|Paying the Piper:
The Effect of Industry Funding on Alcohol Prevention Priorities
We would like to thank Laura Anne Stuart, who helped design the survey, disseminated it, followed up with recipients, analyzed the data, and co-wrote the report. Her successor with the Alcohol Policies Project, Jody McCoy, provided able editing and production assistance.
Center for Science in the Public Interest (CSPI) is a non-profit organization that advocates progressive public health policies and focuses on nutrition and alcohol issues. It has led efforts to improve policies regarding the labeling, advertising, and taxation of alcoholic beverages. CSPI is supported by more than 750,000 subscribers to Nutrition Action Healthletter and its alcohol policies project was assisted by grants from the S.H. Cowell Foundation, San Francisco, CA and The Robert Wood Johnson Foundation, Princeton, NJ.
Center for Science in the Public Interest
The Center for Science in the Public Interest (CSPI) asked a sample of grassroots substance abuse prevention and treatment organizations around the country to indicate whether they supported or opposed thirteen current alcohol policy initiatives. The Prevention Priorities survey found that:
Since the creation of its Alcohol Policies Project in 1981, the Center for Science in the Public Interest (CSPI) has worked to reduce the devastating health and social consequences of alcohol consumption. CSPI has spearheaded efforts to promote public policies that put critical health information about alcohol into consumers' hands. We have concentrated on reforming advertising and promotional practices, improving the labeling of alcoholic beverages, and on restoring higher levels of alcoholic-beverage taxation.
These alcohol policies received widespread support in a 1994 survey of national non-profit organizations by James Mosher and Ellen Frank of the Marin Institute for the Prevention of Alcohol and Other Drug Problems. Approval of the policies was particularly strong among groups that did not accept funding from alcoholic-beverage sources.
In 1995 CSPI decided to survey organizations working at the local level, focusing entirely on those principally involved in alcohol and drug abuse prevention. Beginning in May 1995 we conducted a survey of one hundred four (104) community groups in the substance abuse field to measure grassroots support for various alcohol policy initiatives that were currently being debated or were already in effect.
The Prevention Priorities survey contained questions about thirteen specific alcohol policy initiatives in four categories: Drinking and Driving, Alcohol Marketing, Alcohol Availability, and Alcohol Price. The survey asked respondents (usually executive directors) to indicate whether their organization supported, opposed, or had no position on each initiative. In addition, the survey asked whether the organization currently accepted funds from alcoholic-beverage producers or industry-funded groups. Overall, respondents demonstrated high levels of approval for most of the policies. However, we found that support for these policies weakened among community groups that had financial ties to the alcoholic-beverage industry.
Acceptance of industry support for alcohol-prevention projects has always been somewhat controversial. Critics suggest that companies get unwarranted public relations "mileage" for tiny contributions that pale in comparison to their budgets for marketing and political lobbying. They say that industry funds typically support prevention and educational interventions that advance the philosophical and economic interests of the funders and divert attention from policy and prevention measures that challenge industry interests.
Others defend the practice of taking support from industry, claiming that the funds come with few, if any, strings attached and that the money fills a desperate financial need. They say that funds are often spent for vital programs or services that might otherwise go unsponsored. Alcoholic-beverage producers and trade associations have expressly made the reduction of alcohol abuse the centerpiece of many public relations campaigns. In addition to tens of millions of dollars in public service advertising and grants to environmental, anti-poverty, educational, and arts organizations, alcohol producers and trade associations, such as the Century Council, Beer Institute, and Licensed Beverage Information Council, provide support for alcohol and drug prevention and treatment groups at the local level. This financial assistance may be particularly appealing to small, local prevention, treatment, and educational organizations that would otherwise have access only to relatively limited governmental, foundation, and private resources.
CSPI sent the Prevention Priorities survey to 104 community groups in May 1995. According to industry sources, half of the organizations had accepted funding in the past four years from the Beer Institute or the Licensed Beverage Information Council (LBIC), two alcoholic-beverage industry trade groups. The remaining organizations had received Community Partnership grants from the federal Center for Substance Abuse Prevention (CSAP) within the preceding two years. We coded all surveys based on the respondents' funding sources so that we could differentiate the survey forms upon receipt; otherwise, the surveys were identical and the respondents anonymous. Each survey recipient received one follow-up call to increase the response rate.
