Local photographers on the frontline of Duterte’s drug war reflect on the images that moved them most
By Andrew Katz
A teenage “John Doe” lies on a mortuary table, dead from multiple gunshot wounds. A woman cradles her partner under the harsh light of television cameras, beside a piece of cardboard that labels him a “pusher.” A sister, far from home, uses video-calling on her smartphone to mourn with relatives during the funeral of her brother.
These scenes and more have become commonplace across the Philippines over the last eight months of President Rodrigo Duterte’s deadly crusade. More than 7,000 suspected drug users, dealers and innocents have been reported slain by unidentified vigilantes or during confrontations with police. It was only after the high-profile killing of a South Korean businessman at police headquarters—an embarrassment for Duterte—that the president said the police’s anti-drug units would be dissolved. Still, he pledged to continue the campaign.
As the body count has risen, so has the number of photographers who have seen the streets stained by blood. The killings have drawn in veteran foreign photographers like TIME’s James Nachtwey and Daniel Berehulak, whose investigation for the New York Times recently earned a George Polk Award. But it is a strong group of local photographers—comprised of freelancers and those working for the wires—who have committed to keeping the human toll in the public eye. They live in this hell, waiting for the next lead to the next crime scene.
TIME asked 12 of them to select an image from their archives and in their own words, which have been lightly edited for brevity and clarity, explain the scene and its personal significance. Individually, each image represents a unique moment when humanity has been tested. Together, they align statistics with faces and names—making justice a little harder to avoid, whenever dawn comes.
Warning: Some of the following images are graphic in nature and might be disturbing to some viewers
It was the eve of Halloween when five people were killed inside one small house in Mandaluyong City, a poor community east of Manila. It was an intense night for everyone, including me.
Relatives of the victims were hysterical and emotional. I took this photo because, to me, this is the only time a family was able to grieve—even for just a brief moment. Afterward comes the worries about where to get the money to pay for an autopsy and funeral service.
There’s always a moment of disbelief whenever we go to a crime scene and see the victim for the first time, see how they suffered at the hands of their killers. It all changes whenever a family member arrives. I don’t know if it’s the right way to do it, but I always put myself in their position: trying to imagine what they are going through in that particular moment, seeing a loved one die a horrific death. It’s still hard for me to comprehend the level of grief and anger they must feel.
This photo represents how horrible this so-called “drug war” is, and what it does to a family left behind. I always wonder how—scarred by the experience—this will affect the children when they grow up, how this will affect the whole society.
It was a humid July night, and Manila’s graveyard shift journalists had just responded to yet another police call about an alleged drug addict shot to death by vigilantes responding to President Duterte’s call to clean the streets of crime.
I knew this night was different. A police cordon blocked off journalists and bystanders, as Jennilyn Olayres grieved over the lifeless body of her partner Michael Siaron. The murderers left a sign that read “I am a drug pusher, do not copy,” as a crowd, mostly composed of Manila castaways, mingled. According to witnesses, they saw a gunman on a motorcycle driven by an accomplice shoot Siaron. Another person was wounded in the attack. T.V. floodlights and news cameras popped and flashed as the macabre scene played out in front of me.
As a news photographer it was my job to document what was happening, but a part of me that heard Olayres’s pleas for help also died a little. It was raw and gut-wrenching, but I could do nothing but press the shutter button. “That’s enough! And help us!” she cried out to media workers, authorities and onlookers.
“What are you waiting for?,” I asked a policeman, who shrugged before bluntly retorting: “We can’t do anything as he is already dead.”
Crime scene investigators subsequently arrived. To them, Siaron was just another body to be processed. It was the third extrajudicial killing I had photographed that night, and would land on the front page of the nation’s leading newspaper, the Philippine Daily Inquirer.
The area where the killings occurred earned the moniker “Patay City,” or the dead city, a play on its real name, Pasay City. A report about the night’s fourth body, slain in the same general area, came shortly after. Many of my colleagues and I hurried off, but we all had a heavy heart.
The night shift usually starts at 10 p.m. Cars fill the parking lot and journalists gather at the press corps in the Manila Police District, the main headquarters of the city cops. By then, I need to make sure all my homework and reading is done. I am still a full-time undergraduate student, but taking photos as freelancer. As President Duterte promised, change did come when the war on drugs started.
Now, my nights are spent waiting for phone calls not from my friends, but from homicide investigators. The flashing lights I see aren’t from parties, but from police sirens. And I hear the cries of grieving mothers more than the voice of own my mom.
