Project: Excessive Drinking

1. Project: Excessive Drinking Prepared By:Queastor March 2009

2. Order of Presentation • Objectives • Methodology & Sample • Barnsley’s Drinking Culture • Women’s Attitude To Drinking • Key Reasons For Drinking • Drinking Behaviour • Dangers & Barriers to Drinking • Evaluation Of Current Campaigns • Impact of Campaigns/Drinking Initiatives • Barnsley Initiatives & Future

3. Objectives Business Objective • To actively help Barnsley PCT implement an effective and impactful social marketing intervention to reduce levels of excessive drinking within Barnsley females, ultimately reducing consumption of alcohol Research Objectives • To help Barnsley PCT in achieving this goal, research was commissioned to; • Explore the target audience’s lifestyles, mindset and behaviour, their current life as well as their aspirations and future life plans • Understand and identify the key social influences and pressures at work in the target audiences lives, and specifically which lead them to excessive drinking • Assess attitudes towards alcohol and drinking habits • Evaluate current drinking habits including buying and consumption behaviour, including financial patterns that affect buyer behaviour and purchase patterns • Identify motivators and barriers to drinking alcohol (at home and in pubs/bars etc) • Explore understanding of links between alcohol and health/social problems; do the target audience know/understand the dangers of alcohol abuse and excessive drinking? • Understand motivations and barriers to behavioural change in relation to excessive drinking

4. Approach: The Complete Picture • Customer observations • Bar managers/ staff interviews • ‘On-the-spot’ interviews with customers, allowing us to probe influences on drinking behaviour, decision making process and end purchase • A combination of approaches to ensure provision of the complete picture; • Desk research to build on existing knowledge • Word report produced Secondary Research Immersion Days Drinking Buddy Sessions Stakeholder Depths • Core approach • To discuss drinking behaviour and the role of alcohol in more detail in a relaxed environment with friends • 6 x 1 hour stakeholder interviews with specialists within the Barnsley area

5. Drinking Buddy Sessions Core Approach – 12 x 1.5 in home hour drinking sessions 3 x 18 – 21 year olds 2 x Hazardous drinkers 1 x Harmful drinkers 3 x 22 – 25 year olds 1 x Hazardous drinkers 2 x Harmful drinkers 3 x 26 – 30 year olds 1 x Hazardous drinkers 2 x Harmful drinkers 3 x 31 – 35 year olds 2 x Hazardous drinkers 1 x Harmful drinkers • All females (3 respondents per session) • Hazardous drinkers – regularly drinking 15-35 units a week • Harmful drinkers – regularly drinking 35+ units a week • Fieldwork conducted w/c 16th and 23rd February • Mix of lifestage; pre family and with family

6. Barnsley’s Drinking Culture

7. What Makes Barnsley Different? Barnsley’s Heritage Town Location, Layout & Amenities Women’s Lifestyles “Girls just wanna have fun”

8. Barnsley’s Heritage • Working class area - ex-mining town • Heritage in drinking post work/weekend – strong drinking culture passed on through generations - ‘drinking in excess is the norm’ • High number of pubs/working mans clubs – drinking easily accessible to all • High number of social housing areas = strong sense of community • Many social activities within these areas centre around drinking e.g. BBQs, house parties – particularly during Summer holidays • Drinking is ingrained in Barnsley's heritage and culture “ “ We always go to the club on a Friday, Saturday night and after lunch on a Sunday, we always have My parents went out every weekend like we do, it’s just what you do in Barnsley “ “

9. Location, Layout & Amenities Amenities Location • Many reliant on Barnsley area for entertainment/facilities • General lack of social facilities/amenities & too expensive for some; Metrodome, two screen cinema, park, out of town bowling • Drinking for some is the only source of entertainment/social activity • Although close to the M1/rail links – appears to be isolated – hard for those without own transport/low incomes to reach other towns/cities for social activities/amenities • Many not been further than Meadowhall Town Layout • High number of bars/pubs/clubs within small vicinity = competition = promotions/ cheap drinks • Layout of pubs conducive to ‘pub crawl’ and fast drinking – ‘pub route’/lack of seating in bars “ “ There is nothing to do except drink in Barnsley

10. Women’s Lifestyles Often younger (early 20’s) Tend to be older 25+ Unemployed Part-time employment Reliant on close family – all live nearby More independent/ less reliant on close family Few been outside of Barnsley – socially, shopping etc Generally lack of aspiration/goals – content with life – live week by week and for the weekend! Single Parents In Relationships ‘Barnsley born & bred’ – few moved in/out of Barnsley Typically 1 – 4 children Few have own transport Strong community environment Friends key role in life

