Young people, alcohol, and designer drinks: quantitative and qualitative studyBMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7078.414 (Published 08 February 1997) Cite this as: BMJ 1997;314:414
- Kirsty Hughes, research officera,
- Anne Marie MacKintosh, research officera,
- Gerard Hastings, directora,
- Colin Wheeler, senior lecturerb,
- Jonathan Watson, specialist development and evaluation officer (substance misuse)c,
- James Inglis, consultant in public health medicine/director of health informationc
- a Centre for Social Marketing, University of Strathclyde Stenhouse Building, Glasgow G4 0RQ
- b Department of Marketing, University of Strathclyde Stenhouse Building, Glasgow G4 0RQ
- c Health Education Board for Scotland Woodburn House Edinburgh EH10 4SG
- Correspondence to: Professor Hastings
- Accepted 29 November 1996
Objective: To examine the appeal of “designer drinks” to young people.
Design: Qualitative and quantitative research comprising group discussions and questionnaire led interviews with young people accompanied by a self completion questionnaire.
Settings: Argyll and Clyde Health Board area west Scotland.
Subjects: Eight groups aged 12-17 years; 824 aged 12-17 recruited by multistage cluster probability sample from the community health index.
Results: Young people were familiar with designer drinks especially MD 20/20 and leading brands of strong white cider. Attitudes towards these drinks varied quite distinctly with age clearly reflecting their attitudes towards and motivations for drinking in general. The brand imagery of designer drinks–in contrast with that of more mainstream drinks–matched many 14 and 15 year olds' perceptions and expectations of drinking. Popularity of designer drinks peaked between the ages of 13 and 16 while more conventional drinks showed a consistent increase in popularity with age. Consumption of designer drinks tended to be in less controlled circumstances and was associated with heavier alcohol intake and greater drunkenness.
Conclusions: Designer drinks are a cause for concern. They appeal to young people often more so than conventional drinks and are particularly attractive to 14-16 year olds. Consumption of designer drinks is also associated with drinking in less controlled environments heavier drinking and greater drunkenness. There is a need for policy debate to assess the desirability of these drinks and the extent to which further controls on their marketing are required.
There has been concern that designer drinks might have a particular appeal for teenagers and be legitimising under age drinking
Young people aged 14 and 15 years want drinks to be relatively strong inexpensive and pleasant tasting
Designer drinks are seen by 14 and 15 year olds to have these qualities and as a result are particularly appealing
By contrast for 16 and 17 year olds many designer drinks signal under age drinking and immaturity
Consumption of designer drinks is associated with heavier alcohol consumption drinking in less controlled environments and greater drunkenness
In recent years a new range of fortified wines such as MD 20/20 or “Mad Dog” and strong white ciders such as White Lightning and Ice Dragon has emerged: so called “designer drinks.” The fortified wines have sweet fruity flavours (for example cherry banana and strawberry) a concentration of alcohol by volume of between 13% and 21% and in 1994 sales of at least £40m.1 The white ciders are according to industry sources filtered to remove colour and some flavours to make them more appealing to younger consumers2 3 and usually have an alcohol by volume of between 8% and 9%. The appeal of these drinks to people under the age of 18 has been the focus of mounting public concern.4 5
We reviewed the literature on young people's drinking to assess the main health concerns that have been expressed and the impact that designer drinks are claimed to have on these. We also describe the first major primary research that has been done to test these claims.
Adolescent drinking behaviour
Drinking alcohol in adolescence is a normative behaviour. Most people have their first taste of alcohol around the age of 10 (although Casswell et al report it to be at age 76) and are introduced to it by their parents usually to celebrate a special occasion.7 8 9 By 16 about 90% have tasted alcohol.10 11 12 13 Alcohol is thought to be important in adolescent development and socialisation as it helps young people to integrate with their peers and to negotiate their passage into the adult world.14 15
Although most adolescents drink moderately and sensibly 9 16 17 many however have experience of intoxication 10 and a considerable minority drink heavily. Adolescent intoxication is associated (although not necessarily causally linked) with the occurrence of accidents certain crimes and risky behaviour including unsafe sexual encounters.18 19 20 Heavy drinking while not a predictor of alcohol problems in later life 12 is associated with the use of illicit substances9 21 and poor performance at school.22
Under age drinking has not increased in recent years 23 24 but the quantity of alcohol being consumed on a typical drinking occasion is increasing.25 In addition NHS information and statistics data (table 1) show a significant increase in the number of discharges for “non-dependent abuse of alcohol” among 11 to 17 year olds between 1990 and 1995 suggesting an increase in the occurrence of intoxication in young people. It is also clear that the amount of alcohol consumed and the frequency of drinking by teenagers increases with age 26 as does the tendency for drinking to move out of the parental home and into more public places where it is often done in the company of friends.10 27 Furthermore these phenomena are correlated.28
The impact of designer drinks on this picture is uncertain but concern has been expressed that they may be reinforcing the tendency to drink more on single occasions 25 with concomitant increases in the risks associated with intoxication. There is also concern that these drinks might have a particular appeal for teenagers4 5 29 and that the marketing of them is legitimising an illicit activity.