On a full night we get an average of eight bodies. This photograph was taken after I left a fast food restaurant in Pasay City, close to midnight on Nov. 17. We see the same grief that families cry, the same look on the faces of bystanders and the same script of police answers during interviews. The only thing different are the faces of the dead, but sometimes they start to look the same as well.
Murder has became a norm and lives are as disposable as the cardboard signs that vigilantes use to label the bodies of suspected criminals. When the night shift ends, I take a nap and then rush to my first class in the morning. Sometimes, I even forget to change my shirt.
We talk about the issues in class but forget about them when the bell rings. If they only knew that the screams and cries that I hear at night are louder than that bell. If they only knew they’re walking on the pavement stained with the blood of the man stabbed 10 times last night. If they only knew the bench they’re sitting on is the exact bench the children stood on as they watched the body of their father being carried to the funeral ambulance.
If they only knew, while we spend another day in class, how the life of a family drastically changes forever. But it’s difficult, since the war on drugs hasn’t reached many of us yet.
Basilio H. Sepe
I always admired my countrymen. Not just because of their resiliency as a people, but also how they still appear to be helpful and happy even in times of despair. It is a sight to appreciate and be proud of. But something changed when the so-called war on drugs started. I have been working the night shift for the past several months and have had my fair share of coverage that brings blood and tears. It is saddening and crushing. Situations like these do tend to test the heart. I am seeing my countrymen die even if there is still hope for them to live.
It was at this wake that I knew something was horribly wrong. This was the first time I reported at a funeral. Ronnel Jaraba, 30, was found lifeless along the C3 Road in Metro Manila on Jan. 26. According to his family, he was a former drug user but stopped when he became a father of two kids. His wake took 11 days to complete due to a lack of money. There were a lot of relatives, all mourning his loss, but my attention was focused on his father, Renato. He said Ronnel was his youngest son of three.
It can’t be my child. It can’t be!
He cried, screaming along with the other relatives, and had to be ushered away by his friends so he could calm down. I didn’t realize I was crying while I was taking my shots. It came to a point that even I couldn’t take it anymore. I lowered the camera, went to a secluded place and cried.
Before I left the cemetery, I saw Renato once more. He was calmer, more collected, but I still saw the grief in his eyes. I thanked him before I left and offered my prayers. All the while I was hoping, praying, that these events would stop. It was at this moment that I realized that, as a journalist, it is moments like these that I question my humanity and the reality around me. I cannot be unaffected.
Estimated to be about 15 years old, this boy on a mortuary table in September 2016 is another life lost among the thousands killed in the government’s campaign against illegal narcotics. Witnesses say he ran when the police came to their slum community in Tondo, a district in Manila, and that police opened fire.
He survived the volley of bullets but died on the operating table a few hours later. Nobody came to the hospital to claim and identify the boy.
To me, he represents the thousands who have been killed. He came from the poor sector, maybe with no or little education. He was faceless, voiceless and would not complain of his rights when being violated.
He is just another statistic, another number, another accomplishment report for authorities that claim to be just doing their job.
Hannah Reyes Morales
This photograph was taken during Jhay Lord Clemente’s funeral in Manila on Sept. 18. Jhay Lord was shot with his girlfriend Marlyn; when they found the body his dog was there, sitting quietly beside Jhay Lord. The wake took place outside the building where they lived. Their family had shirts and streamers bearing his photo, with the words “We will love you,” “We will miss you” and “Justice.”
Jhay Lord’s story was among my very first encounters on the bloody “war on drugs.” When he died his family could not afford his burial, so I helped them collect enough donations to bury him. But the deaths continued, and more and more families continue to go in debt for burials. There is very little support for the families of those who died.
His sister Jenny Ann, a domestic worker in the Middle East, could not afford to come home to see her brother’s burial. Instead she had to mourn over a video call. On Facebook, she posted a screenshot of her call with her brother’s body. The caption read, “It’s a shame we don’t have a pic together, Kuya (big brother). But the image of your face won’t leave my mind and heart. This is the only photo I have now—it’s a pity it had to be like this.”
Over Facebook, she asked for the photographs of her brother’s body when it was found on the streets, trying to imagine what his death was like. She grieves on her own.