11. Girls Just Wanna Have Fun! • Key difference in Barnsley compared to other towns is the large number of single sex groups of friends/family on a night out or socialising in each others homes • Strong sense of close friendships within women in Barnsley – friends are very important and drinking is a key link to this friendship • Going out/staying in with the girls plays a key role in their lives - a means of escapism – from children/pressures at home/money worries • High reliance on parents/family to look after children when socialising – deemed the ‘norm’ to leave children at grandparents overnight • Generally women now more independent than they were 20/30 years ago – most have their own source of income (work, state funding, child support from father) – women have the means to socialise/drink “ “ “ All the girls go out, it’s such a laugh I can’t wait to pack the kids off to their dads on a Friday night, I’ve had them all week it’s my time to have some fun “

12. Women’s Attitudes to Drinking

13. Attitudes to Drinking “ “ All my friends drink the amount I do, we’ve been doing it for years and not had any problems I have no idea what the ideal amount is for women to drink in a week “ “ • Drinking isn't recognised by women as a health or social issue • High levels of drinking deemed the norm “ “ I live for Friday night in town, it’s such a laugh with my mates I don’t think we are any different to women in other towns, all women like a drink don’t they “ “

14. Changes in Attitudes and Behaviour • Some feeling that reasons for drinking have changed as they have got older: • Perception that they can handle their drinks more now and there isn’t the pressure to get drunk…but inevitably they do! • For some having children has meant that they go out less frequently and, therefore, when they do it is more of a planned occasion and an excuse to make the most of their free time Previously Now • Majority of respondents started drinking when underage, (aged 14 -15), with many claiming to drink in licensed premises from this age • Started drinking due to peer pressure/everyone did it • Seen as ‘cool’ to drink • Would go out with ‘aim’ of getting drunk “ “ “ When we were younger we would go out to get drunk, now it’s about having a laugh You’re more vulnerable when you are younger “ • Evident that these women are drinking and going out from a young age as it is a key part of Barnsley’s culture • Marked difference in attitude from when they started drinking, now feel less pressurised and more in control of their drinking

15. Key Reasons for Drinking

16. Reasons For Drinking Emotional Rational • Escapism from everyday life – kids, relationships, work • A way of relaxing • To have a laugh/do things you wouldn’t do if sober • To become more confident socially • Nothing else to do in Barnsley • Habitual/ ingrained in their weekly life “ I like to have a drink after the kids have gone to bed, that’s ‘me’ time when I can just switch off and relax “ “ On a weekday I am mum, on a Friday night I am me. It’s good to get away from the kids and let your hair down “ “ Your just more bubbly and confident, we are all confident anyway but you have more fun when you’ve had a drink, talking to people you probably wouldn’t otherwise “ • Personal circumstances/events which triggered more drinking were identified, such as death of close relative and relationship break ups • Key reasons for drinking can be related to when and where they are drinking….

17. Drinking Behaviour

18. A Typical Week Sunday drinking in town perceived to be older (40+ audience) Some going out locally on a Sunday • Levels of alcohol consumed typically peaking at weekend… • Mix of amounts actually consumed during the week

19. Drinking Patterns: During The Week • Some going out for specific nights in town (tended not to be working): • Tuesday Nights – Gay Night • Good atmosphere and safe • Perceived to be main way for women to meet other women in Barnsley • Cheap! • Wednesday Nights – Student Night • Cheap, lots of promotions and offers • Main mentions were Escapades 3 for 1 and Funny Girls £3 inclusive • Felt to be lots of underage drinkers on this night (from those going out but also echoed by bar staff) • Nights chosen to go out and drink on a week night driven by offers and atmosphere/busyness

20. Drinking Patterns: The Weekend • Most seeing Friday/Saturday as the ‘big’ nights out • Mix of frequency of going out on these nights depending on personal situation • Friday seen to be slightly younger crowd and Saturday a more mix of ages • Night chosen driven by habit • These are the nights where they will consume a large proportion of units • Definite route followed round the bars with the only reason for going in some bars mentioned as being the location • Reinforces the fast drinking culture as drinkers get round them all • Particularly when tempted to go into pubs for ‘quick’ drink/shot (seen as additional to usual) • Typical route consisting of up to 20 bars! “ Every Friday the girls go out, we have done for years, it’s just what we do “ “ You can go mad on a Friday and Saturday night cos you know you don’t have to get up the next morning and take the kids to school. They are just as happy having a jama day as me and they’ll get up and see to themselves “ • Friday/Saturday night drinking fuelled by habit but also desire to let hair down after the week

