Food as harm reduction during a drinking session: reducing the harm or normalising harmful use of alcohol? A qualitative comparative analysis of alcohol industry and non-alcohol industry-funded guidance

Abstract

Background The aim of this study was to critically analyse information concerning the relationship between alcohol and food consumption provided via alcohol industry (AI) funded and non-AI-funded health-oriented websites, to determine the role it plays within the alcohol information space, and how this serves the interests of the disseminating organisations. Methods Information on food as a harm reduction measure while drinking alcohol was extracted from 15 AI websites and websites of AI-funded corporate social responsibility (CSR) organisations. As a comparison group, non-AI-funded health websites were also searched (n = 16 websites with food and alcohol-related content). Information was included from webpage content and associated downloadable documents. Critical discourse analysis (CDA) was adopted to allow the texts analysed to be situated within the broader political and social context. Analysis was carried out iteratively, involving continuous comparison within and between websites. Discursive themes were identified by three researchers. Identified discursive elements were discussed to reach a consensus, and a final coding framework was then developed. “Tone” analysis was used to assess whether the overall tone within individual websites was considered to be pro-alcohol consumption, neutral or discouraging of alcohol consumption. Results There were some commonalities across AI and non-AI-funded websites, whereby both appeared to normalise alcohol consumption and to encourage use of food as a measure to enable sustained drinking, to avoid drinking in a way that results in short-term harms, and to prevent or “cure” a hangover. The fact that both AI-funded and non-AI-funded organisations shared many of these narratives is particularly concerning. However, a discourse of food and alcohol that served to promote “moderate” drinking as beneficial to health was used exclusively by AI-funded organisations, focusing on special occasions and individual-blaming. Conclusions Alcohol consumption, including heavy and harmful consumption, is frequently normalised within the online information space. Emphasising food consumption with alcohol may have the effect of supporting consumers to drink for longer periods of time. Health professionals and independent health organisations should review the information they provide in light of our findings and challenge why AI-funded organisations, with a major conflict of interest, and a history of health misinformation, are often given the responsibility for disseminating health information to the public.

Corporate activities that influence population health: A scoping review and qualitative synthesis to develop the HEALTH-CORP typology

“…The ways in which corporations shape preferences for products and influence perceptions about their health-related risks was another major topic of the included articles. Corporations were accused of promoting excessive consumption of harmful products, for example, by engaging in intensive and highly-resourced marketing campaigns that normalize their consumption (e.g., portraying alcohol as part of a normal everyday routine [84]) [12,18,36,42,47,51,63,65,72–74,84–99]. They were reported to influence the public debate about product related-risks by reframing and creating uncertainty about the causes of health issues (e.g., focusing on genetic causes of cancer as opposed to alcohol consumption [100]) [18,20,27,28,31,32,34,36,37,40–42,44,46,48,50–52,56–58,64,65,75,76,79,81,101–104] and acquiring or funding media companies, making it more difficult for public health messages to be heard [20,45,48,49,65,72].…”

“…They were reported to influence the public debate about product related-risks by reframing and creating uncertainty about the causes of health issues (e.g., focusing on genetic causes of cancer as opposed to alcohol consumption [100]) [18,20,27,28,31,32,34,36,37,40–42,44,46,48,50–52,56–58,64,65,75,76,79,81,101–104] and acquiring or funding media companies, making it more difficult for public health messages to be heard [20,45,48,49,65,72]. Though commercial entities promoted education as the solution to managing health-related risks [20,45,51,58,66,68,74,80], they were also accused of attempting to shape the public’s understanding of health issues by providing educational resources that promoted their products and/or downplayed the associated health risks (e.g., alcohol [61,62]) [19,20,36,51,63,65,68,80,84,100].…”

“…The ways in which corporations shape preferences for products and influence perceptions about their health-related risks was another major topic of the included articles. Corporations were accused of promoting excessive consumption of harmful products, for example, by engaging in intensive and highly-resourced marketing campaigns that normalize their consumption (e.g., portraying alcohol as part of a normal everyday routine [84]) [12,18, acquiring or funding media companies, making it more difficult for public health messages to be heard [20,45,48,49,65,72]. Though commercial entities promoted education as the solution to managing health-related risks [20,45,51,58,66,68,74,80], they were also accused of attempting to shape the public's understanding of health issues by providing educational resources that promoted their products and/or downplayed the associated health risks (e.g., alcohol [61,62]) [19,20,36,51,63,65,68,80,84,100].…”

“…Overall, CSR was perceived critically and was seen as being closely related to political practices and preference and perception shaping practices. That is, CSR efforts were seen as attempts to distract from corporate harms [12,18,27,44,48,75,107], shift blame [68,75], enhance brand image and credibility [19,36,44,67,84], influence policymaking [19,37,44,48,68,71], and/or preemptively address threats to business practices [55]. In some cases, these strategic uses of CSR were described by corporations in leaked company documents [48].…”

Characteristics of commercial determinants of health research on corporate activities: A scoping review

“…The most commonly reported frameworks employed were Mialon and colleagues' framework to monitor the corporate political activity of the food industry [41] (5/37, 14%) and the policy dystopia model [42] and its adaptation to the food industry [43] (the latter is an updated version of Mialon and colleagues' CPA framework) (7/37, 19%). The findings from these studies often revealed the diverse, yet oft-repeated mechanisms through which corporation's advance their interests in ways that can harm population health (e.g., use of messaging to normalize harmful commodity use [44,45]).…”