On Oct. 6, I shadowed a police operation known as “Tokhang”—a portmanteau of the words “Toktok” (knock) and “Hangyo” (plead)—at a community of squatters in the Delpan area of Manila. The idea is to knock on a suspected drug user’s house, then the police will plead with him or her to stop or undergo rehabilitation. What I witnessed was different.
The policemen, with guns drawn, would kick each house’s door in and arrest suspicious-looking residents. Without any initial gunshots being heard, the police said that three residents were discovered sniffing shabu—a local name for methamphetamine—and that they had fired at the officers, who retaliated. Then three brothers were suddenly dead.
As a photojournalist, we should always be neutral. It’s hard, as everyone has opinions on different things. It sometimes depends on one’s upbringing, religious belief or the community where the photographer grew up.
After that police raid, I’m not sure if I can still be neutral.
I was already on my third week of covering the nightly killings and police operations involving the so-called “war on drugs” when I arrived at a scene of mass arrests in Quezon City.
It was near midnight and hundreds of alleged residents suspected of using or dealing illegal drugs were lying on the floor of a basketball court inside the police headquarters. Men and women, young and old, all huddled together to get some warmth as they laid down on the cold slab of concrete. Some were already asleep, while others were queuing around tables getting their fingerprints taken and getting “processed.” It brought back memories of images I saw at the concentration camps in Germany.
I asked some of them what they were here for, but they didn’t know. All they knew is that the police came in their communities and loaded them up in vehicles. I asked why did they allow their arrest if they were not doing anything wrong? An old man replied, “how can you argue with someone who is more stronger and have guns?”
This was the very first time I stopped and pondered. What if one of these people was someone I know: a friend, a relative perhaps, or even me? I wondered how this new norm would be for all of us.
I approached the crime scene in Tugatog Public Cemetery in Malabon on Oct. 21 with my heart beating fast and my mind bracing for horror. It was the same place I first covered a crime scene—a cemetery forever marked in my head with memories of terror and trauma.
I expected a dead body with packs of meth, a gun, blood and gore—criteria that seem to be a template in most reports on the drug war. But a ravaged body of a seven-year old girl—raped and killed beside a grave—turned up instead. Near the body was her grieving father, turned mute by pain and anguish.
Police say the rapist was the father’s friend, a drunk and alleged drug addict. They say he is the very justification of the drug war that takes away thousands of lives and violates human rights. That night, I felt our months-long efforts to humanize and seek justice and sympathy for the victims of the killings were made useless. That night, evil won.
Suddenly, the killings seemed reasonable. Suddenly, I was hoping someone would shoot this man dead—the way cops and vigilantes ruthlessly killed the others. Forget due process, forget a trial. I became exactly like the monsters I fought and hated.
Until I realized you cannot use one crime to justify a thousand others.
One night last September, we got information through radio reporters that a killing had occurred in the southern part of Manila. We had just came from another crime scene so we had to race there quickly as we didn’t know if the area was already cordoned off by police. When I arrived, police were already there. It was crowded with onlookers and journalists.
I noticed there were two women looking at the scene in an adjoining alley. I walked under the police line to get near them. When I got there I realized they were the next of kin of the victim: a man who we later learned had nothing to do with drugs, but was killed when masked men with long firearms barged into their home and forcibly dragged him onto the street and shot him.
The two women with fear and uncertainty in their eyes are emblematic of every crime scene we come across every day. The drug war has created a disconnect and fear in the communities and has actually made things the opposite: people are afraid of going out at night not because of petty crime and drugs, but because of the police and death squads roving the streets.
This may not be the most striking or tragic picture that has come out of the killings but this scene, for me, best represents how I feel about the drug war. In mid-August, it shows the bodies of Paul Lester Lorenzo and Danny Laurente being hauled away in a makeshift trolley along a railroad after they were shot dead by police, in what they called an anti-drugs operation.
Residents used a trolley because the bodies could not be reached by the mortuary ambulance. After the bodies were loaded into the trolley, myself and other photographers jumped onto another trolley and rode alongside as we took pictures.
It felt very surreal. A trolley that is normally used by commuters as a cheap alternative to riding the train or bus was now being used to carry lifeless bodies.
I have covered around 200 killings since the drug war began. Everyday scenes in my hometown are now turning into tragic ones. Whenever I go for a drive around town, many places only remind me of the killings.
