Many nations have banned or curtailed advertising to protect public health, particularly in the area of chronic disease control. The World Health Organization (WHO) Framework Convention on Tobacco Control, now ratified by 151i nations, obliges parties to ban all forms of tobacco advertising.1 In 2007, the UK implemented a ban on television advertising of food and drink high in fat, salt and sugar in or around programmes made for children.2 Alcohol advertisements are subject to varying degrees of content, timing and location restrictions in numerous countries.3 Direct to consumer advertising of prescription medicines is permitted in only two industrialised countries, the USA and New Zealand.4

The bulk of these restrictive policies only address traditional forms of advertising communicated through mainstream media such as television, radio and print. Increasingly, however, companies are turning to less orthodox means of advertising, with most centred on web-based dissemination. In September 2007, it was estimated that 1.2 billion people accessed the Internet. This is an explosive 245% increase in access from 2000.5 Encouragingly, the “digital divide” between developed and developing nations is also shrinking.6 The web is no longer simply a way for people to retrieve expert information or purchase goods, but is a fully interactive platform allowing users to communicate freely. Coined in 2004 as Web 2.0, the web is increasingly being driven by consumer-generated content.7

In 2006, annual spending in the USA on word of mouth marketing (WOMM) jumped 35.9% to $981 million and is expected to top $1 billion in 2007, making it one of the fastest growing alternative media segments: “Among the key trends driving growth, the Internet has enhanced the ability of consumers to exchange ideas about brands through social networks like Facebook (http://www.facebook.com) and MySpace (http://www.myspace.com) and consumer-generated media like blogs”.8 The number of users on these social networking sites and the frequency with which they visit them is staggering. For example, Facebook has over 58 million active users and continues to grow. The site has had an average of 250 000 new registrations a day since January 2007. It is the sixth most trafficked website in the US, and more than half of active users visit the site daily. Facebook is a global phenomenon with the top 10 most represented countries being the US, Canada, UK, Australia, Turkey, Sweden, Norway, South Africa, France and Hong Kong.9

In public health, advertising control policies are often applied one medium at a time: typically television first, then outdoor billboards, followed by print. This causes companies simply to change where they place their advertisements but not to reduce the amount of advertising.10 Restrictions on mainstream “old” media advertising are likely to fuel further increases in “new media” marketing techniques.11 12 Even in jurisdictions with public health legislation incorporating broad definitions of advertising that encompass electronic or Internet-based forms, these elements are poorly regulated and often not enforced because of lack of expertise (or political will) on how to approach the issue or because of inability to regulate sites that are hosted outside of the legal jurisdiction.

EXTENT OF HEALTH-RELEVANT PRODUCT ADVERTISING ON YOUTUBE

To assess the prevalence of advertising of concern to public health on the Internet, we searched the video-sharing website YouTube (http://www.youtube.com) on 17 December 2007 for any fast food, beverage, alcohol or tobacco brand from the top 100 global brand list for 2007ii and the first 20 most viewed clips for each term were examined. A massive 85 625 videos for 12 popular tobacco, alcohol, beverage and fast food restaurant brands were found on the site (table 1).

While the business sector has rapidly embraced alternative advertising, there is a dearth of health research and analysis on how alternative advertising may be subverting existing advertising regulations, the audiences this advertising is targeting, how it should or can be regulated and how public health could more effectively use these same approaches. A potential roadblock to advancing this understanding is the loose and fluid use of alternative advertising terminology. In this paper, we provide an overview of some of the key terms, highlighting examples of importance to public heath.

WORD OF MOUTH MARKETING

Word of mouth is “the act of consumers providing information to other consumers”.13 Consumers have always recommended products and brands to other consumers based on their own experiences and preferences. Word of mouth becomes “word of mouth marketing” (WOMM) when companies purposefully employ strategies to commercialise these commonplace consumer communications. The commercial importance of word of mouth cannot be underestimated.14 Some researchers estimate that 10% of consumers “influence” the entire population of consumers’ choices.15 Marketers that can harness the interest of these “influentials” will be able to maximise their advertising reach. Examples of specific WOMM strategies are highlighted below.

