Pssst! Be Alcohol Aware
In 2007, Liverpool PCT and its key partners launched an innovative social marketing campaign that aimed to encourage students to behave responsibly towards alcohol consumption.
Based on Social Norms Theory and the Social Learning Model, a ‘Chill Out Cabin’ was opened in the city centre on nights popular with students. Visitors were offered free mocktails and could take part in a range of entertainment. The cabin provided an alternative to alcohol – giving visitors time to relax and consider how much they had been drinking.
This was supported by health and safety messages sent by Bluetooth, messages projected onto buildings in high-density drinking areas and promotion of the night bus service.
- 3,000 visitors to the Chill Out Cabin, over 19 nights
- 84 per cent of visitors felt it had an impact on their own drinking behaviours
- 41 per cent of visitors said they drank less that evening following their visit to the cabin
- 70 per cent stated they were likely to look for other non-alcoholic options in the future
- Three months after the campaign, 60 per cent of cabin visitors felt that the cabin had some impact on their drinking behaviours
Binge drinking in Liverpool was estimated as the highest in England in 2007, with an estimated 28 per cent of Liverpudlians being binge drinkers (defined as drinking 8 or more units in a day for men and 6 or more units for women). In addition, crime attributed to alcohol in Liverpool was amongst the highest in the North West. The effects of alcohol misuse cost the NHS in the North West an average £400 million per annum, and in 2007 70 per cent of Accident and Emergency (A&E) admissions on some weekends in Liverpool were alcohol related.
In light of the growing concern about alcohol misuse in Liverpool, a half-day seminar with the Liverpool Partnership Group was run in September 2005 to increase understanding of the impact of alcohol-related harm in the City, agree key common actions to address this, and develop a social marketing campaign to raise awareness of the dangers of alcohol misuse.
In December 2005, Citysafe partners (Liverpool’s Crime and Disorder Reduction Partnership) ran a pre-Christmas alcohol misuse awareness campaign entitled ‘Respect Alcohol, Respect Yourself’. Following this campaign, Liverpool City Council and the Liverpool Primary Care Trust (PCT) considered how they could work together to develop a comprehensive social marketing campaign to tackle the issue of alcohol misuse, rather than run competing campaigns.
The new proposal was that the strategic partners of Citysafe (Liverpool City Council, Liverpool PCT, Merseyside Police, and Merseyside Fire and Rescue Service) would work together to devise an overarching alcohol brand to unify all alcohol-related campaign work.
From the concerted efforts of all partners, the ‘Pssst! Be Alcohol Aware’ identity was established and has replaced the range of competing messages, services and brands that previously existed. The aims of the overarching alcohol brand are to:
- Create a joined-up approach to a common issue
- Provide consistent messaging
- Prevent duplication of work
- Instil common brand emphasis, which is less confusing for the audience
- Pool resources for maximum impact
This case study focuses on the second campaign run under the Pssst! brand during the winter of 2007 to 2008, which built on the launch of the brand and the first campaign in November 2006 involving work with Bar Entertainment and Dance Association (BEDA) and local pubs and clubs.
Segmentation was carried out according to two variables:
- Age – 18- to 35-year-olds were identified as a key segment contributing to Liverpool’s rates of binge drinking and alcohol-related crime – of this age group, 40 per cent was made up of the student population. Students aged 18 to 35 were therefore defined as the primary target audience for the first Pssst! campaign
- Geographical area – Areas with the highest density of drinkers and the most incidents involving alcohol were pinpointed using police and Trauma and Injury Intelligence Group (TIIG) data
Objectives and behavioural goals
The overarching objectives of the Pssst! campaign were to:
- Raise awareness of key health and safety messages relating to alcohol, and to influence behaviours as a result
- Reduce alcohol-related crime and the number of A&E admissions
- Provide a real, non-alcoholic alternative to students on a night out
The behavioural goal was for students to adopt healthy and safe drinking behaviours, including:
- Eating a substantial meal before drinking
- Alternating alcoholic drinks with non-alcoholic ones
- Drinking less
- Planning how to get home in advance
- Travelling home in groups
Secondary and primary research
The scoping stage consisted of a mix of secondary and primary research. The secondary research drew on learning from previous campaigns targeting 18- to 35-year-olds in Liverpool. This was supplemented by primary research in the form of focus groups with students aged 18 to 21. These aimed to explore their attitudes and behaviour around alcohol and drinking.