Subjects and methods
We examined whether or not designer drinks appeal to young people; the nature of any such appeal and how it correlates with age; and whether or not the consumption of designer drinks is associated with greater alcohol intake per drinking session or greater loss of control or both.
We conducted both qualitative and quantitative research. The qualitative research comprised focus group discussions. This procedure entails bringing together six to eight respondents who are carefully selected in social demographic terms in an informal setting under the direction of a skilled moderator to discuss the subject of interest in depth. The method has been more fully described in a previous article published in this journal.30 The quantitative research used conventional methods based on questionnaires to collect statistically reliable data from a large representative sample of the population.
Fifty six children and young adults were interviewed in eight groups. These varied in terms of age (12-13; 14-15; 16-17 years) sex social class (A B C1 and C2 D E) and drinking behaviour (tried/not tried drinking) (table 2). Subjects were recruited door to door by professional interviewers and invited to attend discussions about their spare time activities at a prearranged venue. Respondents were paid a standard fee for attending and fieldwork took place in the west of Scotland during the summer of 1995. Each discussion lasted about two hours during which respondents were shown a wide range of alcohol products and related promotional material. They were encouraged to talk openly and informally about their drinking and their thoughts about the different products. Projective questioning procedures were used to tap emotional responses. All the discussions were tape recorded and then transcribed.
A multistage cluster probability sample of 12-17 year olds was drawn from the community health index (a listing of names and addresses of people registered with a general practitioner within the health board area) for Argyll and Clyde Health Board. The initial sample frame comprised a list of all postcode sectors but those covering the most rural parts (that is islands and sectors with fewer than 500 households) were excluded for reasons of cost. A random sample of 30 postcode sectors was then drawn stratified by district and Carstairs score31 (a measure of affluence or deprivation within an area) across the board. Within each of the 30 postcode sectors 40 people aged 12-17 years inclusive were selected from the index by using a random procedure stratified by age and sex.
A total sample of 824 respondents was achieved equivalent to a response rate of 78% after allowance for ineligible contacts. The achieved sample under-represented males and similarly under-represented 16 and 17 year olds and was therefore reweighted with census data.
The qualitative research informed the development of a two part questionnaire that then underwent detailed piloting. The first part of the questionnaire was completed in a face to face interview; the second seeking more sensitive information was completed by the respondent in confidence.
Most of the young people were familiar with designer drinks especially MD 20/20 and the leading brands of strong white cider. Their attitudes towards them varied quite distinctly with age clearly reflecting their attitudes towards and motivations for drinking in general.
“You can't remember what you did…but you can laugh at it.”
“Everyone tells you what you've done and it's a class night.”
(Girls; 14 to 15; C2 D E; drinkers; Paisley)
“I'd go out for ‘a pint’…just a pint and I wouldn't get drunk off it. But I still go out and get leathered sometimes.”
“If you down Mad Dog (MD 20/20) dead quick you get steaming then you throw up but if you're in pubs you can take your time. You drink to socialise as well.”
(Boys; 16 to 17; A B C1; drinkers; Port Glasgow)
Children aged 12 and 13 years used alcohol to experience the adult world and to satisfy their curiosity. It also enabled many of them to socialise and to say that they had tried drinking. Those aged 14 and 15 were testing out their own limits and having fun. They enjoyed losing control every once in a while. For them drinking to get drunk was important as was sharing the experience with others. Those aged 16 and 17 were anxious to show their maturity and experience with alcohol drinking more like adults.
The drinks consumed matched these attitudes and motivations: 12 and 13 year olds experimented with any available drinks; 14 and 15 year olds consumed a wider range of drinks and wanted these to be relatively strong inexpensive and pleasant tasting (typically sweet)–all characteristics of designer drinks. On an emotional level they enjoyed drinking for fun getting drunk and losing control–again values offered by designer drinks. The characteristics and brand imagery of designer drinks in contrast with those of more mainstream products were thought to meet these requirements admirably.
“Because it's called Mad Dog (MD 20/20) you think you'll go mad.”
