 9.0% 10 10.0 6.3% 38 30.1 55.1% 31 38.9 34.8% 69 69.0 43.7% Dont Know 29 34.5 42.0% 50 44.5 56.2% 79 79.0 50.0% Total 69 69.0 100.0% 89 89.0 100.0% 158 158.0 100.0%

19B SIGNIFICANCE Chi-Square Tests

Gender and appropriate message

Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases

Asymp. Sig. (2Value 7.481

a

df 2 2 1

sided) .024 .022 .412

7.678 .674

158

a. 1 cells (16.7%) have expected count less than 5. The minimum expected count is 4.37.

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19C STATUS COMPARED TO AGE APPROPRIATE ADVERTS

STATUS and age appropriate message

Yes Status Student Count Expected Count % within Status Fulltime work Count Expected Count % within Status Part time work Count Expected Count % within Status Unemployed Count Expected Count % within Status Total Count Expected Count % within Status

Age_app_adverts No 3 4.9 3.9% 6 2.2 17.6% 1 1.0 6.3% 0 2.0 .0% 10 10.0 6.3% 41 33.6 53.2% 14 14.8 41.2% 2 7.0 12.5% 12 13.5 38.7% 69 69.0 43.7% Dont Know 33 38.5 42.9% 14 17.0 41.2% 13 8.0 81.3% 19 15.5 61.3% 79 79.0 50.0% Total 77 77.0 100.0% 34 34.0 100.0% 16 16.0 100.0% 31 31.0 100.0% 158 158.0 100.0%

19D SIGNIFICANCE Chi-Square Tests

Gender and age appropriate message

Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases

Asymp. Sig. (2Value 20.194

a

df 6 6 1

sided) .003 .002 .030

20.830 4.704

158

a. 4 cells (33.3%) have expected count less than 5. The minimum expected count is 1.01.

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APPENDIX TWENTY Where Alcohol Reduction Campaigns Should Be Advertised

20A ALCOHOL REDUCTION ADVERTS LOCATION COMPARED WITH GENDER

Where should adverts be/ Gender Public Transport Count % within Where_shld_adverts_be Public Place Count % within Where_shld_adverts_be Pubs/clubs Count % within Where_shld_adverts_be Social Media Count % within Where_shld_adverts_be Billboards Count % within Where_shld_adverts_be TV/Radio Count % within Where_shld_adverts_be Magazines/Newsp Count apers University/Workpl ace Hospital/GP % within Where_shld_adverts_be Count % within Where_shld_adverts_be Count % within Where_shld_adverts_be Everywhere Count % within Where_shld_adverts_be Nowhere Count % within Where_shld_adverts_be Total Count % within Where_shld_adverts_be Gender_18_24 Male 8 36.4% 16 45.7% 2 16.7% 10 55.6% 7 53.8% 5 71.4% 5 100.0% 0 .0% 0 .0% 15 41.7% 1 25.0% 69 43.7% Female 14 63.6% 19 54.3% 10 83.3% 8 44.4% 6 46.2% 2 28.6% 0 .0% 4 100.0% 2 100.0% 21 58.3% 3 75.0% 89 56.3% Total 22 100.0% 35 100.0% 12 100.0% 18 100.0% 13 100.0% 7 100.0% 5 100.0% 4 100.0% 2 100.0% 36 100.0% 4 100.0% 158 100.0%

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20B SIGNIFICANCE

Chi-Square Tests Location and gender

Pearson Chi-Square Likelihood Ratio Linear-by-Linear Association N of Valid Cases 158 Value 19.594
a

df 10 10 1

Asymp. Sig. (2-sided) .033 .007 .977

24.127 .001

10 cells (45.5%) have expected count less than 5. The minimum expected count is .87.