Viral marketing

Viral marketing is “unpaid peer-to-peer communication of provocative content originating from an identified sponsor using the Internet to persuade or influence an audience to pass along the content to others”.16(p 33) The goal of viral marketing is to “manufacture a marketing message—typically online and in a tangible format such as a video clip or e-mail—that can spread among consumers quickly and exponentially”.17(p 49) Viral marketing is when the longstanding tradition of consumer word of mouth becomes “word of mouse”.18(p 159)

While many successful viral campaigns have had an “offbeat, mysterious, tasteless, or irreverent component”,17(p 49) one of the earliest and most successful viral marketing campaigns was a simple message included in all Hotmail e-mails.19 Every Hotmail e-mail message included a tagline and web link that encouraged people to get their own free Hotmail account. The e-mail service provider attracted 11 million users in the first 18 months of operation through this technique. A unique feature of viral marketing is that the contact between the supplier and the consumer is minimal. Only a few customers are contacted directly and are then expected to pass on the message or entice others to use a service or product. Customers act as intermediaries, and the supplying firm only contacts the first few adopters.18

The UK-basediii “Do you believe in coincidence?” campaign, run by Grolsch beer, combined a viral video with interactive TXT (SMS) messaging.20 A website link to the campaign (http://www.grolsch.co.uk/coincidence) instructs readers to enter their name and cell phone number. A box must be ticked confirming that participants are over 18; however, no proof of age is required. A short video is then played of two men drinking Grolsch beer in a pub. 10–15 seconds into the video one of the men starts text messaging on a cell phone, looks at the camera and asks “if you believe in coincidence?” Immediately, and “coincidentally”, a friendly TXT message arrives on the cell phone of the person who has entered their number on the site. The message includes encouragement to tell friends about the video and includes a web page link to enter friends’ mobile numbers and e-mails so that they can be surprised by the “coincidence trick”. Of course, this “trick” only works if a real cell phone number is entered and the person viewing the video has their cell phone to hand. Given that the majority of young people in the UK have a cell phone, and use it frequently, this is not likely to be a significant barrier to the campaign’s success.21

Rizla, a cigarette rolling paper, has used a web-based viral game to increase the number of people in its consumer database. “Pass the parcel”, a favourite game at children’s birthday parties, was e-mailed to 15 000 people on the company’s database. Each recipient was permitted to unwrap three layers of a virtual “parcel” to reveal 2000 Rizla branded prizes. What made the game a viral strategy was that each recipient was encouraged to send the game on to friends and, for each friend who registered, another opportunity was granted to unwrap a layer of the parcel.22 The game was meant to reflect “the brand’s image as fun, interactive, individual, colourful and creative”.23 This is despite the UK Tobacco Advertising and Promotion Act 2002iv prohibiting the transmission of a tobacco advertisement in electronic form and also not allowing tobacco advertisements to be sent to all consumers on a database.

Buzz marketing

The term “buzz” is not consistently defined in marketing literature.24 Some marketing experts contend that a buzz marketing activity is meant to generate publicity, excitement, and deliver information about a new product. Specifically, the activity must be “outrageous” and publicity worthy in order to be effective.17 While not termed buzz marketing at the time, a very early (1929) example occurred when Great American Tobacco hired young women to smoke their “torches of freedom” (Lucky Strike cigarettes) as they marched in an Easter Sunday parade.25 As public smoking by women was still very much taboo, this generated widespread newspaper coverage and provoked a national debate that helped to shift the social acceptability of women smoking.

A more contemporary example is international pop star Justin Timberlake’s participation in a global ad campaign for McDonald’s. While on the surface this appears to be nothing more than the traditional use of celebrity power to attract brand interest, the “pre-campaign” elements of the promotion bear all the hallmarks of buzz marketing.26 Paparazzi photos from the ad video shoot appeared in magazines, and supposed “bootleg” copies of the star singing the “yet to be released” newly penned McDonald’s theme song were circulated on the Internet. In media interviews, McDonald’s refused to comment on the campaign, which further served to create an element of anticipation and suspense among fans, evidenced by online discussions on fan sites speculating about what the final ads and song would be like.

