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Alcohol Abuse in the Midsomer Constituency

It’s holiday period now, so instead of some difficult discussion about epidemiological problems,  confounding or, like two weeks ago the picking apart of a not very good study that made it into national  newspapers (well…tabloids), this new post falls in the category “hey, did you know this ?!”  I was aware that constantly watching movies was probably not the best way of spending your life. If we  limit ourselves to health then I assumed that this was primarily the result of being a couch potato and,  well, if you are watching television by definition you cannot do something else…something healthier or,  well, something more useful (although I am sure there must be something beneficial to “zoning out” for a  bit). I also read the occasional story about violent movies, or for that matter computer games or music,  being held responsible for various acts of violence of, well, let’s call them less stable members of society.  Although most of these articles are generally found in the Daily Mail, so I did not spend too much time  contemplating them.  I did however, come across a study published in May of this year (2015) in which the link between alcohol  use in films and alcohol use amongst adolescents was investigated based on longitudinal data. And using  longitudinal data, that’s always a good idea.   As a sidenote, while reading up a little on the effect of movies, computer games and  movies on behaviour I came across a website on “sublimal messages, hidden messages  and backwards masking” in Marylin Manson songs. You can find it here <link>. You can  listen to samples on the site too, which makes it quite intriguing. I don’t know how  much of this is true, but as far as conspiracy theories goes this one is pretty neat. It  does sound like quite a lot of work, to make a song work both forwards and backwards  in time….  So the sidenote is an exciting, if not a bit of a creepy, illustration of hidden messages in media; which is  what I wanted to talk about. If you regularly watch programmes like “Made in Chelsea” (in the UK  broadcasted by Channel 4), or any similar type of programme I am sure is available in most countries, you  will have realized that ‘product placement’ is the whole point of the show (well, product placement and a  lot of unnecessary drama). So putting stuff in the background of television programmes must be a good  idea. Marketing people have figured this one out, so there must be a net benefit. And indeed, for tobacco  smoking this is well known and you can see an overview of the evidence, as well as the US Surgeon  General’s advice to link this to movie ratings here <link>.   The main reason is that this kind of “hidden marketing” is aimed at changing the behaviour of children and  adolescents so that, in this case, they start smoking. New customers is what the tobacco industry is  interested in, for obvious reasons, but if you think about the consequences…it really is pretty despicable  behaviour. And is the same apparent for alcohol consumption as well?  Of course it is! Same strategies, same effects, same profits.   Waylen, Leary Ness and Sargent from my University together with colleagues from Geisel School of  Medicine in the US looked at the Avon Longitudinal Study of Parents and Children (ALSPAC) to see if an  association between “Alcohol Use in Films and Adolescent Alcohol Use” (this, incidentally, is the title of  the paper) was apparent. As mentioned above, their study was published in the journal Pediatrics last May  (but available online from April 2015), and you can find it here <link>.   I am not going to dwell too much on the dataset and the methodology. The ALSPAC study is a very well  know, prospective, study with pretty good methodology, so we will leave it at that (if you want to know  more, you can find that here <link>). Because of the extensive data available the study was able to take  into account a large number of potentially confounding variables, including pre- and postnatal parental  socio-economic factors, childhood development and disorders (such as ADHD), sensation seeking personal  characteristics, parental monitoring, and parental alcohol use. The study could also look at mediating  factors – factors on the causal pathway that could affect the path from seeing alcohol use in the movies to  changing one’s alcohol use – such as smoking and how many of their friends drank alcohol. So that is all  pretty thorough, while also the study was based on a pretty large sample of 5,509 adolescents of 15 years  of age. “Exposure” was measured by asking adolescents whether they had seen any of 50 randomly selected films  from a list of 366 popular contemporary films. The amount of time alcohol use was shown in each film was  recorded in seconds and total exposure was the sum or durations in each film they had seen. Sometimes  ‘exposure assessment’ is not such a great job, but I can think of worse jobs than to have to watch a large  number of movies during office hours (timing the exposure is not great I suppose, but someone has to do  it!). There is a methods paper about this if you are interested <link>, but my main interest – what movies  were included – was unfortunately nowhere to be found.    