21. Typical Night Out • 6pm onwards • 8pm onwards • Working men’s club’s/local pubs • 9 -10pm – 3ish(?) • To gain confidence • Social activity • Cost saving • Skipping meals (save room for drink) • Vodka, lager, wine & alcho-pops • Close to home/convenient • Know people/friends/family there • Cheap drinks • ‘Cheeky vimto’s’, shots, lager • See familiar faces • Good atmosphere • Opportunity to have good fun with friends • Really let hair down.. By this point fairly drunk! • Lager, spirits, cocktails, alcopops, shots “ “ “ We usually drink a litre of vodka between the three of us before we go out I would never go out in town without drinking, you feel paranoid, like everyone is looking at you for not drinking “ Drinking At home Drinking locally Into town

22. Choice Of Venue • Key reasons for choice of bar based on: Music played Based on personal choice Route/Habit A typical route followed through town Desire to go where is busy Route/Habit A typical route followed through bars Desire to go where is busy Offers/promotions Appeal for cheap drinks and promotions such as 3 for 1 and all inclusive offers Promotions will influence choice of drink

23. Drinking Patterns: Night Out top of town/ideal starting place (Bar names have been removed) – ‘classier’, known for offers – good environment, more upmarket, nicer quality/branded drinks, trendier - £1 a shot – very cheap! Good for shots – cheap! – good music – cheap bottles (both known for being more suitable for old men, off putting for some) cheap pints – good for a dance! music liked, good for a dance 3 for 2 alcohopop offers good music good music – late night drinks offers/all inclusive – on route on route – on route – cheap drink offers/cocktails – everyone goes open till 6am/cheap!

24. Recognition of Price Clear awareness of offers and which bars offer promotions/low price and on which drinks: (names removed for wider sharing) • 241 Fridays • very cheap shots • - £1 a shot • – generally cheap • – 3 for 2 alchopops • – cheap pints • cheap bottles • – all inclusive offers Wednesday £3/Friday £7 • – offers on a Wednesday (otherwise perceived to be expensive) • – cheap cocktails, 99p any drink

25. Premises Encouraging Hazardous & Harmful Drinking • Encourages excessive consumption of spirits as seen as much greater value for money • £1 extra to make spirits double • The lack of seating and “stand up and drink” culture of Barnsley, encourages quick drinking and moving on from one place to the next • Lack of seating • Pints for 1p when you buy double spirits • Forces high consumption and mixing of drinks • Customers often will drink more when this offer is on and drink spirits they would not usually consume, in an effort to get value for money • All you can drink offers for limited entrance price

26. Drinking Patterns: At Home • Weekend night in with friends as part of TV/film/games night • Weekday with partner/on own • Summer BBQ’s and parties Social activity in which drink is inherently linked Cost saving (vs going out) Avoidance of going out as feel old! (minority) Way of relaxing Routine/done every day Social activity which can also involve kids “ In the summer everyone will just come round to ours, there can be a big group of us and we’ll sit in the garden and drink and the kids all play together “ “ You can have a good night in for £20, whereas going out with a taxi and everything you’d spend at least £60 “ • Most common mentions of alcohol consumed at home were vodka, white wine and lager • Majority tending to keep supplies in, purchased from local off license rather than supermarket (particularly for low affluence, non car owners)

27. Ways And Means Of Getting A Night Out • Money can present a barrier to their usual drinking patterns, but they will overcome this by: • Going for the cheapest drinks • Looking for offers • Downgrading brands • If worst comes to worst sacrificing other things, such as food during the week • Children - Will often take them to their parents or the child's dad to stay to ensure that they can fully relax on the night and the next day or… • Will involve them in the activity eg. Visit local working men’s clubs and pubs as they provide entertainment for the kids or drink at home, particularly during summer months when kids can play outside • Whilst money is an issue for some, there are felt to be ways to make the night ‘cheaper’ without sacrificing the enjoyment

28. Dangers of Drinking and Barriers

29. Awareness Of Dangers • Awareness/knowledge of long term alcohol effects were generally very low • The association with liver damage was mentioned spontaneously but this was only in the vaguest sense • Understanding of units was very low, and those that were aware often incorrectly estimated the recommended amount per week for women • The only danger commonly known was the risk of drinking whilst pregnant. This emphasises the importance of the GP/health services in communicating health messages to this age group • The dangers that were recognised were generally those that would impact in the short term… “ “ “ I have no idea how many units are in a pint of lager I know you shouldn’t drink when pregnant although quite a few of my friends did “