Kimberly dela Cruz
It’s tradition for us Filipinos to have someone watch over the casket during the wake of a loved one. It goes on for days until the money needed for the funeral is raised or everyone in the family has said their goodbye. When I took this photo of Dalisay dela Cruz, I was coming out of the house, having seen the bed where her grandson Noel Navarro used to sleep with his kids.
The light was beautiful and I was thinking of what she told me just moments ago, on how the night he died she was woken up from her sleep from the next room, hearing the commotion of a police operation. She said her grandson was pleading for help, for his daughter. She saw it through a hole in the wall; the cops punched him a couple of times before they shot him.
At 75, Dalisay was the breadwinner of the family, selling vegetables. What little money her grandson used to earn from horticulture, he spent on his kids. They couldn’t proceed with the burial because her son and Noel’s brother were arrested that night. They were struggling to raise money for bail and the funeral. During the wake, she showed me the handful of seeds her grandson gave her the day he died. They have grown into sprouts.
Published on Feb. 23
Andrew Katz is TIME’s International Multimedia Editor. Follow him on Twitter @katz.
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Alcohol marketing and drunkenness among students in the Philippines: findings from the nationally representative Global School-based Student Health Survey
1School of Public Health, Georgia State University, P.O. Box 3995, 30302-3995, Atlanta, GA, USA
2National Epidemiology Center, Department of Health, Manila, Philippines
Monica H Swahn: ude.usg@nhawSM; Jane B Palmier: moc.liamg@reimlapenaj; Agnes Benegas-Segarra: moc.liamg@sagenebsenga; Fe A Sinson: moc.oohay@1002nosnisf
Author information ►Article notes ►Copyright and License information ►
Received 2013 Jun 24; Accepted 2013 Nov 26.
Copyright © 2013 Swahn et al.; licensee BioMed Central Ltd.
This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC.
A largely unaddressed issue in lower income countries and the Philippines, in particular, is the role of alcohol marketing and its potential link to early alcohol use among youth. This study examines the associations between exposures to alcohol marketing and Filipino youths’ drinking prevalence and drunkenness.
Cross-sectional analyses were used to examine the Global School-based Student Health Survey (GSHS) conducted in Philippines (2011). The self-administered questionnaires were completed by students primarily 13 to 16 years of age (N = 5290). Three statistical models were computed to test the associations between alcohol marketing and alcohol use, while controlling for possible confounding factors.
Alcohol marketing, specifically through providing free alcohol through a company representative, was associated with drunkenness (AOR: 1.84; 95% CI = 1.06–3.21) among youths after controlling for demographic and psychosocial characteristics, peer environment, and risky behaviors. In addition, seeing alcohol ads in newspapers and magazines (AOR: 1.65, 95% CI = 1.05–2.58) and seeing ads at sports events, concerts or fairs (AOR: 1.50, 95% CI = 1.06–2.12) were significantly associated with increased reports of drunkenness.
There are significant associations between alcohol marketing exposure and increased alcohol use and drunkenness among youth in the Philippines. These findings highlight the need to put policies into effect that restrict alcohol marketing practices as an important prevention strategy for reducing alcohol use and its dire consequences among vulnerable youth.
Keywords: Alcohol, Alcohol marketing, Drunkenness, Philippines, Survey
Alcohol use is the most commonly used psychoactive substance in the world and is one of the leading causes of death and disability . Alcohol abuse causes 3.2% of all deaths worldwide annually and also accounts for 4.0% of the global disease burden each year . Research has shown that alcohol use is associated with alcohol addiction , other drug use , unintentional injuries [3,5], physical fighting , criminal activity , suicidal ideation and attempts [7-9], and increased risk of HIV/AIDS [10,11].
In order to address this global public health issue, the World Health Organization (WHO) recently prioritized the global reduction of the harmful use of alcohol . Even with limited data, it is still evident that low and middle-income countries bear a disproportionate public health burden due to increasing alcohol consumption and limited or non-existent prevention policies and programs .
Alcohol use among youth is affected by a range of psychosocial and environmental factors. Relatively recent research has increasingly focused on the role of exposure to alcohol marketing broadly defined and its influences on youth drinking in particular. However, such research has been largely limited to high income countries, with a few exceptions [13-17].