Forty-four (44) surveys were returned, a response rate of 42%. The number of responses from each list was almost equal -- twenty-one (21) from the industry-supported groups and twenty-three (23) from those that received federal grants.
The responses were divided into the following categories:
Overall, the groups demonstrated high levels of support for almost all initiatives. The average level of support for all initiatives was 64%, and only one initiative received less than 50% approval. In addition, respondents noted almost no opposition to the prevention measures. Organizations were much more likely to report no position on a specific initiative than they were to oppose it. However, groups that currently accept alcohol industry funds, or had accepted them in the past four years, showed significantly lower levels of support for almost all of the alcohol policy initiatives on the survey.
Category One: Drinking and Driving
The first category of the survey, Drinking and Driving Initiatives, included questions about administrative license revocation laws, lower blood alcohol content laws, and designated driver campaigns.
Administrative license revocation laws, measures which are gaining popularity on the state level, mandate that drivers who are arrested while suspected of being under the influence of alcohol automatically lose driving privileges. This initiative received one of the lowest levels of support -- only 50% overall -- with 16% of all respondents opposing the measure.
The difference in support between groups which accepted alcohol industry money and those which didn't was dramatic. Sixty-two percent (18 of 29) of those not accepting alcohol industry funds supported administrative license revocation laws compared to only 29% (4 of 14) of groups currently underwritten by the alcohol industry and 43% (9 of 21) of groups which had taken money in the past.
Initiatives to lower permissible blood alcohol content (BAC) levels for drivers were somewhat more popular. Currently, most states allow a maximum permissible BAC level of .10 percent. Eleven states have lowered BAC levels to .08 percent, and many more states are expected to follow suit. Preliminary research by the National Highway Traffic Safety Administration (NHTSA) indicates that such laws help reduce drinking and driving crash deaths.
Fifty-nine percent (26 of 44) of all respondents approved the lower legal BAC limit. Organizations (20 of 29) which do not accept alcohol industry funds were 60% more likely to support lower BAC levels than those (6 of 14) which currently take industry money and 30% more likely than groups (11 of 21) that recently took money.
Of all the drunk-driving policies, designated-driver campaigns were the most popular. Typically, these campaigns seek to reduce drunk-driving crashes by attempting to change individual behavior through the mass media. Public service announcements, often sponsored by large alcohol producers, encourage consumers to select a non-drinking driver to transport a group of drinkers.
Designated-driver campaigns have steadily gained recognition and popularity since the late 1980's, even receiving endorsement from President Clinton. Thus, it is no surprise that 84% of all survey respondents (37 of 44) and 86% (30 of 35) of industry-supported groups backed this initiative.
Although the difference in support was minimal (86% for industry vs 83% for CSAP grantees), alcoholic-beverage industry approval of designated-driver campaigns may have influenced the attitudes of the industry-sponsored organizations. The designated-driver campaign option was the only policy in the survey to receive a higher margin of support from groups that receive alcohol-industry funds than from those which don't.
This result may reflect the skepticism that alcohol-policy advocates have voiced about the designated-driver program. Some have suggested that the excessive focus on this prevention effort represents a very narrow approach to reducing the social costs of excessive alcohol consumption. Critics maintain that designated-driver campaigns may subtly encourage excessive drinking by winking at heavy drinking by anyone but the driver.
Category Two: Alcohol Marketing
Notwithstanding vehement industry opposition to alcohol marketing reforms, all groups indicated strong support for most of the alcohol-marketing initiatives described in the Prevention Priorities survey, including health warning labels on beverage containers, health warning posters, and health warnings in ads.
Eighty-two percent (36 of 44) of respondents approved a requirement for rotating health messages in all alcoholic-beverage advertisements. In 1993, the alcohol industry lobbied heavily against a proposed federal law that would have required these messages. Not a single group indicated opposition to such a measure, and 71% of organizations currently accepting funds from the alcohol industry (10 of 14) said they would support it (76% -- 16 of 21 -- of organizations which had received alcohol money in the last four years showed support as well). Eighty-six percent (25 of 29) of the groups that do not accept alcohol-industry money approved the measure.
