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It is good news our Government has now committed to a review of our alcohol legislation. Advocates, including the Health Coalition Aotearoa, have produced recommendations for the scope of the review, including giving effect to Te Tiriti o Waitangi in the legislation, stricter legal restrictions on availability and reform of the licensing process to give communities the voice they were intended to have.[[1]] A key issue the review must traverse is how can we ensure safe and responsible supply of alcohol while reducing the inequities in wellbeing and health to which alcohol significantly contributes.

One aspect not yet clear is whether the scope of the review will include adequate consideration of alcohol marketing. Alcohol marketing is mentioned in the current Sale and Supply of Alcohol Act but remains ignored and unenforced. Instead, Aotearoa New Zealand suffers, along with many similar countries, from an acceptance of pervasive alcohol marketing and the façade of an industry run voluntary code, providing no real protection from exposure to powerful and persuasive encouragement to drink and drink more.

The evidence supporting a need for regulation of marketing is clear. There is a causal effect of alcohol marketing on younger people where most of the research has been focused.[[2]] Exposure to alcohol marketing leads to young people drinking at a younger age and drinking more. In Aotearoa, tamariki Māori are exposed to five times as much alcohol marketing compared with others,[[3]] and this is likely to contribute to consumption of larger amounts of alcohol products by Māori rangitahi.[[4]] In turn, this contributes to the striking inequity in premature mortality, with Māori more than twice as likely to die from alcohol attributable causes.[[5]]

One of the benefits of alcohol marketing for the global producers is to recruit new consumers and, especially important for them, an ongoing supply of heavy consumers, described in industry sources as “the heavy drinking loyalists of tomorrow”.[[6]] Everywhere commercial alcohol producers rely on heavy consumption for significant proportions of their sales and profits, approximately 50% in Aotearoa.[[7]]

Marketing’s effects are broad and therefore the urgently needed policy response must go beyond a focus on protecting young people. Research has also indicated impacts of marketing among adult drinkers, especially among heavier drinkers and those who are attempting to reduce their consumption. Heavy drinkers find alcohol advertising more appealing, and marketing is more likely to lead to consumption; problem drinkers are both more exposed to and more interested in alcohol marketing. They report distress and threats to their sobriety from repeated exposure.[[8]]

Alcohol is one of the most heavily advertised products globally. The big global corporations, such as the Asahi Corporation, owner of the heavily promoted Ready To Drink (RTD), Long White, have ample resources to market their products. Integrated marketing campaigns use sophisticated creative material, branded events and take advantage of the unprecedented targeting the use of digital data now allows. The ubiquity of the marketing creates a one-sided picture of alcohol products as if they are ordinary commodities. The cumulative effect over time is a normalisation of alcohol products that may constrain the policy options believed to be appropriate, such as the need to regulate affordability and accessibility to prevent increases in alcohol harm.[[9]]

There is growing recognition that this marketing endeavour is unfair to all but the transnational alcohol corporations that produce, and market, the bulk of the global and New Zealand alcohol market, and their marketing partners such as the owners of the global branded sports and music events. Concern has been fuelled by the rapid and dynamic expansion of alcohol marketing in the digital media.[[10]] The data we shed in our daily lives are being sold to enable targeting of individuals, look alike audiences, and to increase the power of marketing in the digital ecology in which people now spend much of their lives; 94% of New Zealanders were active internet users in 2021.

This expansion of alcohol marketing into the digital ecology is transformational and the ease with which it crosses national boundaries has stimulated considerable international concern.[[11]] Digital marketing takes advantage of data about interests, emotional states, location, brand preferences and response to marketing and creates a seamless environment in which marketing can transform into purchase at the touch of a button. There has been a marked increase in online purchase in Aotearoa during the COVID-19 pandemic.[[12]] Digital marketing ensures a very effective use of the advertising dollar; for example, for as little as US$2 an advertising campaign based in Australia could reach one thousand young people profiled as interested in alcohol.[[13]] Engagement with alcohol marketing in the digital media is also more powerful than with traditional modes.[[14]]

Despite increasing concerns over privacy and the commodification of digital data, effective regulation of digital platforms has not yet been achieved. However, the example of tobacco shows that where governments put in place comprehensive bans on marketing, this reduces exposure to marketing in all modes. Within the World Health Organization, discussions are currently taking place towards an international code to regulate alcohol marketing, both to support the uptake of national bans on alcohol marketing and to respond to cross-border marketing.

