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How do the four Ps of marketing contribute to initiation, risky use and harmful use of alcohol, tobacco and gambling? A synthesis of evidence Martine Stead, Kathryn Angus, Richard Purves With contributions from Juriaan Witteman, Wim van Dalen, Franca Beccaria , Enrico Petrilli, Peppino Ortoleva, Giuliana Galvagno, Ben Baumberg. AIMS To explore: • How does marketing encourage or facilitate addiction-related behaviours – from initiation through risky use, harmful use to cessation and relapse? • What are the mechanisms through which marketing exerts an influence? • What is the role of the marketing ‘four Ps’ (product, place, price and promotion)? METHODS ‘Realist review’ – an approach to evidence review which focuses on understanding the pathways, processes and mechanisms through which effects are created. Search and synthesis of a diverse range of evidence including: • Studies of effects of marketing on behaviour • Studies of addiction pathways and ‘careers’ • Theories and models of addiction, consumer behaviour and marketing • Analysis of marketing strategies • Marketers speaking in their own words (industry presentations, internal advertising documents, retailer/trade journals) PROMOTION PLACE Includes all forms of advertising, sponsorship, social media Includes all settings where products can be accessed including online; distribution; location and density; accessibility; interior design. • Availability and access are recognised determinants of addiction-related behaviours • Density and location of alcohol and gambling outlets contribute to uptake, regular use and harmful use • Exposure to tobacco at point of sale increases likelihood of uptake and discourages cessation • Advertising exposure independently increases drinking & smoking uptake • Mere exposure to advertising and other marketing cues can trigger cravings and use in heavy and dependent users Examples of promotion strategies: • Products are associated with desired benefits through advertising and branding • Social norms are both harnessed and shaped by brand communications • Behaviour is reinforced and dissonance is reduced by constantly reminding consumers of benefits Examples of place strategies: • Distribution channels are managed so that products are widely available in places convenient to consumers (including online) • Products are carefully placed to maximise visibility, to prompt purchase, to condition and reinforce, and to influence norms PRICE PRODUCT Includes pricing strategy, pricemarking, promotions, low cost variants Includes new product development; product range; packaging. • ‘Entry’ products are designed to be appealing to new/young users • Product ranges are designed to ‘graduate’ consumers from easy-to-use entry products to stronger variants. • Heavy/harmful use is facilitated by products which encourage repeated use • A consistent relationship between price and purchase/consumption Examples of price strategies: • ‘Free’ trials (eg. online gambling) entice new users • Low price products (eg. 10-pack cigs, cheap ciders) are affordable to young users; cheap cigs are used by low income consumers to sustain consumption (rather than quit) • Financial incentives & loyalty schemes are used to reinforce use The research leading to these results or outcomes has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013), under Grant Agreement nº 266813 - Addictions and Lifestyle in Contemporary Europe – Reframing Addictions Project (ALICE RAP – www.alicerap.eu). The views expressed here reflect those of the authors only and the European Union is not liable for any use that may be made of the information contained therein. Participant organisations in ALICE RAP can be seen at: http://www.alicerap.eu/aboutalice-rap/partner-institutions.html