Intriguingly, research on the predictors of alcohol use and its adverse outcomes among youth is scarce in the Philippines. Data from the WHO indicates that almost 9% of the Philippines population who are 15 years of age and older (estimated at 86 million) have an alcohol use disorder . In addition, 25% of males and 8.3% of females (15-85+ years) are heavy episodic drinkers . A related and also largely unaddressed issue in the broader Western Pacific region, and the Philippines in particular, is the role of alcohol marketing and its potential link to early alcohol use among youth. Since the 1990s, concern has grown about heavy drinking and alcohol-related harm, and the link with the growth in alcohol marketing that targets young people [19,20]. In the Philippines, new marketing strategies for beer and spirits are now being used to target youth and women, particularly by the large local companies, Asia Brewery and San Miguel Corporation . Although the Philippines has a national legal minimum age for off and on premises sales of alcoholic beverages  and a recently enacted drunk driving law , there are no restrictions on the marketing of such alcoholic beverages to youth and minors. A high proportion of marketing expenditures are on non-media forms of promotion . Alcohol company sponsorship of sports and cultural events is a major marketing strategy, which is under-researched and rarely addressed by policy makers . Sponsorships at sports events in particular (which attract more young people) provide promotional opportunities that imprint brand names and products on young consumers and potential consumers . Direct marketing includes brand promotions at venues or retail outlets at which drinkers can be approached directly, or creating the brand’s own events at which the public or invited customers attend. New brands and products, such as ready-to-drinks (RTDs) are often launched in this way to give people an opportunity to sample the product .
Analysts of the Asian alcohol markets describe RTDs as a starting point for young consumers moving from non-alcoholic beverages to alcoholic drinks. Growth in RTDs is anticipated in the Philippines among women and new young drinkers . Marketing of RTDs in the Philippines began on a small scale but volume sales increased markedly as local companies began to compete with the imported brands led by Diageo Philippines Inc. . There is intense competition between global alcohol companies such as Diageo, Heineken, Carlsberg, Anheuser Busch, SABMiller and Kirin to position themselves to get a share of the emerging markets in the Western Pacific region. Review of recent corporate reports of global alcohol companies shows that the strategy is to target growing countries with high youth populations .
In two of the few studies conducted on exposure to alcohol marketing among youth in a low income country, findings demonstrate that alcohol marketing, specifically through the provision of free alcohol to school-attending youth (ages 13–16), is relatively common in Zambia (30%)  and among vulnerable service seeking youth in Uganda (27.0%)  and that this form of marketing is associated with problem drinking and drunkenness [23,24]. Previous research conducted primarily in North America and Europe shows that exposure to alcohol advertising and ownership of alcohol promotional items has been found to increase the risk of alcohol use among adolescents [14,25]. Moreover, based on extensive research, it is clear that alcohol marketing also influences youths’ attitudes and perceptions about alcohol, which are related to expectancies and intentions to consume alcohol beverages [26,27]. In addition, youth who report liking alcohol advertisements are also more likely to use alcohol [28-30]. More troubling is the issue of the long-lasting effect of alcohol marketing exposure. As an example, research shows that exposure to alcohol advertising in youth predicts youth’s intentions of alcohol consumption up to two years later .
The totality of previous research indicate that alcohol marketing to youth is a growing public health concern and that this problem may be exacerbated among youth living in countries with limited alcohol policies and self-regulation by the alcohol industry [32,33]. This may be the case because of the resources available to the alcohol industry to promote their marketing efforts. Alcohol Justice (formerly the Marin Institute) is a group dedicated to respond to the alcohol industry and their marketing practices primarily in the U.S. They report that the alcohol industry spends more than $6 billion each year on marketing its products . Unfortunately, many alcohol marketing practices are aimed directly at youth and those that are outside of the home (e.g., billboards, advertisements at sports events and concerts, buildings, newspapers and magazines, and on the internet) pose particular concerns because parents cannot typically shield their children from those exposures . However, spending on these forms of marketing, labeled “out-of-home advertising” have increased by billions in recent years . Alcohol advertising and marketing of alcohol products clearly increase intent to use as well as actual alcohol use among adolescents [26,27,29,30]. Additionally, recent research shows that youth are more exposed to alcohol marketing than adults and need stronger protections . The increased use of digital media is set to make matters worse. Alcohol marketers are rapidly using social networking for their campaigns, and such media is used more heavily by young people which will likely exacerbate their exposure to alcohol marketing .
The purpose of this study is to examine the prevalence of alcohol marketing exposure in a nationally representative sample of youth in Philippines and to examine if there are significant associations between alcohol marketing and drunkenness among Filipino youth. Findings from this study will be important for prevention and intervention efforts that seek to reduce alcohol use and adverse health consequences among youth.