Other marketing literature defines buzz marketing more broadly as the intentional and explicit use of techniques to create “contagious talk about a brand, service, product, or idea”.27(p 602) The Internet is littered with blogs, listservs, video sharing websites and online forums that discuss and promote brands and consumer products. What is not so easy to determine is who is posting these comments. Is this genuine, spontaneous consumer-generated content or the work of hired buzz agents? “Buzz agents” or “brand pushers” are hired by companies to target potential customers in the form of offline and online conversations. Often these agents will be coached to ask particular questions and make comments to encourage interesting conversations on Internet forums. Research examining the views of teenage buzz agents found that they like the role, view it as a job, usually conceal the fact that they are buzz agents and generally see no ethical dilemma in concealing the true nature of their connection to the brands they are promoting.24

For example, Rate It All (http://www.rateitall.com) allows users to create, promote and publish their own interactive ratings lists on virtually any product or service. Participants can also earn money through the site by writing reviews, creating web lists, creating new listings for existing ratings lists, creating a user profile with a picture or referring friends. The product review on the site for RJ Reynolds’ newly (2007) launched female-focused brand, Camel No. 9 Menthe cigarettes, contains many reviews from supposed customers. Favourable comments included, “Excellent. A full blend. Great aftertaste, and genius style” and “I bought a pack of these yesterday and love them! I usually don’t bother with a lighter cigarette but these are awesome”.28 It is not possible to tell whether these comments were posted by actual adult users of the product, RJ Reynolds’ employees, public relations consultants or buzz agents. It is noteworthy, however, that RJ Reynolds announced in November 2007 that they will no longer be using US print media to promote their tobacco products. Claiming to be responding to tobacco control and community concerns about the glamorous Camel No. 9 ads in women’s magazines, it is possible that they have found more effective ways of promoting their brands.29

In March 2006, the Australian state of Victoria banned the use of buzz marketing to promote tobacco products. For the purposes of the legislation, buzz marketing is defined as “the use of colours, images and props to create an environment consistent with a brand’s identity or reminiscent of previous tobacco advertising”.30(p 1) This definition does not encompass the buzz marketing techniques described above, but does limit the ability of tobacco companies to overtly promote their brands in youth-friendly venues and events.

WOMM disguised as market research

An Australian company, Soup (http://www.soupsite.com.au/), sends free product samples to registered members under the guise of soliciting feedback but, more importantly, Soup members generate WOMM about new goods entering the marketplace. When members join Soup, they must complete a profile which includes questions about hobbies, interests, occupation and the number of contacts they have in their mobile phone and e-mail. Members are also asked to describe how often they endorse products to friends, if they see themselves as leaders among their peers and how important it is for them to be the first to try a new product. Soup clients include Coca-Cola, promoting their new energy (high sugar/high caffeine) drink, Mother, and Smirnoff Vodka’s new pre-mixed Smirnoff Double Black and Cola. Soup hosted an exclusive event for Smirnoff where selected “lucky” members were invited to an “exclusive” taste testing event. A sample e-mail sent to Soup members (9 November 2007) to try a new alcoholic beverage is below:

As the weather heats up and summer hits the city, a new drinking movement is about to be launched. We have an exclusive opportunity for Soup members (YOU!!) to be involved in trialling a new alcoholic beverage. This drink has taken the UK by storm, and looks set to kick off a similar trend in Australia.

To participate you need to be:

1. Able to pick up the product from a local bottle shop.

2. Hosting or heading out to a “BYO” social occasion in the next two weeks!!

3. Willing to try, and encourage your friends to try, a new alcoholic beverage.

If this sounds like a project you would like to be involved in, please click on the link below to answer a few questions to check your eligibility.

