Effects of 'Pinkwashed' Alcohol Ads in an Online RCT

The primary objective of this study is to examine how exposure to "pinkwashed" alcohol advertisements (i.e., ads that associate the company with breast cancer awareness or charities) affects consumers' perceptions that alcohol increases the risk of breast cancer. The investigators will randomize participants to view 3 'pinkwashed' social media advertisements for alcohol or 3 control advertisements for alcohol (i.e., 'de-pinked' standard alcohol advertisements that match the intervention advertisements on overall design but do not mention breast cancer). Each participant will view the 3 advertisements for their arm (presented in random order) and respond to survey questions programmed in Qualtrics.

Study Overview

• Status: Completed
• Conditions: Cancer; Breast Cancer
• Intervention / Treatment: Behavioral: Control - Standard Advertisements; Behavioral: Pinkwashed Advertisements

• Study Type: Interventional
• Enrollment (Actual): 602
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Chapel Hill, North Carolina, United States, 27516
      • UNC - Chapel Hill

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• 18 years old or older

Exclusion Criteria:

• Less than 18 years old

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Control - Standard Advertisements; In the control condition, participants will view 3 advertisements for alcohol (shown in random order) that do not mention breast cancer awareness or charities. Advertisements will be real social media posts used by alcohol companies, modified only to remove dates, likes/comments, and references to specific geographic locations.	Behavioral: Control - Standard Advertisements; Real advertisements from the same alcoholic beverage companies' social media accounts that do not contain messaging or other features associated with breast cancer awareness or research.
Experimental: Pinkwashed Advertisements; In the pinkwashed condition, participants will view 3 advertisements for alcohol (shown in random order) that associate the alcohol company with breast cancer awareness or research (e.g., indicate that a portion of sales will be directed to a breast cancer-related foundation). Advertisements will be real social media posts used by alcohol companies, modified only to remove dates, likes/comments, and references to specific geographic locations.	Behavioral: Pinkwashed Advertisements; Real advertisements from alcoholic beverage companies' social media accounts that contain messaging or other features that associate the alcohol company with breast cancer awareness or research.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Breast cancer risk perceptions	This outcome will be measured with an adapted item from the HINTS (2020) survey. The question is worded " In your opinion, how much does drinking [wine/beer/liquor] affect the risk of developing each of the following outcomes... Breast cancer." Response options are on a five point likert-type scale ranging from "Decreases risk a lot" (=1) to "Increases risk a lot " (=5). Participants will be asked to respond to this item three times, once for each type of alcoholic beverage presented (wine, beer, liquor). Scores from the three items will then be averaged for analyses. Higher scores indicate higher risk perceptions.	During ~20 minute online survey

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Perceived product healthfulness	This outcome will be measured with one item adapted from Bollard et al (2016). The question will read: "How healthy or unhealthy do you think it is to drink this product?" and will be measured with a 5-point likert-type response scale ranging from "Very unhealthy" (1) to "Very healthy"(5). Higher scores indicate greater healthfulness perceptions.	During ~20 minute online survey
Perceived social responsibility of brand	This outcome will be measured with one item adapted from Nan & Heo (2017). The question will read: "How socially responsible do you think the company that makes this product is?" and will be measured with a 5-point likert-type response scale ranging from "Very socially irresponsible" (1) to "Very socially responsible" (5). Higher scores indicate perceptions of social responsibility.	During ~20 minute online survey
Favorable attitudes toward brand	This outcome will be measured with one item adapted from Nan & Heo (2017). The question will read: "How do you feel about the company that makes this product?" and will be measured with a 5-point likert-type response scale ranging from "Dislike it a lot" (1) to "Like it a lot" (5). Higher scores indicate more favorable attitudes.	During ~20 minute online survey
Purchase intentions	This outcome will be measured with one item adapted from Hall et al (2020). The question will display all three advertisements that the participant was exposed to (either pinkwashed or control). It will then query: "How likely would you be to buy any of these products in the next 4 weeks, if they were available?" and will be measured with a 5-point likert-type response scale ranging from "Not at all likely" (1) to "Extremely likely" (5). Higher scores indicate greater purchase intentions.	During ~20 minute online survey
Perceived misleadingness of ads	Measure of how misleading a participant perceives the advertisement. Assessed with 1 item adapted from Hall et al. 2020	During ~20 minute online survey
Support for breast cancer warnings	Measure of participant support of including breast cancer warning labels on alcoholic beverage products. Assessed with 1 item adapted from Hall et al. 2018	During ~20 minute online survey
Stomach cancer risk perceptions	This outcome will be measured with an adapted item from the HINTS (2020) survey. The question is worded " In your opinion, how much does drinking [wine/beer/liquor] affect the risk of developing each of the following outcomes... Stomach cancer." Response options are on a five point likert-type scale ranging from "Decreases risk a lot" (=1) to "Increases risk a lot " (=5). Participants will be asked to respond to this item three times, once for each type of alcoholic beverage presented (wine, beer, liquor). Scores from the three items will then be averaged for analyses. Higher scores indicate higher risk perceptions.	During ~20 minute online survey
Mouth and throat cancer risk perceptions	This outcome will be measured with an adapted item from the HINTS (2020) survey. The question is worded " In your opinion, how much does drinking [wine/beer/liquor] affect the risk of developing each of the following outcomes... Mouth and throat cancer." Response options are on a five point likert-type scale ranging from "Decreases risk a lot" (=1) to "Increases risk a lot " (=5). Participants will be asked to respond to this item three times, once for each type of alcoholic beverage presented (wine, beer, liquor). Scores from the three items will then be averaged for analyses. Higher scores indicate higher risk perceptions.	During ~20 minute online survey
Liver cancer risk perceptions	This outcome will be measured with an adapted item from the HINTS (2020) survey. The question is worded " In your opinion, how much does drinking [wine/beer/liquor] affect the risk of developing each of the following outcomes... Liver cancer." Response options are on a five point likert-type scale ranging from "Decreases risk a lot" (=1) to "Increases risk a lot " (=5). Participants will be asked to respond to this item three times, once for each type of alcoholic beverage presented (wine, beer, liquor). Scores from the three items will then be averaged for analyses. Higher scores indicate higher risk perceptions.	During ~20 minute online survey
Liver disease risk perceptions	This outcome will be measured with an adapted item from the HINTS (2020) survey. The question is worded " In your opinion, how much does drinking [wine/beer/liquor] affect the risk of developing each of the following outcomes... Liver disease." Response options are on a five point likert-type scale ranging from "Decreases risk a lot" (=1) to "Increases risk a lot " (=5). Participants will be asked to respond to this item three times, once for each type of alcoholic beverage presented (wine, beer, liquor). Scores from the three items will then be averaged for analyses. Higher scores indicate higher risk perceptions.	During ~20 minute online survey
Hypertension risk perceptions	This outcome will be measured with an adapted item from the HINTS (2020) survey. The question is worded " In your opinion, how much does drinking [wine/beer/liquor] affect the risk of developing each of the following outcomes...Hypertension." Response options are on a five point likert-type scale ranging from "Decreases risk a lot" (=1) to "Increases risk a lot " (=5). Participants will be asked to respond to this item three times, once for each type of alcoholic beverage presented (wine, beer, liquor). Scores from the three items will then be averaged for analyses. Higher scores indicate higher risk perceptions.	During ~20 minute online survey

