Anatomía Patológica de la apendicitis aguda

A key policy tactic of the alcohol industry is to ensure the positive perception of alcohol. This goal is achieved through product advertising, marketing and promotion, and the depiction of behaviours associated with drinking in ways that encourage use. These dealings are part of an overall business approach to ensure that alcohol remains a highly acceptable product, to strengthen the viability of alcohol in the marketplace, and to increase product market share. The founding of the World Trade Organization (WTO) in

the 1990s is a pivotal point in setting the global agenda (Gould 2005), whereby the

maintenance of global trade is supported by a free and open market economy. This crucial decision in the history of alcohol availability lends support to advertising and marketing strategies. International trade treaties represent a considerable challenge to restrictions on alcohol advertising.

There is little doubt that a ban on advertising and marketing of alcohol contravenes world trade practices. “The various interests that profit from alcohol sales have good reason to believe broadened trade rules could end the debate over alcohol advertising” (Gould 2005, p. 360). Yet, uncertainty for regulators persists. Gould (2005) identifies a number of challenges to health protection regulation, and government maintenance of regulation, in the face of trade liberalisation. New and largely unevaluated technologies present an additional problem for regulators and for public alcohol policy; a global response to this emerging issue is needed (Casswell & Maxwell 2005). These authors state “new products have led to new levels of inventiveness in naming and packaging” (p. 345), making regulation much more complicated. They also propose: current attempts at regulation ignore the full marketing mix evident; a global approach needs to set clear limits on alcohol marketing, and conceptual and methodological difficulties abound in measuring the effects of advertising bans.

The results of advertising and marketing are not always clear. Positive associations with a range of drinking patterns and consumption measures are observed in Australia (Jones & Magee 2011). Motor vehicle fatalities are reduced through alcohol advertising bans; elimination of the tax deductibility of advertising is another potential policy approach (Saffer 1997). Content of advertising is important in analysis that seeks to determine these connections (Finn & Strickland 1982; Strickland, Finn & Lambert 1982), as is the

frequency and nature of advertising (Madden & Grube 1994). But, much research fails to investigate the complexities of these relationships; positive correlations can be hard to demonstrate. Reference to decision making processes reveals connections between media alcohol portrayal and children’s drinking, but, analysis of exposure and effect often underestimates the full extent of influence (Austin, Chen & Grube 2006). “Some results are suggestive …. there is a need for more sophisticated econometric, exposure and experimental studies that take into account a wider range of variables” (Smart 1988, p. 314).

Overall, the effects of advertising are inconsistent (Collins et al. 2007). Differences are evident between drinking groups; heavy drinkers and those with positive expectancies of future drinking most often expose themselves to alcohol advertising and have stronger recall of advertising content (Smart 1988). Variation is evident between the forms of advertising and incremental effects on youth. Collins and others (2007) show that drinking and driving intentions are predicted through ownership of a hat, poster or shirt advertising alcohol; some other forms of advertising show little or no influence. Concerns are raised regarding sponsorship of events where children and adolescents are present (Davoren & Sinclair 2012), as well as the negative effect on the drinking habits of sports people (O'Brien et al. 2011). Within these various contexts, alcohol advertisers are well aware of the demographics of alcohol consumption across different population groups and pitch their efforts accordingly, cause for much public health disquiet (Garfield, Chung & Rathouz 2003). Yet, scepticism regarding advertising claims is a protective factor reducing risk from the media message (Austin, Chen & Grube 2006).

The appeal of advertising content to vulnerable target groups, like young people, is in need of a new policy response (Casswell & Maxwell 2005). Links between an awareness of

alcohol marketing, drinking intentions and drinking behaviours are well established for the young (Gordon et al. 2010). The likelihood that adolescents will use alcohol, and if they already use will consume more, increases with exposure to advertising and promotion (Anderson et al. 2009). “The tragedy from alcohol use often hits earlier in life than other preventable health risks” (Kessler 2005, p. 294), necessitating the restriction of advertising to young people. Increased exposure to a variety of media, such as music video and television coverage of alcohol use, is a risk factor in adolescence (Robinson, Chen & Killen 1998). Adolescent drinking is predicted from multiple modes of advertising; prior experience with alcohol determines the source of advertising as the predominant influence (Ellickson et al. 2005). For example, brand allegiance and a predilection for broadcast alcohol advertisements at eighteen years influence the volume of beer consumed at twenty- one years of age (Casswell & Zhang 1998). Movie portrayal of alcohol and drinking leads to higher consumption in young adult males (Engels et al. 2009). Of note, the perceived consequences of drinking, as alcohol expectancies, remain an important pathway of media influence; these require future research to determine the extent of effect (Collins et al. 2007).

Despite alcohol advertising likely increasing overall consumption and misuse, especially for the young, bans on advertising have little effect. Retail discounting and coupons are used as successful industry responses (Saffer 2002). In the worlds of Saffer (2002), “counter advertising, rather than new advertising bans, is the better choice for public policy” (p. 173). There is interest in health as a ‘good’ (Godfrey 1989), presenting untold opportunity for the promotion of public health messages and public health policy for alcohol. Counter messaging by public health officials is a largely untried and untested area for alcohol intervention in Australia. Some media messages emphasising alcohol harms have been broadcast, but with little, if any, long term effect. As a related issue, a recent

review of food labelling law and policy recommends that general health warning messages be placed on alcohol labels, as well as specific pregnancy related warnings

(Commonwealth of Australia 2011). It is yet to be seen how all the recommendations of the Blewett Review of Food Labelling Law and Policy (Blewett et al. 2011) are finally actioned by the Australian Government and if the mandatory labelling of alcohol with general health warnings is eventually able to be brought into effect. Policy communities continue to advocate for the Australian Government to take full control of the alcohol labelling agenda (Foundation for Alcohol Research & Education 2012b). The wording of general health warning labels is yet to be decided, and will persist as a contestable area between government players and industry representatives.

The brewer Lion Nathan promised to voluntarily adopt consumer health messages in support of responsible drinking choices (Hagan & Miletic 2011). This decision provides the multinational company with a ‘head start’, and will afford further opportunity for business control of alcohol messages. Nonetheless, problems abound with the partial labelling of some alcohol products and not others. Uninformed drinkers may avoid labelled products and choose those with no displayed health warnings (Agostinelli & Grube 2002). This choice can lead to unintended harms, especially related to pregnancy. Research referred to by Agostinelli and Grube (2002) indicates both cognitive and

affective factors are important in the impact of alcohol labelling; visceral responses to words such as ‘poison’ and ‘cancer’ produce greater avoidance behaviour than the more general warnings of ‘harm to health’, at least in a sample of college and high school students. These authors also state “taken together, the accumulated evidence suggests that warning labels are being noticed and their content is remembered” (p. 19). This being so, there is a ‘duty of care’ on the part of governments and public health officials to inform the general public of the risks associated with alcohol, irrespective of whether these warnings

are heeded and despite an industry preference. Such warnings need to be backed up by sustained policy effort to address other influences, such as situational availability and improved health from reduced consumption.