Advergames

While product placement in movies and video games is not a new marketing tactic, “advergames” turn the concept of “product placement” into “product entertainment”. Advergames, hosted on company websites, intend to “present a game that consumers might actually want to play in order that they may spend an extended period of time with the brand”.31(p 15) Instead of seeking out entertainment opportunities (films, TV shows, popular music, video games) in which to promote a product, advergames are developed exclusively to promote brands. Advergames engage consumers for extended periods of time, typically 10–15 minutes, which, when compared with a traditionally broadcast 30-second commercial, is a substantial level of interaction.

A content analysis of 40 popular food and beverage brand sites found that 100% of websites with designated children’s areas (23/40 or 58%) had advergaming content.32 In an Australian experimental study, children who played an advergame featuring Kellogg’s cereal, Froot Loops (the cereal with the highest level of processed sugar of any breakfast cereal on the Australian market at the time of study), found that older children (age 7–8) who played the advergame reported a significantly higher preference for Froot Loops cereal than the control group.33 The game required children to toss either fruit or Froot Loops into a monster’s mouth. The children scored 5 points for each piece of fruit that made the target, but 10 points for each Froot Loop.

Social/friend network marketing

Social/friend networking sites such as Facebook (http://www.facebook.com) and MySpace (http://www.myspace.com) are a global phenomenon. The primary feature of these sites is that users upload personal details about themselves to their own page and then link their page to the pages of their friends, creating a social network. Facebook users may also form groups based on common interests to further expand their network. The tremendous growth and popularity of these sites among ever younger users means that they cannot be ignored by those interested in the heath of young people.34 These sites are being closely examined and leveraged by the business sector.

A unique feature of Facebook is that any action taken, such as adding new photos or joining a new group, is fed to all your Facebook friends through a continuous news feed. This news feed also contains commercial advertisements. Advertisers can develop highly targeted ads that are based on the personal profile information of users. In November 2007, Facebook launched “social ads” to provide advertisements based on the activities and preferences of the user and their friends.v Now, when you receive a notice that a friend has joined “the fast food lovers association of Scotland” group, an ad for a fast food chain may appear alongside.

Businesses or other entities may also have their own Facebook pages, making it possible for users to be “friends” with their favourite brands, restaurants, music, films, etc. There is currently no publicly available policy on the Facebook website about whether certain industries, ie tobacco, alcohol, firearms, are banned from advertising to users. It is easy to find representation for any popular brand on the Facebook page. For example, a search for “Marlboro cigarettes” returns 82 possible groups. Again, the issue of authenticity is in question—who starts these “groups” and why?

Implications

There is an enormous amount of advertising now occurring outside the traditionally regulated avenues of print and broadcast media. Regulation of that media may well have pushed advertisers into even more cost-effective methods of product promotion. Monitoring, assessing the impact of and potentially regulating these alternative forms of advertising must be a priority in chronic disease prevention. Public health cannot afford to ignore these emerging media. Dismissing these new technologies as being merely “for the kids” ignores the enormous health-relevant content and traffic already occurring on these sites.

Health agencies could develop and post their own viral videos on websites such as YouTube. While it is possible to find many examples of social marketing ads developed for television posted on YouTube, we were unable to find any evidence of health agencies entering into content agreements with YouTube. For-profit companies have content arrangements with YouTube to ensure that videos are preferentially featured on the homepage or when certain search terms are entered. Generating large viewership of videos can be planned for and requires expertise and some investment.

Additionally, health groups need to be more strategic about their presence on social networking sites. For example, while a search for “quit smoking” on Facebook returns many (500+) potential consumer-generated support groups and applications, only one sponsored group appears in the first 50 results. A sponsored group is where an organization or company, in this case New York State Smoker’s Quitline, has paid to have their group featured on Facebook. Health agencies could experiment with developing sponsored groups and free Facebook pages to determine how best to attract their target audience to campaigns and services.

Public health organisations routinely spend significant funds developing new and revamping existing websites with youth focus-tested content, in the hope of attracting young users. Yet the aforementioned globally popular websites remain largely ignored by health promoters and public health researchers. There is an untapped potential to exploit the existing infrastructure and audience of these sites and to channel funds to developing and promoting provocative content that can appear alongside, or ahead of, the potentially harmful advertising.35