The forthcoming review of alcohol legislation in Aotearoa provides an opportunity to re-evaluate our regulation in the context of the changed alcohol environment. This will include filling gaps in current law, such as failure to regulate alcohol marketing, and including online delivery and giving effect to Te Tiriti, while also reforming regulatory processes such as when the licencing process has not provided adequate opportunity for local government and communities to have their say. Above all, this reform could support te oranga (full participation in society) and te mana whakahaere (autonomy), which are in themselves important elements of Māori health.[[15]] The reform could also provide an opportunity to protect those most vulnerable to alcohol harm, and contribute to fairer and more equitable outcomes.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Professor Sally Casswell, FRSNZ, ONZM: Professor of Public Health and Social Research; Board Member of Health Coalition Aotearoa; Director, Social and Health Outcomes Research and Evaluation (SHORE), SHORE & Whariki Research Centre, College of Health, Massey University, New Zealand.

Correspondence Email

S.Casswell@massey.ac.nz

Competing Interests

Nil.

1) Health Coalition Aotearoa. Priorities for amendments to the Sale and Supply of Alcohol Act. Appendix 1 Roopu Apaarangi Waipiro. 2021, August 25. Available from: https://www.healthcoalition.org.nz/wp-content/uploads/2022/05/Appendix-priorities-of-Health-Coalition-Aotearoa-re-SASAA-reform-26.08.21-002.pdf.

2) Sargent JD, Babor TF. The Relationship Between Exposure to Alcohol Marketing and Underage Drinking Is Causal. J Stud Alcohol Drug. 2020;Supplement 19:113-24. doi: 10.15288/jsads.2020.s19.113.

3) Chambers T, Stanley J, Signal L, Pearson AL, Smith M, Barr M, et al. Quantifying the nature and extent of children’s real-time exposure to alcohol marketing in their everyday lives using wearable cameras: Children’s exposure via a range of media in a range of key places. Alcohol Alcohol. 2018;53:626-33.

4) Fleming T, Ball J, Peiris-John R, Crengle S, Bavin L, Tiatia-Seath J, et al. Youth19 Rangatahi Smart Survey, Initial Findings: Substance Use. Youth19 Research Group, The University of Auckland and Victoria University of Wellington; 2020. Available from: https://communityresearch.org.nz/wp-content/uploads/2021/12/Youth19SubstanceUseReport.pdf.

5) Connor J, Kydd R, Shield K, Rehm J. The burden of disease and injury attributable to alcohol in New Zealanders under 80 years of age: marked disparities by ethnicity and sex. N Z Med J. 2015;128:15-28.

6) Hessari NM, Bertscher A, Critchlow N, Fitzgerald N, Knai C, Stead M, et al. Recruiting the “heavy-using loyalists of tomorrow”: An analysis of the aims, effects and mechanisms of alcohol advertising, based on advertising industry evaluations. Int J Environ Res Public Health. 2019;16:4092. doi: 10.3390/ijerph16214092.

7) Cuong PV, Casswell S, Parker K, Callinan S, Chaiyasong S, Kazantseva E, et al. Cross-country comparison of proportion of alcohol consumed in harmful drinking occasions using the International Alcohol Control (IAC) study. Drug Alcohol Rev. 2018;37:S45-S52.

8) Alcohol Focus Scotland. Realising our rights: How to protect people from alcohol marketing. A Report by the Alcohol Marketing Expert Network. 2022. Available from: https://www.alcohol-focus-scotland.org.uk/media/440173/realising-our-rights-alcohol-marketing-report-summary.pdf.

9) Babor T, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, et al. Alcohol: No Ordinary Commodity Research and Public Policy. 2nd ed. Oxford: Oxford University Press; 2010.