Collaborators and Investigators

• Sponsor: University of North Carolina, Chapel Hill
• Investigators: Principal Investigator: Marissa G Hall, PhD, UNC-Chapel Hill; Principal Investigator: Anna H Grummon, PhD, Stanford Univeristy; Principal Investigator: Kurt Ribsl, PhD, UNC-Chapel Hill

Publications and helpful links

General Publications

• Hall MG, Lazard AJ, Grummon AH, Mendel JR, Taillie LS. The impact of front-of-package claims, fruit images, and health warnings on consumers' perceptions of sugar-sweetened fruit drinks: Three randomized experiments. Prev Med. 2020 Mar;132:105998. doi: 10.1016/j.ypmed.2020.105998. Epub 2020 Jan 23.
• Nan X, Heo K. Consumer Responses to Corporate Social Responsibility (CSR) Initiatives: Examining the Role of Brand-Cause Fit in Cause-Related Marketing. Journal of Advertising. 2007;36(2):63-74. doi:10.2753/JOA0091-3367360204
• Bollard T, Maubach N, Walker N, Ni Mhurchu C. Effects of plain packaging, warning labels, and taxes on young people's predicted sugar-sweetened beverage preferences: an experimental study. Int J Behav Nutr Phys Act. 2016 Sep 1;13(1):95. doi: 10.1186/s12966-016-0421-7.
• Hall MG, Marteau TM, Sunstein CR, Ribisl KM, Noar SM, Orlan EN, Brewer NT. Public support for pictorial warnings on cigarette packs: an experimental study of US smokers. J Behav Med. 2018 Jun;41(3):398-405. doi: 10.1007/s10865-018-9910-2. Epub 2018 Feb 6.

Helpful Links

• HINTS survey items

Study record dates

Study Major Dates

• Study Start (Actual): January 11, 2023
• Primary Completion (Actual): January 19, 2023
• Study Completion (Actual): January 19, 2023

Study Registration Dates

• First Submitted: January 17, 2023
• First Submitted That Met QC Criteria: January 17, 2023
• First Posted (Actual): January 26, 2023

Study Record Updates

• Last Update Posted (Estimated): November 13, 2023
• Last Update Submitted That Met QC Criteria: November 9, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Other Study ID Numbers: 20-2338

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: The investigators will share our deidentified individual participant data, as well as our statistical analysis plan and analytic code on Open Science Framework (OSF), a publicly available data repository.
• IPD Sharing Time Frame: The deidentified dataset, SAP, and analytic code will be posted to OSF within 6 months of results publication. Materials will be available for 7 years after initial posting.
• IPD Sharing Access Criteria: There will be no access criteria; information will posted on a publicly available repository.
• IPD Sharing Supporting Information Type: SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No