The current study is based on the Global School-based Student Health Survey, conducted in Philippines in 2011 among students in grades 1st-4th (N = 5290). The GSHS was developed and supported by the World Health Organization in collaboration with the United Nations Children’s Fund, the United Nations Educational, Scientific, and Cultural Organization, the Joint United Nations Programme on HIV/AIDS, and with technical assistance from the Centers for Disease Control and Prevention . The goal of the GSHS is to provide data on health behaviors and relevant risk and protective factors among students across all regions served by the United Nations. Country specific questionnaires, fact sheets, public-use data files, documentation and reports are publicly available from the Centers for Disease Control and Prevention and the World Health Organization .
The GSHS is comprised of a self-administered questionnaire, administered to students primarily 11–16 years of age. The survey uses a standardized scientific sample selection process, common school-based methodology, and a combination of core questionnaire modules, core-expanded questions, and country-specific questions. The Philippines GSHS employed a two-stage cluster sample design to produce a representative sample of students in 2nd-4th year levels of Secondary Education or High School. The first-stage sampling frame consisted of all schools containing any of 2nd-4th year levels. Schools were selected with probability proportional to school enrollment size. The second stage of sampling consisted of randomly selecting intact classrooms (using a random start) from each school to participate. All classrooms in each selected school were included in the sampling frame. All students in the sampled class rooms were eligible to participate in the GSHS .
Survey procedures were designed to protect students’ privacy by allowing for anonymous and voluntary participation. Students completed the self-administered questionnaire during one class period and recorded their responses directly on computer-scannable questionnaire answer sheet .
The current analyses are based on the restricted data file that includes an expanded list of questions. The school response rate was 97%, the student response rate was 84%, and the overall response rate was 82%. A total of 5290 students participated in the Philippine survey . The sample consisted of 2,279 males and 2,986 females, and of the following age groups: 11 years old or younger (n = 20), 12 years old (n = 205), 13 years old (n = 980), 14 years old (n = 1,350) 15 years old (n = 1310) and 16 years old or older (n = 1384).
The alcohol marketing factors examined were seeing alcohol advertisements at sports and public events, during sports on TV, on billboards, in newspapers and magazines, seeing actors drink, possessing alcohol brand logo and being offered alcohol from an alcohol company representative. Responses to these questions were dichotomized to indicate any exposure versus none for each of the seven marketing variables (Table 1). The analyses controlled for the following potential confounders (all dichotomized): current alcohol use, bullying victimization, lack of friends, missing school, and illicit drug use (Table 1). Drunkenness, the outcome measure, was assessed through students’ reports of the number of times they had gotten drunk during their lifetime on a 4-item scale ranging from 0 times to 10 or more times. Responses to the outcome measure were dichotomized to reflect none versus at least one episode of drunkenness during lifetime.
Variable name, description and prevalence of variables examined in the GSHS study of Philippine school students (2011)
Logistic regression analyses were computed to determine the associations between alcohol marketing exposures and drunkenness using a 3-step model-building strategy. Model 1 included sex, age, alcohol use in the past 30 days, and usual amount of alcohol use. Model 2 included variables from Model 1 along with bully victimization, lack of friends, missing school, and illicit drug use. Model 3 included variables from Model 1 and Model 2, in addition to factors relating to alcohol marketing, such as seeing alcohol ads at sports events, fairs or concerts, or on TV, seeing actors drink, alcohol advertisements on billboards, and in newspapers and magazines, being offered alcohol from an alcohol company representative and having a brand logo item.
Analyses were conducted with the SAS 9.1 and SUDAAN 10 statistical software packages to accommodate the sampling design, and produce weighted estimates. IRB approval was obtained from the Georgia State University to conduct these analyses.