Students acknowledge the negative consequences of excessive drinking (such as hangovers, vomiting, crime and embarrassing behaviour). However, they ignore these factors because they are perceived to be outweighed by social benefits, including:
- Social confidence
- Group bonding
- A sense of freedom
Amongst students, these perceived benefits are enhanced by beliefs that drinking is an integral part of the university experience and that binge drinking is the social norm during university years. In addition:
- Students feel university is their last opportunity to ignore the costs of alcohol and get really drunk before the responsibility of a career and ‘real life’ kick in
- Students do not recognise their drinking as problematic, because their perceptions are relative to those around them (i.e. ‘there’s always someone who’s drunker than I am’)
- Perceptions that ‘everyone does it’ and ‘the best nights out are when we’ve been drinking’ support the belief that drinking to excess is normative behaviour and that there is no alternative
Quotes from focus groups include:
“If you’re going to have a good night, you’re going to have a drink.” (Female focus group participant)
“Everyone picks on you if you’re not drinking, forcing you to have a drink.” (Male focus group participant)
“I definitely do that, if she’s not as drunk as me, I buy her a drink and make her drink it.” (Female focus group participant)
“A pint of beer is probably cheaper than a coke.” (Male focus group participant)
“I drink until my money runs out.” (Male focus group participant)
“You drink loads without even thinking about it, then you come home and might have a bit more.” (Female focus group participant)
“I’ve found one place that gives you a ‘quad vod’ for £3.10. You literally go there and have two. You only need another drink when you’re out. You’ve already had a bottle of wine or something before you’ve gone out.” (Female focus group participant)
“Sometimes you don’t eat at all to have a big night.” (Male focus group participant)
“We’ve been doing this since we were 15 with our mates, just out of boredom. You might have a wee bit of money, so you go out and buy some alcohol.” (Male focus group participant)
“There’s not much choice in Liverpool. There’s an absolute ton of bars and clubs, but not much else.” (Male focus group participant)
The research identified the following sources of competition for the campaign.
- Other alcohol-related campaigns – For many years, a range of Liverpool organisations have launched public awareness campaigns aimed at tackling alcohol consumption. The public has been bombarded with a variety of competing alcohol-related messages, due to the volume of different campaigns launched simultaneously
- University events encouraging drinking – There are approximately 50,000 students in Liverpool. Drinking is a large part of their social life and there are a number of student nights held across the city throughout the week
Most social situations targeting students encourage binge drinking and new students are ‘initiated’ by activities that involve alcohol consumption (like Freshers’ Week, tours of the city’s pubs and drinking events designed as ice-breakers for new students). Research was carried out during Freshers’ Week to find out about students’ experiences during this week and gauge what other types of promotional material the campaign would be competing with. In addition, the health promotions team explored whether the Students’ Union had alcohol policies and if they were being adhered to.
The research identified that students were binge drinking because it was perceived to be the accepted social norm at university. This perception is created and reinforced by the media, drinks promotions and social interaction amongst students (e.g. sharing ‘war stories’ about the ‘night before’). Most social situations targeting students encourage binge drinking and the students felt that there was no real alternative. With this in mind, research was conducted to identify behavioural theories which could support the development of appropriate interventions.
- Social Norms Theory – This theory states that people’s behaviour is strongly influenced by their perception of how other members of their social group behave and their level of desire for conformity with the group. People often exaggerate or misperceive the behaviour of their peers. For example, if individuals perceive unhealthy behaviour to be the norm in their social group, they are more likely to engage in that type of behaviour. Therefore, if a group can be educated about healthy behaviours that are the norm among their peers, behaviour can be affected in a positive manner.