10) Carah N, Brodmerkel S. Alcohol marketing in the era of digital media platforms. J Stud Alcohol Drug. 2021;82:18-27.

11) World Health Organization. Reducing the harm from alcohol – by regulating cross-border alcohol marketing, advertising and promotion: A technical report. 2022. Available from: https://apps.who.int/iris/rest/bitstreams/1422772/retrieve.

12) Huckle T, Parker K, Romeo J, Casswell S. Online alcohol delivery is associated with heavier drinking during the first New Zealand COVID-19 pandemic restrictions. Drug Alcohol Rev. 2020;published online Nov 30. doi 10.1111/dar.13222.

13) Casswell S. Alcohol marketing has crossed borders and entered the metaverse – how do we regulate the new digital risk? The Conversation; 2022, May 23 [cited 2022]. Available from: https://theconversation.com/alcohol-marketing-has-crossed-borders-and-entered-the-metaverse-how-do-we-regulate-the-new-digital-risk-183334.

14) Noel J, Sammartino C, Rosenthal S. Exposure to Digital Alcohol Marketing and Alcohol Use: A Systematic Review. J Stud Alcohol Drug. 2020;Supplement(s19):57-67.

15) Durie M. Te Pae Mahutonga: a model for Maori health promotion. Health Promotion Forum Conference, Napier; 1999.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

It is good news our Government has now committed to a review of our alcohol legislation. Advocates, including the Health Coalition Aotearoa, have produced recommendations for the scope of the review, including giving effect to Te Tiriti o Waitangi in the legislation, stricter legal restrictions on availability and reform of the licensing process to give communities the voice they were intended to have.[[1]] A key issue the review must traverse is how can we ensure safe and responsible supply of alcohol while reducing the inequities in wellbeing and health to which alcohol significantly contributes.

One aspect not yet clear is whether the scope of the review will include adequate consideration of alcohol marketing. Alcohol marketing is mentioned in the current Sale and Supply of Alcohol Act but remains ignored and unenforced. Instead, Aotearoa New Zealand suffers, along with many similar countries, from an acceptance of pervasive alcohol marketing and the façade of an industry run voluntary code, providing no real protection from exposure to powerful and persuasive encouragement to drink and drink more.

The evidence supporting a need for regulation of marketing is clear. There is a causal effect of alcohol marketing on younger people where most of the research has been focused.[[2]] Exposure to alcohol marketing leads to young people drinking at a younger age and drinking more. In Aotearoa, tamariki Māori are exposed to five times as much alcohol marketing compared with others,[[3]] and this is likely to contribute to consumption of larger amounts of alcohol products by Māori rangitahi.[[4]] In turn, this contributes to the striking inequity in premature mortality, with Māori more than twice as likely to die from alcohol attributable causes.[[5]]

One of the benefits of alcohol marketing for the global producers is to recruit new consumers and, especially important for them, an ongoing supply of heavy consumers, described in industry sources as “the heavy drinking loyalists of tomorrow”.[[6]] Everywhere commercial alcohol producers rely on heavy consumption for significant proportions of their sales and profits, approximately 50% in Aotearoa.[[7]]

Marketing’s effects are broad and therefore the urgently needed policy response must go beyond a focus on protecting young people. Research has also indicated impacts of marketing among adult drinkers, especially among heavier drinkers and those who are attempting to reduce their consumption. Heavy drinkers find alcohol advertising more appealing, and marketing is more likely to lead to consumption; problem drinkers are both more exposed to and more interested in alcohol marketing. They report distress and threats to their sobriety from repeated exposure.[[8]]

Alcohol is one of the most heavily advertised products globally. The big global corporations, such as the Asahi Corporation, owner of the heavily promoted Ready To Drink (RTD), Long White, have ample resources to market their products. Integrated marketing campaigns use sophisticated creative material, branded events and take advantage of the unprecedented targeting the use of digital data now allows. The ubiquity of the marketing creates a one-sided picture of alcohol products as if they are ordinary commodities. The cumulative effect over time is a normalisation of alcohol products that may constrain the policy options believed to be appropriate, such as the need to regulate affordability and accessibility to prevent increases in alcohol harm.[[9]]