30. Spontaneously Mentioned Dangers Of Drinking Hangover Unwanted pregnancy Being hospitalized Sickness Drink Driving Falling over Loss of memory Crying/losing composure Choking on vomit whilst drunk The dangers spontaneously mentioned were generally those that impacted in the short term Danger to unborn child when pregnant Having to get up in the night for their baby Alcohol related death to friend or family Having to look after their children, the day after drinking

31. Short Term Barriers To Drinking Crying/losing composure Being hospitalized Falling over Not a key barrier - this was often a source of amusement to groups of friends who would laugh about it the following day This can cause embarrassment but is seen as part and parcel of a night out and a normal event This had happened to a number of respondents, though often only prompted a brief period of reduced drinking The women appeared to live very much in the here and now, and focused on these key short term barriers to drinking too much, not the long term effects Loss of memory This was a concern for some and there was admittance to feelings of unease the following day after reflecting on their behaviour

32. Long Term Dangers Won’t Affect Us • When probed, there was limited knowledge of long term dangers • The danger to the liver was commonly cited as a potential consequence of alcohol. When this was mentioned it was often a problem associated with alcoholics and those of middle to older age – ‘not me’ • There was no link made between excessive binge drinking and potential long term health effects • There was no understanding of the link between cancer and excessive alcohol intake • Increased likelihood of obesity through excessive drinking was also not noted, with many respondents not seeing the link between alcohol and calories because the fact the calories were in liquid form rather than being food • Some were aware of the dangers of dependant drinking through family experience but didn’t believe they were drinking to those levels There is a need to educate and communicate that excessive drinking behaviour will not only impact upon their long term future health but it can also have serious health implications in the short term

33. Continued Drinking V Binge Drinking Common perception amongst this group was that it was continued regular drinking that was a danger to health not drinking in excess once/twice a week It is apparent that the message of drinking heavily on one night being potentially harmful is not getting through, most associations with dangerous drinking were all to do with regularity rather than the amount consumed. This is particularly concerning given that the greatest danger to the health of this age group appears to come from 2 to 3 nights of excessive drinking every week, rather than a regular dependency “ “ I drink a lot when I drink but I don’t drink everyday or anything like that Its much worse if you have some everyday than just drinking at the weekend “ “ “ I know that my drinking isn’t a problem because I don’t need a drink every night, like an alcoholic would “

34. Impact Of Campaigns/Drinking Initiatives

35. Awareness of Campaigns/Initiatives? • Most felt TV was the most appropriate mode of communication, however, for this to be successful, shock tactics were deemed necessary to capture attention and promote a strong message • Posters etc in bars were not thought to be working, as at that point women were already out drinking and were unlikely to take notice of safe drinking information within a bar environment • Overall it was felt that education and awareness raising of the dangers of drinking in excess was needed at a young age, as seen with sexual health and smoking education in primary education • Overall there was high awareness of the ‘you wouldn’t start a night like this’ TV adverts • The actual impact of the campaign, however, was mixed most felt that the ‘women's’ night out was aimed at a younger audience, what they did when they were younger, amusing – not taken seriously, therefore, the message lost • The ‘men’s’ night out, was more impactful as more shocking – resulting in death, women could see the dangers being communicated of being out of control when drunk • Few had seen adverts on TV/ in bars etc which included messages regarding units and safe drinking levels

36. What Can Smoking/Drink Driving Campaigns Tell Us? • The usage of graphic depictions of damaged organs on smoking packets • This could be applied to drinking and examples of damage to organs caused by excessive drinking • The use of children in effectively communicating the dangers of drinking • This resonated with many of the respondents and they were upset at recent adverts involving children, e.g. drink driving • Alcohol related adverts could emphasise the consequences that excessive drinking has on those around them, particularly their children • The link between smoking as a danger to health is well known. Widespread understanding of this, however, was a lengthy process and it will clearly take time for similar links to be made between alcohol and health • Many of the respondents smoked yet understood the dangers of smoking, which illustrates that even if a message can get through to people of the dangers of excessive drinking, they will not necessarily reduce their alcohol intake. However, a number of anti-smoking strategies did seem to resonate with respondents about effectively communicating the dangers.