So, assuming the methodology is fine, then what were the main results? I have, of course, given away the  main result already above….  Interestingly, exposure to alcohol in films in the 15-year olds from the southwest of England (give or take)  was on average less than an hour, which turns out to be much less than adolescents from the United States  or Germany – who were exposed to about 3 hours of alcohol use in movies. Assuming everyone watches  American movies primarily, I hate to think how many hours of movie watching is required before you  managed to watch 3 full hours of alcohol consuming! On average!   After watching of all this consuming of alcohol on the television, adolescents in the highest exposure  group were 1.2 times (95% confidence interval 1.1-1.3) more likely to have tried alcohol compared with  those least exposed, and 1.7 times more likely to binge drink. They were more than twice (in fact 2.4  times (95% CI 1.9-3.1)) more likely to drink weekly and, and this surprised me, twice as likely to have  alcohol-related problems as those least exposed. I could not find the base rate for the least exposed  group, so don’t really know how much of an actual problem this is, but twice as likely to have alcohol-  related problems, at age 15 (!), seems quite a lot.  Unless, of course, people with certain problems, including alcohol-related ones, watch more movies  anyway and thus get a higher cumulative exposure to alcohol consumption. As far as I could work out the  epidemiological models did not adjust for total duration of films watched.  Based on these results the authors suggest that movies with alcohol use should get a higher BBFC or MPAA  rating (for example BBFC 18 or MPAA R),which they argue is justified because these rating systems are in  place to protect children from seeing media that may adversely affect their behaviour. I am not sure that  is such a great idea personally, since how does this compare to any other negative behaviour in movies;  violence, war, affairs, generally being mean to others, or god forbid (quite literally) naked people….  I am sure we all have different opinions about this (for example, someone at Spiked magazine gets very  angry about this <link>), but for many movies the consumption of alcohol or smoking of tobacco is really  not that integral to the plot (for some it is; I name for example “The Hangover”, which is great and  presumably has some important lessons about binge drinking to teach us all). Maybe a solution could be for  a director to make a case for why this is important? Would James Bond me less cool if he drank less? It  would probably reduce the collateral damage considerably, and I would imagine he would not get captured  continuously….  This brings me to the second sidenote, and another story that hit it bigtime in the UK last week. The  ‘hidden phenomenon’ of harmful drinking among middle-class over-50s (Daily Mail, Guardian). According to  Age UK’s chief economist, Professor Jose Iparraguirre, the author of the research published in BMJ Open   <link>, this is “associated with affluence and with a ‘successful’ ageing process”. Now this may well be  through, and I am sure additional research will be done about this. But given the impact alcohol  consumption on the television can have on alcohol use, as we have just seen above, I am hereby proposing  an alternative explanation.   Yes, you have heard it here first and I am pro-actively claiming all the credits when someone publishes  about this sometime in the future!  Over 50s, especially those of higher socioeconomic class, in the UK all watch  Midsomer Murders. In case you have no idea what this is, it is a  police/murder mystery series set in the affluent part of England which is  best characterized by a high death rate of 2-3 per episode (to put this into  perspective, it is set in small villages with often no more than 50 people)  and a very slow pace. I have seen quite a lot of them…and indeed, DCI  Barnaby does (in addition to be being a bit slow to catch up, which generally  leads to 1-2 additional, and unnecessary murders) consume quite a lot of  alcohol.   In every episode! In fact, there is alcohol every day for dinner, there is a regular sneaky pint on the job, one needs a pint  when scouting out the local fair, and well, every weekend or evening covered in an episode involves a  glass of wine.  Midsomer Murders has been on the television since the mid 1990s, so   Post hoc ergo propter hoc Remember, you heard it here first…And I am taking full credits! 
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