The prevalence for each variable examined in this study is outlined in Table 1. Among participants, 23.3% reported current alcohol use and 20.7% reported drunkenness. The bivariate associations between sex, age, and alcohol marketing with current alcohol use, and drunkenness are presented in Table 2. Boys were more likely than girls to report current alcohol use or drunkenness. Youth 16 years of age or older were also more likely to report alcohol use or drunkenness. Exposures to alcohol marketing through seeing actors drinking alcohol on TV, alcohol brand advertising during sports on TV, on billboards, possessing items with an alcohol brand logo and being offered alcohol from an alcohol company representative were associated with increased reports of current alcohol use. All forms of alcohol marketing exposures significantly increased risk for reports of drunkenness, except for newspapers/magazines. Seeing actors drinking on TV significantly increased reports of current alcohol use (OR: 1.48, 95% CI = 1.17–1.87), and drunkenness (OR: 1.25, 95% CI = 1.05–1.49). Seeing alcohol ads on billboards also significantly increased reports of current alcohol use (OR: 1.32, 95% CI = 1.09–1.59), and drunkenness (OR: 1.21, 95% CI = 1.09–1.36). Seeing alcohol ads at sports events, fairs or concerts significantly increased reports of drunkenness (OR: 1.71; 95% CI = 1.27–2.30). In addition, being offered free drinks through an alcohol company representative significantly increased reports of current alcohol use (OR: 2.22, 95% CI = 1.57–3.13), and drunkenness (OR: 2.17, 95% CI = 1.47–3.22). Alcohol marketing through receipt of brand logo items significantly increased reports of current alcohol use (OR: 1.86; 95% CI = 1.53–2.27), and drunkenness (OR: 1.43; 95% CI = 1.23–1.67).
Bivariate associations between demographic characteristics, alcohol marketing, and drunkenness among participants in the Philippine GSHS Study
Multivariate analyses presented in Table 3, show that current alcohol use was the strongest correlate of drunkenness across the three models computed. In Models 2 and 3, having missed school and other drug use were also associated with increased reports of drunkenness. In Model 3, which examined the potential role of alcohol marketing factors, having received free alcohol from a company representative was significantly associated with drunkenness after controlling for demographic characteristics, personal competencies and peer environment (AOR: 1.84, 95% CI = 1.06–3.21). In addition, seeing alcohol ads in newspapers and magazines (AOR: 1.65, 95% CI = 1.05–2.58) and seeing ads at sports events, concerts or fairs (AOR: 1.50, 95% CI = 1.06–2.12) were significantly associated with increased reports of drunkenness.
Multivariate logistic regression analyses of the associations between demographic characteristics, alcohol marketing and drunkenness among participants in the Philippine GSHS (2011)
This study examined the prevalence of exposure to alcohol marketing practices among nationally representative school-attending youth in the Philippines, and whether exposure to alcohol marketing is associated with drunkenness. The findings show that there is a high prevalence of exposure to different forms of alcohol marketing strategies. The most commonly reported exposures were seeing alcohol use by actors, seeing alcohol name brands at sport events or on TV and seeing billboards with an alcohol advertisement. However, the form of alcohol marketing that appears particularly troubling is provision of free drinks by alcohol companies directly to youth which was reported by 10% of the students. Moreover, receiving free alcohol from alcohol companies remained associated with drunkenness in multivariate analyses indicating that it appears to be a relatively robust risk factor for alcohol misuse. This issue regarding providing free drinks to youth has been observed in other countries  and warrants attention by researchers and policy makers.
It is clear from previous research that direct marketing of alcohol products increases alcohol use and problems among youths and those findings are corroborated by the findings in the current study. The results of this study indicate a high prevalence of current alcohol use (23.2%) and drunkenness (20.7%) among the school-attending youth in the Philippines., in addition to a very strong association between current drinking and drunkenness. Our findings are also supported by research in the U.S. that shows that distributing alcohol merchandise to youth predicts their alcohol use . In this study, nearly 15% of youth reported owning an item with an alcohol logo on it. However, owning an item with an alcohol brand logo on it was not associated with drunkenness.
The findings of this study show that alcohol marketing strategies in the Philippines through providing free alcohol to youth and through print and television media appear to reach a relatively large population of youth. These findings regarding the association between provision of free alcohol to youth and self-reports of drunkenness, mirror those conducted in Sub-Saharan Africa . These alcohol marketing practices, aimed directly to children, have been banned in other countries and have important policy implications for countries where such bans do not exist. The implications of the empirical findings from the current study clearly indicate that stricter policies to prevent underage alcohol advertisements are needed. Such measures need to be urgently considered and applied given the frequency and levels of exposure to alcohol marketing, in particular, the free distribution of alcohol to youths, as observed in the current study.