- Social Learning Model – This model looks at how people learn by watching others: letting someone else try out the behaviour; seeing if it looks sensible; rehearsing it in their own minds; and then trying it for themselves. In addition, people are most likely to imitate behaviour if they see it leading to positive outcomes in another person. Individuals learn most from people they identify with, such as parents, peers and celebrities. Based on this, champions or role models can be used to encourage imitation of positive learned behaviour
The Pssst! umbrella brand was created to unify the multiple, competing alcohol-misuse campaigns being conducted by different strategic partners in the city. The campaign also sought to address the competition of university events encouraging binge drinking. To mitigate this culture, Citysafe spent a lot of time negotiating support from Liverpool John Moores University and Liverpool University. Subsequently Pssst! gained a strong presence at University Freshers’ Fairs to highlight alternatives to binge drinking and introduce students to the Pssst! brand. The campaign also encouraged students to show how ‘There’s more to student life than Getting Pssst!’ through film, photography, Facebook, YouTube and the student radio.
During the development stage, further focus groups were conducted to test the concepts with students to ensure they were relevant to the target audience and the communication channels and tone of voice were appropriate.
Chill Out Cabin
A ‘Chill Out Cabin' was opened in the city centre on nights popular with students. The cabin offered a non-alcoholic experience within the students’ usual drinking environment. Visitors were offered mocktails (non-alcoholic cocktails) to experience the benefits of alternating alcoholic drinks with non-alcoholic ones, and could listen to music, play games and enjoy massages and beauty treatments to experience alternative activities.
The cabin offered visitors the opportunity to sit down and relax away from alcohol – giving visitors a real alternative to binge drinking and time to think about how much they had already drunk and how much they planned to drink following their visit.
“What we decided we’d do is utilise the space in between venues, as this is often where alcohol-related problems happen. People often got into fights or trouble between going from bar to bar. We also know lots of people were frontloading – drinking a lot at home and then coming into town drinking. We wanted to create something outside the bars to actually get their attention and act as an intervention.” (Emma Page, Senior Social Marketing Executive)
Based on Social Norms Theory and Social Learning Theory, the Chill Out Cabin created an environment in which students were watching their peers enjoying activities that did not involve alcohol. The cabin encouraged group participation, interaction and the chance to try something new alongside peers, resulting in social learning.
Alcohol ‘wheels’ were used to illustrate alcohol units by type of drink so students could see how much they had drunk compared to what is ‘healthy’. Interaction with staff, who were from a similar age group, and other visitors allowed students to discuss their drinking habits in an informal manner. Such discussions helped break down social norms, where visitors may have found that other students were not drinking as much as they perceived.
To convey health messages, a broadcast and print media advertising campaign was run, featuring advertising on buses and phone kiosks, building projections and Bluetooth messages with healthy drinking tips.
“Telling them what was going to happen with them in 40 years time wasn’t going to resonate with them. It needed to be something which was a lot more immediate. We sent out the Bluetooth messages in really busy drinking areas in Liverpool. They were getting tips, like make sure you drink some water, so it wasn’t about what they could do to be healthier in 40 years time, it was about what would help them feel better that evening.” (Emma Page, Senior Social Marketing Executive)
The campaign focused not on taking away the benefits of drinking identified during the scoping phase (namely social confidence, group bonding and a sense of freedom), but on exchanging them for other benefits. Pssst! did not say ‘don’t drink’, but instead aimed to provide realistic and attractive alternatives to excessive alcohol consumption. For instance, the Chill Out Cabin offered students the opportunity to hang out with mates, drink mocktails, enjoy massages, music and dancing, providing clear and enjoyable alternatives to alcohol. The campaign also gave advice on how to drink responsibly – not necessarily by abstaining, but by eating a full meal before going out; by alternating alcoholic with non-alcoholic beverages; and by drinking plenty of water.