A clear majority also backed improvement of the current warning labels on alcoholic-beverage containers (e.g., requiring contrasting typeface and background on labels for easier readability). Sixty-four percent (9 of 14) of the organizations currently accepting industry funds and 67% (14 of 21) of the organizations which had accepted funds in the last four years supported label improvements. Eighty-three percent (24 of 29) of non-industry-funded groups reported approval. The survey indicated identical levels of support for an initiative to require health warning posters at bars, restaurants, liquor outlets and other places where alcohol is sold.
A proposal to ban alcoholic-beverage advertisements on billboards met with less consistent enthusiasm. Although 57% (25 of 44) of all groups approved the measure, support was strongest among respondents that received no industry funds. Seventy-two percent (21 of 29) favored a ban on alcohol billboard ads compared to only 38% (8 of 21) of those groups that accepted industry funds in the past and 29% (4 of 14) of those which currently accept alcohol money.
Baltimore passed laws in 1994 prohibiting alcohol and tobacco billboards in certain locations. Anheuser-Busch Company, the world's largest brewer, along with the billboard company, Penn Advertising, sued the city, challenging the ordinance's constitutionality. Such vocal industry opposition to billboard restrictions may have influenced the low level of support for this measure among industry-funded groups.
Category Three: Alcohol Availability
The section of the Prevention Priorities survey concerning alcohol availability initiatives included questions about limitations of service at sports stadiums, elimination of sales at specific retail outlets, and restrictions on the concentration of alcohol outlets. Overall, respondents indicated high levels of support for the measures; however, groups funded by the alcohol industry, in general, showed considerably less interest in those initiatives than did the other organizations.
To prevent rowdiness among fans and drunk driving after games, alcohol-policy advocates and stadium managers have proposed and implemented limits on alcohol service in sports stadiums. Those measures include restrictions on the size of alcoholic-beverage containers, bans on the sale of alcohol in the stands, cutting off alcohol sales late in the game, and limiting sales to low-alcohol beverages only.
Sixty-one percent (27 of 44) of respondents approved these measures. However, among industry-funded groups, only 36% (5 of 14) of current grantees and 47% (10 of 21) of past grantees supported them. In contrast, 72% (21 of 29) of groups which do not receive alcohol-industry money endorsed those restrictions.
Similar policies would eliminate the sale of alcohol at gas stations, convenience stores, and movie theaters. Such reforms may help lower alcohol consumption, prevent underage drinking, and decrease drunk-driving crashes. This group of initiatives received the least support of all items on the survey, netting an overall 41% approval rating. However, 55% (16 of 29) of organizations which do not accept alcohol industry funds supported the measures, twice the backing demonstrated by groups which accepted industry money in the past and four times that of groups which currently accept industry funding.
Corner liquor stores blight many inner-city neighborhoods and contribute to increased crime and health problems in those areas. A question about proposals to limit the density of these outlets met with 61% (27 of 44) approval from all respondents. Groups without financial ties to the alcohol industry showed the strongest support -- a 76% (22 of 29) approval rating -- versus only 36% (5 of 14) support among industry grantees and 47% (10 of 21) among groups that received grants in the past.
Category Four: Alcohol Price
Higher prices on alcoholic beverages can be an effective deterrent to underage drinking. Raising excise taxes on alcoholic beverages at the federal and state levels would help reduce demand and, at the same time, generate tax revenue which can be used to fund substance abuse programs.
Our questions in this area focused on policy proposals to increase federal excise taxes, equalize federal excise tax rates across beverage types, and increase state excise taxes with the funds earmarked for prevention programs.
Fifty percent (22 of 44) of all respondents favored an increase in federal excise tax rates. Only 21% of groups (3 of 14) that received industry funds and 33% (7 of 21) of those which had in the past supported federal excise tax increases. Twenty-nine percent (4 of 14) of industry grantees actually opposed this initiative, the highest level of opposition for any measure on the survey. Organizations not on the industry dole were more than twice as likely to support higher taxes than recipients of industry funds.