There is growing recognition that this marketing endeavour is unfair to all but the transnational alcohol corporations that produce, and market, the bulk of the global and New Zealand alcohol market, and their marketing partners such as the owners of the global branded sports and music events. Concern has been fuelled by the rapid and dynamic expansion of alcohol marketing in the digital media.[[10]] The data we shed in our daily lives are being sold to enable targeting of individuals, look alike audiences, and to increase the power of marketing in the digital ecology in which people now spend much of their lives; 94% of New Zealanders were active internet users in 2021.

This expansion of alcohol marketing into the digital ecology is transformational and the ease with which it crosses national boundaries has stimulated considerable international concern.[[11]] Digital marketing takes advantage of data about interests, emotional states, location, brand preferences and response to marketing and creates a seamless environment in which marketing can transform into purchase at the touch of a button. There has been a marked increase in online purchase in Aotearoa during the COVID-19 pandemic.[[12]] Digital marketing ensures a very effective use of the advertising dollar; for example, for as little as US$2 an advertising campaign based in Australia could reach one thousand young people profiled as interested in alcohol.[[13]] Engagement with alcohol marketing in the digital media is also more powerful than with traditional modes.[[14]]

Despite increasing concerns over privacy and the commodification of digital data, effective regulation of digital platforms has not yet been achieved. However, the example of tobacco shows that where governments put in place comprehensive bans on marketing, this reduces exposure to marketing in all modes. Within the World Health Organization, discussions are currently taking place towards an international code to regulate alcohol marketing, both to support the uptake of national bans on alcohol marketing and to respond to cross-border marketing.

The forthcoming review of alcohol legislation in Aotearoa provides an opportunity to re-evaluate our regulation in the context of the changed alcohol environment. This will include filling gaps in current law, such as failure to regulate alcohol marketing, and including online delivery and giving effect to Te Tiriti, while also reforming regulatory processes such as when the licencing process has not provided adequate opportunity for local government and communities to have their say. Above all, this reform could support te oranga (full participation in society) and te mana whakahaere (autonomy), which are in themselves important elements of Māori health.[[15]] The reform could also provide an opportunity to protect those most vulnerable to alcohol harm, and contribute to fairer and more equitable outcomes.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Professor Sally Casswell, FRSNZ, ONZM: Professor of Public Health and Social Research; Board Member of Health Coalition Aotearoa; Director, Social and Health Outcomes Research and Evaluation (SHORE), SHORE & Whariki Research Centre, College of Health, Massey University, New Zealand.

Correspondence Email

S.Casswell@massey.ac.nz

Competing Interests

Nil.

1) Health Coalition Aotearoa. Priorities for amendments to the Sale and Supply of Alcohol Act. Appendix 1 Roopu Apaarangi Waipiro. 2021, August 25. Available from: https://www.healthcoalition.org.nz/wp-content/uploads/2022/05/Appendix-priorities-of-Health-Coalition-Aotearoa-re-SASAA-reform-26.08.21-002.pdf.

2) Sargent JD, Babor TF. The Relationship Between Exposure to Alcohol Marketing and Underage Drinking Is Causal. J Stud Alcohol Drug. 2020;Supplement 19:113-24. doi: 10.15288/jsads.2020.s19.113.

3) Chambers T, Stanley J, Signal L, Pearson AL, Smith M, Barr M, et al. Quantifying the nature and extent of children’s real-time exposure to alcohol marketing in their everyday lives using wearable cameras: Children’s exposure via a range of media in a range of key places. Alcohol Alcohol. 2018;53:626-33.

4) Fleming T, Ball J, Peiris-John R, Crengle S, Bavin L, Tiatia-Seath J, et al. Youth19 Rangatahi Smart Survey, Initial Findings: Substance Use. Youth19 Research Group, The University of Auckland and Victoria University of Wellington; 2020. Available from: https://communityresearch.org.nz/wp-content/uploads/2021/12/Youth19SubstanceUseReport.pdf.