Pssst! also promoted the other benefits of sensible alcohol consumption, including:
- A more relaxed evening and less of a hangover
- Less likelihood of suffering from the unattractive physical effects of alcohol (like bloodshot eyes, bad breath and red face)
- Greater likelihood of arriving home earlier and safer, having a more relaxing sleep and a more enjoyable day after
Pssst! did not want to exploit scare mongering, but an important element of the campaign was to highlight the real risks of alcohol consumption. This meant ensuring messages reflected immediate impacts, which the audience could relate to. For instance:
- Throwing up is the first sign of alcohol poisoning and needs to be taken seriously
- Alcohol is the leading cause of A&E admissions on a weekend
Pssst! worked to dismiss the belief that alcohol provides harmless fun, empowering drinkers to weigh up the real costs of excessive drinking and to evaluate for themselves whether the potential risks outweigh the perceived benefits. By doing so, the campaign used the same risk-based structure that underpinned the Department of Health’s National Social Marketing Strategy for Alcohol.
Following the campaign launch in winter 2007, an opportunity for partnering with the bus company Arriva arose, when it was identified that they ran the night bus students frequently used after a night out drinking. Subsequently information was provided about the night bus service through the campaign and students were encouraged to plan how to get home safely in advance. Arriva assisted with the campaign by promoting key messages on their night buses and through their loading team, who ensured problems did not arise in queues for the buses.
“Arriva we didn’t initially plan, it was an opportunity which came up. We were looking at the safety side of things and we found out that they offered this night bus which ran, and students use buses a lot so it tied in really well to the campaign. So we got in touch with their area manager to ask if we could work together. We gave information about the night bus to the visitors of the cabin. Arriva briefed their staff who load their buses to promote the cabin and the night bus service to young people in the city centre. They also put information on their buses.” (Emma Page, Senior Social Marketing Executive)
The Chill Out Cabin was highly successful and popular, with many of its visitors commenting that there should be more of them and that it should stay open later. It successfully enabled students to take a break from the social norm of drinking heavily on a night out and to contemplate just how much they would normally drink. It was also a good opportunity to ask if they had booked a taxi home or knew about the night bus, so they could make plans to get home safely before they drank too much. Only one problem arose with the cabin, due to a minor location problem which was soon rectified. The cabin toured popular student drinking spots for 19 nights over the winter period of 2008 to 2009.
In general, the supporting communication materials worked very well, particularly the projections on bars in busy drinking areas. However, the Bluetooth initiative was felt to be less successful.
“I think the thing that had less of an impact was the Bluetooth. That didn’t work as well as people had to have their phones turned on and because they were drinking they might not read them.” (Emma Page, Senior Social Marketing Executive)
The impact of the campaign was evaluated by measuring awareness, attitudes and behaviours of the target audience.
Awareness and attitudes
- Awareness of Pssst! brand and awareness of other alcohol campaigns
- Knowledge of units
- Attitudes towards drinking (based on insights from the primary research)
- Units consumed
- Activities taken part in (such as going to parties including alcohol, going on a night out without alcohol, taking part in a hobby and taking part in exercise)
- Frequency of taking precautions (such as going home with friends, drinking non-alcoholic drinks, drinking lower-strength drinks and eating before going out)
- Occurrence (due to alcohol) in the last two months of: being sick; being involved in a fight; visiting A&E or receiving medical help; or being arrested, cautioned or a victim of crime
Pssst! was evaluated by an independent research agency at two stages: during the campaign, and three months later. At both stages researchers spoke to cabin visitors and a general sample of the student population as follows:
- 300 street interviews with the general student population during and after the intervention
- 100 interviews were carried out in the Chill Out Cabin, followed by in-depth interviews after the end of the campaign
This allowed researchers to establish a baseline for each group and to measure behavioural outcomes over a period of time which could be directly linked to the cabin. Focus groups were also carried out following the campaign to evaluate the campaign in more depth.