20C Where alcohol campaigns should be/age Ages Where should adverts be by Ages 18-19 yrs Public Transport Count % within Where_shld_adverts_be Public Place Count % within Where_shld_adverts_be Pubs/clubs Count % within Where_shld_adverts_be Social Media Count % within Where_shld_adverts_be Billboards Count % within Where_shld_adverts_be TV/Radio Count % within Where_shld_adverts_be Magazines/Newspapers Count % within Where_shld_adverts_be University/Workplace Count % within Where_shld_adverts_be Hospital/GP Count % within Where_shld_adverts_be Everywhere Count % within Where_shld_adverts_be Nowhere Count % within Where_shld_adverts_be Total Count % within Where_shld_adverts_be 2 9.1% 4 11.4% 1 8.3% 7 38.9% 4 30.8% 0 .0% 1 20.0% 1 25.0% 0 .0% 6 16.7% 0 .0% 26 16.5% 20-22 yrs 8 36.4% 20 57.1% 6 50.0% 8 44.4% 5 38.5% 7 100.0% 1 20.0% 2 50.0% 1 50.0% 19 52.8% 3 75.0% 80 50.6% 23-24 yrs 12 Total 22

54.5% 100.0% 11 35

31.4% 100.0% 5 12

41.7% 100.0% 3 18

16.7% 100.0% 4 13

30.8% 100.0% 0 7

.0% 100.0% 3 5

60.0% 100.0% 1 4

25.0% 100.0% 1 2

50.0% 100.0% 11 36

30.6% 100.0% 1 4

25.0% 100.0% 52 158

32.9% 100.0%

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APPENDIX TWENTYONE

21A ALCOHOL ADVERTISING MATERIALS Alocohol_Ads*$AlcAdsLoca Crosstabulation AlcAdsLoca Promo Poster Alocohol Ads Yes Count % within Alocohol_A ds Total Count 17 10 7 15 12 10 8 12 15 5 2 2 21 17 81.0% Leaflet 10 47.6% Merchandise 7 33.3% Bann ers 15 71.4 % Info Board 12 57.1% Toilet 10 47.6 % Menu 8 38.1 % Bar 12 57.1 %
a

Enter/Exit Doors 15 71.4%

Elec_Msg_Br d 5 23.8%

TV/Video Feed 2 9.5% Aisle 2 9.5% Total 21

Percentages and totals are based on respondents. a. Dichotomy group tabulated at value 1.

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APPENDIX TWENTYTWO Alcohol Reduction Materials

22A ALCOHOL REDUCTION ADVERTISING COMPARED WITH ADVERTISING MATERIALS AlcRedMaterial AlcoRed_Ad_Loc_Info_board
a

Ad_Material_Po Ad_Material_Le ster aflets 11 100.0% 100.0% 11 1 9.1% 100.0% 1 11 Total 11

Yes

Count % within AlcoRed_Ad_Loc_Info_board % within $AlcRedMaterial

Total

Count

Percentages and totals are based on respondents. a. Dichotomy group tabulated at value 1.

22B ALCOHOL REDUCTION ADVERTISING COMPARED WITH ADVERTISING MESSAGE AlcRedMaterial Ad_Material_M essage AlcoRed_Ad_Loc_Menus Yes Count % within AlcoRed_Ad_Loc_Menus % within $AlcRedMaterial Total Count 100.0% 4 100.0% 1 5 4 80.0%
a

Ad_Material_Me nu 1 20.0% Total 5

Percentages and totals are based on respondents. a. Dichotomy group tabulated at value 1.

22C ALCOHOL REDUCTION ADVERTISING COMPARED WITH ADVERTISING MESSAGE AlcRedMaterial

a

Ad_Material_Po Ad_Material_Le ster AlcoRed_Ad_Loc_Toilet Yes Count % within AlcoRed_Ad_Loc_Toilet % within $AlcRedMaterial Total Count 100.0% 3 100.0% 1 3 3 100.0% aflets 1 33.3% Total 3

Percentages and totals are based on respondents.

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