5) Connor J, Kydd R, Shield K, Rehm J. The burden of disease and injury attributable to alcohol in New Zealanders under 80 years of age: marked disparities by ethnicity and sex. N Z Med J. 2015;128:15-28.

6) Hessari NM, Bertscher A, Critchlow N, Fitzgerald N, Knai C, Stead M, et al. Recruiting the “heavy-using loyalists of tomorrow”: An analysis of the aims, effects and mechanisms of alcohol advertising, based on advertising industry evaluations. Int J Environ Res Public Health. 2019;16:4092. doi: 10.3390/ijerph16214092.

7) Cuong PV, Casswell S, Parker K, Callinan S, Chaiyasong S, Kazantseva E, et al. Cross-country comparison of proportion of alcohol consumed in harmful drinking occasions using the International Alcohol Control (IAC) study. Drug Alcohol Rev. 2018;37:S45-S52.

8) Alcohol Focus Scotland. Realising our rights: How to protect people from alcohol marketing. A Report by the Alcohol Marketing Expert Network. 2022. Available from: https://www.alcohol-focus-scotland.org.uk/media/440173/realising-our-rights-alcohol-marketing-report-summary.pdf.

9) Babor T, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, et al. Alcohol: No Ordinary Commodity Research and Public Policy. 2nd ed. Oxford: Oxford University Press; 2010.

10) Carah N, Brodmerkel S. Alcohol marketing in the era of digital media platforms. J Stud Alcohol Drug. 2021;82:18-27.

11) World Health Organization. Reducing the harm from alcohol – by regulating cross-border alcohol marketing, advertising and promotion: A technical report. 2022. Available from: https://apps.who.int/iris/rest/bitstreams/1422772/retrieve.

12) Huckle T, Parker K, Romeo J, Casswell S. Online alcohol delivery is associated with heavier drinking during the first New Zealand COVID-19 pandemic restrictions. Drug Alcohol Rev. 2020;published online Nov 30. doi 10.1111/dar.13222.

13) Casswell S. Alcohol marketing has crossed borders and entered the metaverse – how do we regulate the new digital risk? The Conversation; 2022, May 23 [cited 2022]. Available from: https://theconversation.com/alcohol-marketing-has-crossed-borders-and-entered-the-metaverse-how-do-we-regulate-the-new-digital-risk-183334.

14) Noel J, Sammartino C, Rosenthal S. Exposure to Digital Alcohol Marketing and Alcohol Use: A Systematic Review. J Stud Alcohol Drug. 2020;Supplement(s19):57-67.

15) Durie M. Te Pae Mahutonga: a model for Maori health promotion. Health Promotion Forum Conference, Napier; 1999.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

It is good news our Government has now committed to a review of our alcohol legislation. Advocates, including the Health Coalition Aotearoa, have produced recommendations for the scope of the review, including giving effect to Te Tiriti o Waitangi in the legislation, stricter legal restrictions on availability and reform of the licensing process to give communities the voice they were intended to have.[[1]] A key issue the review must traverse is how can we ensure safe and responsible supply of alcohol while reducing the inequities in wellbeing and health to which alcohol significantly contributes.

One aspect not yet clear is whether the scope of the review will include adequate consideration of alcohol marketing. Alcohol marketing is mentioned in the current Sale and Supply of Alcohol Act but remains ignored and unenforced. Instead, Aotearoa New Zealand suffers, along with many similar countries, from an acceptance of pervasive alcohol marketing and the façade of an industry run voluntary code, providing no real protection from exposure to powerful and persuasive encouragement to drink and drink more.