The Chill Out Cabin received over 3,000 visitors across the 19 nights it was open and served over 2,500 mocktails. Of 100 interview respondents:
- 99 per cent of visitors felt the cabin was an appropriate way to promote sensible drinking
- 84 per cent felt it had an impact on their own drinking behaviours
- 41 per cent of visitors said they drank less that evening following their visit to the cabin
- 70 per cent stated that they were likely to look for other non-alcoholic options in the future
Research three months after the campaign found positive trends in the drinking behaviours of cabin visitors compared to the general student population:
- 60 per cent of cabin visitors still felt that the cabin had some impact on their drinking behaviours and stated they would like to see the cabin open more frequently and in more locations across the city centre
- Trends suggest that cabin visitors were drinking slightly less and on fewer occasions than the general student population
Liverpool is no longer the binge drinking capital of the North West, according to research released by health watchdog the North West Public Health Observatory. The December 2010 league tables for the North West show that the top spot Liverpool once held is now occupied by Manchester, while Liverpool sits in third position. The improvements indicate that the Pssst! campaign to tackle the city’s alcohol-related problems is starting to take effect.
Results and learning from the winter 2007 to 2008 campaign were shared with the Pssst! steering group and the partner organisations.
As part of its Alcohol Harm Reduction Strategy 2007 to 2010, Liverpool PCT committed to continue tackling alcohol misuse in the city, through initiatives including: education in schools; intervention in the workplace; improved access to treatment; and raising awareness of the dangers of alcohol misuse.
The Pssst! brand has continued to be used for further seasonal alcohol harm social marketing projects in Liverpool.
Winter 2008 to 2009
An awareness campaign was delivered, targeting 18- to 35-year-old city drinkers and highlighting the message of moderation during the pre-Christmas period.
Research showed that following previous campaigns, the target audience wanted ‘real life’ and ‘shocking’ imagery.
Interventions included: six sheet bus stop posters between L1 and L3, mapped using police and high traffic data; ATMs throughout the city centre displayed campaign messages to people as they withdrew cash for their nights out; beer mats, urinal and mirror stickers; washroom posters; bar screen media; ‘electro jackets’; and Facebook advertising.
- Seven per cent spontaneous and 38 per cent prompted recall of Pssst! Brand
- Website traffic increased threefold during the campaign
- Fifty-five per cent believed the adverts to be ‘quite to very effective’ in informing people about the dangers of alcohol
Winter 2009 to 2010
A campaign was delivered targeting 18- to 25-year-old city female drinkers and highlighting the message of personal safety and the increased risk of vulnerability to sexual assault when drunk.
Research showed that messages of female vulnerability had the most impact on the target audience and that at the time there was a lot of media focus on the dangers of being at risk of sexual assault when drunk.
Interventions included: Information cards handed out to girls going home (for example on night buses and at marshalled taxi ranks); bar posters; branded pac-a-macs (lightweight anoraks) handed out in the evening; radio advertising on Juice FM; and joint working with British Transport Police to distribute branded personal alarms at Lime Street and central stations.
- Four in 5 respondents had seen or heard campaigns on the danger of alcohol
- Forty-one per cent recalled (unprompted and prompted) the Pssst! campaign
- Seventy-nine per cent felt the visuals were very effective as a means of informing on the dangers
- Eighty-one per cent of under 25-year-olds who came into the city centre to socialise were aware of the Pssst! brand
Students were very receptive to the campaign. What worked particularly well was that they were not being told about units when they were sober. Instead, many of them were approached after they had already had a couple of drinks and were planning to drink more. Discovering that they were already over the recommended total units came as a big shock and made them reconsider drinking more.
“We had alcohol wheels which showed different units in different drinks. If we’d given them those in the daytime people probably wouldn’t be interested in it, but when we used them they’d already been drinking before they came out, so it was something they were more receptive to. They could actually see how much they had already drank that evening and were shocked to see that they were already over their units and had been planning to continue drinking. It really made people stop and review their drinking that evening.” (Emma Page, Senior Social Marketing Executive)
Students said that they loved having something else to do besides drinking and wanted more cabins to be made available throughout the city. It would have been good to capitalise on the interest generated by the cabin and have it open for longer and later. However this intervention was quite expensive (especially with mocktails given out for free) and so was not sustainable. Subsequently in the future it would be best to work with existing services, such as ‘pop up shops’ rather than developing something from scratch, so that initiatives can be sustained for longer periods of time.
By working under an umbrella brand with multiple partners, Pssst! has been able to concentrate resources, focus campaigns and ensure that the residents of Liverpool are not bombarded by messages that become background noise.