37. Evaluation Of Current Campaigns

38. Weight Based Campaign Evaluation • Content: Although aimed at males, the advert examines the issue of weight gain caused by drinking over recommended unit levels • Reaction: The connection between excessive intake of units and weight gain was often not made by women and most failed to establish this link – seen as amusing! • Overall: This approach was too subtle and although there was some concern to putting on weight from some respondents, most did not understand the effect excessive drinking could have on weight “ That message don’t mean anything to me as I don’t think you can put on much weight by drinking a lot “

39. Unit Based Campaign Evaluation • Content: Advert explaining the number of units in a glass of wine and how regularly exceeding this amount everyday could have serious health implications • Reaction: The reaction was generally negative towards this advert. The respondents did not understand what the advert actually meant for them and their drinking behaviour. A number of respondents did not often drink wine and felt the advert was not aimed at their age “ I don’t measure drinking in units, I don’t know what they mean, what even is a unit? “ • Overall: The lack of understanding about what constitutes a unit and what a unit actually means reduced the impact of this advert. “ If they said you can’t have more than 5 glasses a week then I’d understand it “

40. Warning Of Potential Health Dangers • Content: Warning of the dangers of excessive drinking and how this can impact upon the liver • Reaction: This was deemed too subtle and did communicate the issue strongly enough. The type of alcohol was also deemed as not the type that would be regularly drunk by females in Barnsley. The olive was not always known by the respondents we spoke with • Overall: The advert was not direct enough to get across the message it was trying to with this audience. It needs to be more obvious to grab the audiences attention “ What is that in the glass? A melon? I don’t know what it means “

41. Key Considerations

42. Key Considerations • One of the key barriers to overcome with this target is the apparent lack of awareness that they themselves are drinking to excess • Therefore it is important to raise awareness of excessive levels beyond speaking about units to bridge the knowledge gap between their perceived ‘safe’ levels and their excessive drinking • There is a role in educating from a young age ie. Before children start drinking to warn them of the dangers prior to them getting into the routine of drinking • In order to break this routine behaviour of weekend drinking, there is a need for more facilities and amenities to provide alternative options to drinking. These amenities must be accessible in terms of locality and price in order to tempt these women. Potentially these would be more successful if targeted at parents and children. • These services/amenities must then be well promoted to encourage trial

43. Potential Opportunities To Target

44. School Holidays Are A Time For Drinking And Going Out For many females we spoke with who had children; School holidays = • It appeared that school holidays were a time when mothers would socialise together with children. Due to a lack of finances, lack of transport and often a perceived lack of things to do in Barnsley, mothers would bring their children together so they could occupy each other whilst they would often drink. It was also a time when they could go out in the week and not have to get children ready for school. “ “ We always go out in the week when it’s the school holidays as we can have a lie in or let their dads look after them In the summer holidays, we have BBQ’s everyday and all the mothers drink all day together “ “

45. How School Holidays Can Be Used To Reduced Excessive Drinking • School holidays and in particular the summer holidays are a time when drinking amongst mothers in this target group increases • They need to be provided with alternatives that involve their children and activities away from alcohol. There does appear to be a feeling amongst some mothers of being trapped during the holidays with their children and the only escape is to drink alcohol • They need to be provided with transport to places of interest and cheap/free activities such as swimming that all the family can be involved in - helping to alleviate the present drinking cycle that they find themselves in during the holidays

46. The Role Of The Healthcare Practioners

47. If They Won’t Come To You, Go To Them • Although contact was often made with GP’s on a yearly basis, it appeared that those living in more deprived areas were not as likely to visit on a regular basis. It is thus important that contact is made outside these traditional channels. The following are potential ways to contact; • Text messages sent on a Friday and Saturday night, warning of potential dangers of excessive drinking. Whilst this would not guarantee a reduction in drinking, it would at least get the issue top of mind and provide an area of discussion for friends • Some form of on-street presence from health services during weekend nights out, to give advice about drinking and to hand out information. Again, whilst not working for all, this would also highlight the issues. Presently it is not always understood in this group that there are health dangers associated with drinking, so any way awareness can be raised will help

48. The Role Of Licensed Premises

49. How Licensed Premises Can Help Offering cheaper soft drinks- Currently non-alcohol drinks in Barnsley can often be more expensive than alcohol and poorly presented, offering no incentive to buy Offering Food- This could serve to alleviate drinking without consuming any food and increase dwell time in pubs and bars. “ We go in and we just buy as many as we can hold and drink them then have a dance then go and get some more.. You can drink as much as you want Reduce all you can drink promotions – It is clear that these promotions are encouraging binge drinking and drinkers themselves admit that it encourages them to drink more than they would usually Promoting Sensible Drinking “ Encouraging Families- Barnsley town centre appears a no go area for families after 6pm, with bars offering only drink. Families need to be encouraged that there are pubs that offer food and are suitable to bring their children Compulsory Bar Scheme- Bars need to take a greater responsibility for their actions and the consequences of their drink prices. A scheme for bars to adhere to a common code of conduct would help to reduce a lot of binging issues

50. Messages To Communicate