The evidence supporting a need for regulation of marketing is clear. There is a causal effect of alcohol marketing on younger people where most of the research has been focused.[[2]] Exposure to alcohol marketing leads to young people drinking at a younger age and drinking more. In Aotearoa, tamariki Māori are exposed to five times as much alcohol marketing compared with others,[[3]] and this is likely to contribute to consumption of larger amounts of alcohol products by Māori rangitahi.[[4]] In turn, this contributes to the striking inequity in premature mortality, with Māori more than twice as likely to die from alcohol attributable causes.[[5]]

One of the benefits of alcohol marketing for the global producers is to recruit new consumers and, especially important for them, an ongoing supply of heavy consumers, described in industry sources as “the heavy drinking loyalists of tomorrow”.[[6]] Everywhere commercial alcohol producers rely on heavy consumption for significant proportions of their sales and profits, approximately 50% in Aotearoa.[[7]]

Marketing’s effects are broad and therefore the urgently needed policy response must go beyond a focus on protecting young people. Research has also indicated impacts of marketing among adult drinkers, especially among heavier drinkers and those who are attempting to reduce their consumption. Heavy drinkers find alcohol advertising more appealing, and marketing is more likely to lead to consumption; problem drinkers are both more exposed to and more interested in alcohol marketing. They report distress and threats to their sobriety from repeated exposure.[[8]]

Alcohol is one of the most heavily advertised products globally. The big global corporations, such as the Asahi Corporation, owner of the heavily promoted Ready To Drink (RTD), Long White, have ample resources to market their products. Integrated marketing campaigns use sophisticated creative material, branded events and take advantage of the unprecedented targeting the use of digital data now allows. The ubiquity of the marketing creates a one-sided picture of alcohol products as if they are ordinary commodities. The cumulative effect over time is a normalisation of alcohol products that may constrain the policy options believed to be appropriate, such as the need to regulate affordability and accessibility to prevent increases in alcohol harm.[[9]]

There is growing recognition that this marketing endeavour is unfair to all but the transnational alcohol corporations that produce, and market, the bulk of the global and New Zealand alcohol market, and their marketing partners such as the owners of the global branded sports and music events. Concern has been fuelled by the rapid and dynamic expansion of alcohol marketing in the digital media.[[10]] The data we shed in our daily lives are being sold to enable targeting of individuals, look alike audiences, and to increase the power of marketing in the digital ecology in which people now spend much of their lives; 94% of New Zealanders were active internet users in 2021.

This expansion of alcohol marketing into the digital ecology is transformational and the ease with which it crosses national boundaries has stimulated considerable international concern.[[11]] Digital marketing takes advantage of data about interests, emotional states, location, brand preferences and response to marketing and creates a seamless environment in which marketing can transform into purchase at the touch of a button. There has been a marked increase in online purchase in Aotearoa during the COVID-19 pandemic.[[12]] Digital marketing ensures a very effective use of the advertising dollar; for example, for as little as US$2 an advertising campaign based in Australia could reach one thousand young people profiled as interested in alcohol.[[13]] Engagement with alcohol marketing in the digital media is also more powerful than with traditional modes.[[14]]

Despite increasing concerns over privacy and the commodification of digital data, effective regulation of digital platforms has not yet been achieved. However, the example of tobacco shows that where governments put in place comprehensive bans on marketing, this reduces exposure to marketing in all modes. Within the World Health Organization, discussions are currently taking place towards an international code to regulate alcohol marketing, both to support the uptake of national bans on alcohol marketing and to respond to cross-border marketing.

The forthcoming review of alcohol legislation in Aotearoa provides an opportunity to re-evaluate our regulation in the context of the changed alcohol environment. This will include filling gaps in current law, such as failure to regulate alcohol marketing, and including online delivery and giving effect to Te Tiriti, while also reforming regulatory processes such as when the licencing process has not provided adequate opportunity for local government and communities to have their say. Above all, this reform could support te oranga (full participation in society) and te mana whakahaere (autonomy), which are in themselves important elements of Māori health.[[15]] The reform could also provide an opportunity to protect those most vulnerable to alcohol harm, and contribute to fairer and more equitable outcomes.

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

Acknowledgements

Correspondence

Professor Sally Casswell, FRSNZ, ONZM: Professor of Public Health and Social Research; Board Member of Health Coalition Aotearoa; Director, Social and Health Outcomes Research and Evaluation (SHORE), SHORE & Whariki Research Centre, College of Health, Massey University, New Zealand.

Correspondence Email

S.Casswell@massey.ac.nz

Competing Interests

Nil.