The timing is critical for new policy initiatives and prevention strategies aimed to reduce alcohol use among adults and youth . Recent reports by the alcohol industry indicate that they will produce and sell cheaper alcohol to Asia and African markets in order to increase its consumer market . The goal of targeting low-income consumers and creating affordable brews will be achieved through using local ingredients, and also utilizing inexpensive individual-sized packaging to make purchasing alcohol more affordable . Previous research clearly highlights that affordability of alcohol is strongly linked to alcohol use , and that these new industry strategies are likely to have a negative impact on alcohol use and alcohol-related adverse outcomes among youth in the Philippines and the Western Pacific region.
Policy and intervention suggestions for agencies provided by the World Health Organization to counteract alcohol marketing and reduce harmful effects of alcohol use include regulating alcohol marketing content and the volume of marketing, regulating marketing in media and sponsorship activities of alcohol industry, restricting or banning alcohol promotions targeting young people, regulating alcohol marketing techniques like social media, developing effective surveillance systems to monitor alcohol marketing, and enforcing marketing restrictions . More research is necessary regarding the exposure of youth to alcohol advertising and levels of consumption to gain formative information needed to counteract these marketing influences and inform policy makers to support and implement such strategies.
The WHO has taken an important leadership role related to underage drinking prevention in their Report on the Seventh Meeting of the Regional Advisory Panel on Impacts of Drug Abuse: Technical consultation on the global strategy to reduce the harmful use of alcohol . Per the Report, mandatory as well as voluntary regulations of marketing of alcohol products need to be considered and included in a comprehensive strategy to reduce the harmful use of alcohol. The Report also underscores that these measures need to be urgently considered and applied given the frequency and levels of exposure to alcohol marketing, in particular, the free distribution of alcohol to youths, as observed in the current study.
Although regulation of alcohol marketing to youth has been scarce in low and middle income countries, some progress is currently underway to enact policy in this area. . In Zambia, bans have recently been implemented against the manufacturing and sale of strong liquor individual- sized sachets sold at very low prices, often in unlicensed bars and to minors . Moreover, a recent commentary recommends that there should be a total ban on alcohol advertising in South Africa [42,43]. Additionally, the South African Minister for Social Development, Bathabile Dlamini, has stressed the need for restricting alcohol advertising in the country, in order to reduce the burden of social and health consequences of binge drinking among South Africans . Researchers who have modeled the effectiveness of a ban on alcohol advertising on youth drinking in the U.S. found that among interventions shown to be successful in reducing youthful drinking prevalence, advertising bans appear to have the greatest potential for premature mortality reduction . Another study performed an econometric analysis using data from the National Longitudinal Survey of Youth and estimated that a 28% reduction in alcohol advertising would reduce adolescent monthly alcohol use from 25% to between 24% and 21%, and would reduce adolescent binge drinking from 12% to between 11% and 8% . This study also concluded that a total ban on all forms of alcohol marketing would results in further decreases in alcohol use and binge drinking among youth .
These same economists performed a study of 20 countries over 26 years and showed that a ban on all alcohol advertising could reduce underage monthly alcohol participation by about 24% (almost as much as a 100% increase in alcohol prices) and would reduce binge drinking by about 42% .
There are several limitations that should be considered when interpreting the findings of this study. First, the study is based on self-reported data of students in the Philippines. Accordingly, the findings may not be generalized to other populations or to youth who are no longer in school. Second, while our findings show statistically significant associations between marketing practices, other correlates, and drunkenness, more specific temporal ordering cannot be determined, nor can causality be inferred. Finally, the study did not include specific measures of other marketing strategies and educational experiences or other factors that may influence or confound the associations observed between alcohol marketing and drunkenness.
This study demonstrated that there are significant exposure to alcohol marketing and that this exposure is associated with alcohol use and drunkenness among school-attending youth in the Philippines. These findings highlight the need for leaders to prioritize implementation of policies that limit alcohol exposure and that restrict alcohol marketing practices as important prevention strategies for reducing alcohol use and its adverse health consequences among youth in the Philippines.
The authors declare that they have no competing interests.
MHS conceptualized the study, guided the analyses and drafted sections of the manuscript. JBP conducted the literature review and drafted sections of the manuscript. ABS led the acquisition of the data and provided contextual information. FAS led the acquisition of the data, and interpreted and reviewed analyses. All authors reviewed multiple versions of the manuscript and read and approved the final manuscript.
The authors thank Huang Yao M.A., M.S. for her contribution to the analyses of this manuscript. We greatly appreciate her dedication and assistance in the data management and analysis for this study as Dr. Swahn’s Graduate Research Assistant while a graduate student at Georgia State University.
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