The proposal to equalize federal alcohol excise tax rates received a slightly higher overall approval rating of 59% (26 of 44). Currently, distilled spirits are taxed at a disproportionately higher rate of $13.50 per 100-proof gallon, or $.12 per drink. Wine and beer are taxed at rates of $.04 and $.05 per drink, respectively. Equalizing these tax rates (resulting in relative increases in the prices of beer and wine vis a vis liquor) received a favorable vote from 43% (6 of 14) of industry grantees and 57% (12 of 21) of those with industry grants in the past four years. Organizations that do not currently accept industry grants demonstrated even stronger approval at 69% (20 of 29).
Respondents noted considerably more enthusiasm when asked if they would support an increase in state excise tax rates, with the new revenue earmarked for alcohol-related prevention, treatment, and law-enforcement programs. Seventy percent (30 of 44) of respondents answered positively, including half of current industry grantees (7 of 14) and 62% (13 of 21) of past grantees. Seventy-nine (23 of 29) of those not accepting alcohol industry grants supported the measure. The high approval probably reflects the likelihood that the respondents hoped or expected to be recipients of such tax revenue.
Category Five: Organizational Policies on Alcohol Consumption
In addition to our questions about "external" alcohol policies, we also asked groups about the use of alcohol at their organizational social functions. Although only a minority reported alcohol use at group social events, those groups that accept, or had accepted industry money were far more likely to consume alcohol than organizations without alcohol-industry funding. Twenty-nine percent (4 of 14) of groups that currently accept industry funds and 19% (4 of 21) of groups that had accepted funds in the past said that they served alcohol at organization functions. In sharp contrast, none of the groups that abjure alcohol funding reported serving alcohol.
Discussion and Conclusions
This survey of community-based substance abuse prevention and treatment programs confirmed prior reports (e.g., Join Together surveys) that prevention policy measures enjoy strong support among groups that work on alcohol-related issues. It also verified suspicions and previous data (Mosher and Frank, supra) indicating that the source of a program's funding may have an influence on the positions that the organization takes on alcohol policy measures.
On average, the policy proposals in the survey received support from sixty-four percent of the respondents. Support among groups that now take industry funds averaged 45%, and for those that had accepted alcohol money in the past four years, support averaged 54%. In contrast, groups that avoid industry donations had an average support rate of 74%.
Despite its modest sample size and non-random respondent selection process, the survey raises serious ethical and political issues concerning the funding of community-based alcohol prevention organizations by entities related to the alcoholic-beverage industry. It casts doubt on the philanthropic motives of alcohol-industry givers. At the very least, these findings support one or both of the following conclusions : 1) that groups which accept alcohol-industry funding are more reluctant to support alcohol policy measures than "independent" organizations, and 2) that alcohol-industry funders seek out such groups when it comes to making grant awards.
The findings of this survey come at an especially difficult time for the substance abuse prevention and treatment field. Proposed Congressional budget cuts will likely gut the Safe and Drug-Free Schools Act, reduce the Office of National Drug Control Policy (ONDCP), and severely curtail demonstration projects supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), including Community Partnership grants administered by the Center for Substance Abuse Prevention (CSAP). In the future, the vastly reduced pool of demonstration funds for substance abuse prevention and treatment purposes will lead to even fiercer competition for federal and other sources of money. Groups which now rely heavily on the federal funding stream may begin to sek alternative funding sources, including donors from the alcoholic-beverage industry, in order to assure their survival.
The extent to which greater dependence by prevention organizations on alcoholic-beverage industry largesse will affect alcohol policy campaigns remains unclear. However, this survey reinforces the common-sense notion that "he who pays the piper calls the tune." The findings strengthen the need for policy makers, alcohol prevention organizations, the media, and the general public to identify the funding sources of advocacy groups, whatever positions they take on policy matters. At the very least, the survey raises questions about the motivations of alcoholic-beverage producers and trade organizations which have recently expanded their promotion of alcohol prevention and education initiatives and the availability of funding for community and state-wide groups.