1) Health Coalition Aotearoa. Priorities for amendments to the Sale and Supply of Alcohol Act. Appendix 1 Roopu Apaarangi Waipiro. 2021, August 25. Available from: https://www.healthcoalition.org.nz/wp-content/uploads/2022/05/Appendix-priorities-of-Health-Coalition-Aotearoa-re-SASAA-reform-26.08.21-002.pdf.

2) Sargent JD, Babor TF. The Relationship Between Exposure to Alcohol Marketing and Underage Drinking Is Causal. J Stud Alcohol Drug. 2020;Supplement 19:113-24. doi: 10.15288/jsads.2020.s19.113.

3) Chambers T, Stanley J, Signal L, Pearson AL, Smith M, Barr M, et al. Quantifying the nature and extent of children’s real-time exposure to alcohol marketing in their everyday lives using wearable cameras: Children’s exposure via a range of media in a range of key places. Alcohol Alcohol. 2018;53:626-33.

4) Fleming T, Ball J, Peiris-John R, Crengle S, Bavin L, Tiatia-Seath J, et al. Youth19 Rangatahi Smart Survey, Initial Findings: Substance Use. Youth19 Research Group, The University of Auckland and Victoria University of Wellington; 2020. Available from: https://communityresearch.org.nz/wp-content/uploads/2021/12/Youth19SubstanceUseReport.pdf.

5) Connor J, Kydd R, Shield K, Rehm J. The burden of disease and injury attributable to alcohol in New Zealanders under 80 years of age: marked disparities by ethnicity and sex. N Z Med J. 2015;128:15-28.

6) Hessari NM, Bertscher A, Critchlow N, Fitzgerald N, Knai C, Stead M, et al. Recruiting the “heavy-using loyalists of tomorrow”: An analysis of the aims, effects and mechanisms of alcohol advertising, based on advertising industry evaluations. Int J Environ Res Public Health. 2019;16:4092. doi: 10.3390/ijerph16214092.

7) Cuong PV, Casswell S, Parker K, Callinan S, Chaiyasong S, Kazantseva E, et al. Cross-country comparison of proportion of alcohol consumed in harmful drinking occasions using the International Alcohol Control (IAC) study. Drug Alcohol Rev. 2018;37:S45-S52.

8) Alcohol Focus Scotland. Realising our rights: How to protect people from alcohol marketing. A Report by the Alcohol Marketing Expert Network. 2022. Available from: https://www.alcohol-focus-scotland.org.uk/media/440173/realising-our-rights-alcohol-marketing-report-summary.pdf.

9) Babor T, Caetano R, Casswell S, Edwards G, Giesbrecht N, Graham K, et al. Alcohol: No Ordinary Commodity Research and Public Policy. 2nd ed. Oxford: Oxford University Press; 2010.

10) Carah N, Brodmerkel S. Alcohol marketing in the era of digital media platforms. J Stud Alcohol Drug. 2021;82:18-27.

11) World Health Organization. Reducing the harm from alcohol – by regulating cross-border alcohol marketing, advertising and promotion: A technical report. 2022. Available from: https://apps.who.int/iris/rest/bitstreams/1422772/retrieve.

12) Huckle T, Parker K, Romeo J, Casswell S. Online alcohol delivery is associated with heavier drinking during the first New Zealand COVID-19 pandemic restrictions. Drug Alcohol Rev. 2020;published online Nov 30. doi 10.1111/dar.13222.

13) Casswell S. Alcohol marketing has crossed borders and entered the metaverse – how do we regulate the new digital risk? The Conversation; 2022, May 23 [cited 2022]. Available from: https://theconversation.com/alcohol-marketing-has-crossed-borders-and-entered-the-metaverse-how-do-we-regulate-the-new-digital-risk-183334.

14) Noel J, Sammartino C, Rosenthal S. Exposure to Digital Alcohol Marketing and Alcohol Use: A Systematic Review. J Stud Alcohol Drug. 2020;Supplement(s19):57-67.

15) Durie M. Te Pae Mahutonga: a model for Maori health promotion. Health Promotion Forum Conference, Napier; 1999.

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