(Boy; 14 to 15; C2 D E; drinkers; Paisley)
“It (TNT–a brand of white cider) makes you think about blowing your mind.”
(Girl; 14 to 15; C2 D E; drinker; Paisley)
“It's (TNT) a pure novelty…that's blatantly made to get (the) young. Nobody over 18 would ever dream of drinking that kind of thing.”
“You'd look stupid if you went to a nightclub and sat with a bottle of Mad Dog (MD 20/20) ‘cos everybody is sitting drinking pints and stuff.”
(Boys; 16 to 17; A B C1; drinkers; Port Glasgow)
Young adults aged 16 and 17 years had started to establish tastes for more “mature” drinks including a wider range of spirits and bottled beers. They went to pubs and clubs were keen to establish relationships with the opposite sex and wanted to appear adult and sophisticated. For them many designer drinks signalled immaturity and the under age drinker and were rejected as a result.
The quantitative research showed that over two thirds (577/824; 70%) of 12-17 year olds drank alcohol and that of these more than half (295/577; 51%) had tried MD 20/20 and more than two fifths (244/577; 42%) had tried one of four brands of strong cider. As with the qualitative findings however there were considerable variations with age.
The frequency of drinking amount consumed and the extent of drunkenness increased with age (table 3). For example while only 2% of 12 year olds drank every week 4% of 12 year old drinkers had consumed 15 units or more on their last drinking occasion and 19% of those who had drunk in the previous 6 months claimed to have been really drunk. The equivalent figures for 17 year olds were 57% 26% and 69% respectively. The drinking environment also varied with age with 14-15 year olds drinking mainly in the open air (table 4).
Turning specifically to designer drinks we looked in detail at how the subjects perceived the market leader MD 20/20. The 577 young drinkers perceived it to have several appealing attributes including a sweet taste (482) pleasant taste (336) affordability (247) and being well known (410). It was also thought to be popular with people of their age (384); unpopular with people of their parents' age (420); a drink for the inexperienced drinker (261) and easy to drink outside (304). It scored better on many of these attributes than conventional beer (for example Budweiser; table 5).
When we gave the subjects a hypothetical choice of drinks (table 6) including a range of soft energy and alcoholic drinks the appeal of MD 20/20 was strongest among 13-15 year old drinkers but declined among 16-17 year olds. In contrast beer consistently increased in popularity with age.
Turning to actual consumption beer and spirits seemed to be the main drinks consumed although designer drinks were also popular with all 12-17 year olds. The popularity of designer drinks however peaked between the ages of 13 and 16. In contrast more conventional drinks such as spirits showed a consistent increase in popularity with age (table 7). For example strong white ciders were more popular among 13-14 year olds than other age groups with almost a quarter having consumed these drinks but much weaker conventional ciders such as Strongbow or Woodpecker (alcohol by volume 4.5-4%) showed no variation in consumption by age. Similarly the appeal of the recent arrival MD 20/20 decreased after age 16 but the appeal of the more traditional Buckfast did not.
Designer drinks tended to be consumed in less controlled circumstances. For example while just over a quarter (27%) of all drinkers had had their last drink in the open air this figure increased to over half (53%) for those who had drunk strong white cider and 65% for those who had drunk fortified wines (table 8).
Finally the survey showed that an interest in designer drinks was associated with heavier alcohol consumption and greater loss of control. Strong cider and fortified or tonic wines accounted for the highest alcohol consumption with an average intake on one drinking occasion of 6.8 units and 6.0 units respectively from these drinks alone. By contrast the lowest average intake was observed for conventional wines with a mean consumption of 2.1 units. Similarly those who had drunk strong cider and fortified wines on their last occasion of drinking reported greater sociability greater loss of control and greater aggressiveness or antisocial behaviour from their general drinking than drinkers who had not consumed such drinks.
This research provides the first systematic evidence that designer drinks–a new range of fortified fruit wines and strong white ciders–are a cause for concern. They do seem to have both tangible and emotional qualities that make them appealing to young people often more so than conventional drinks. They are also being consumed by many youngsters. Furthermore this appeal and the level of consumption seems to peak before adulthood suggesting that these drinks are particularly attractive to 14-16 year olds. It is also clear that their consumption is associated with drinking in a less controlled environment heavier drinking and greater drunkenness.
There is a need for a thorough policy debate particularly concerning the extent to which these products should be freely marketed and whether further controls are required.
We thank Argyll and Clyde Health Board for providing access to the community health index and the interviewers and young people for collecting and providing the data. Particular thanks also go to Susan Anderson of the Centre for Social Marketing who coordinated the field force.
Funding: Health Education Board for Scotland.
Conflict of interest: None.