One Nation to Prevent Alcohol Abuse- “Embrace and Respect Our Island Cultures”, A Counter Marketing Alcohol Prevention Campaign Involving Youth, Policy and Formative Research Methods to Change Social and Environmental Norms On Guam

Background: Alcohol abuse is both a public health problem and a cultural challenge in Guam.  Epidemiological data indicate that 36% of high school youth are current drinkers and 19% engage in binge drinking –Chamorro and other Micronesian youth having the highest rates.  Among adults, 43% are current drinkers.  Alcohol is implicated in close to one-third of all suicide-related incidents.   Focus groups among youth uncovered a prevailing misperception that alcohol is part of the “true Pacific island culture,” with alcohol consumption linked to traditional cultural practices of islander hospitality, and parental role modeling. 

Program background: Guam’s Department of Mental Health & Substance Abuse (DMHSA), Prevention & Training Branch was awarded the 5- year Strategic Prevention Framework State incentive grant (SPF-SIG) by the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Prevention (SAMHSA CSAP) in October 2004 to build local capacity and infrastructure for science-based prevention, with alcohol abuse prevention as a priority.  

Evaluation Methods and Results: Working through community coalitions, DMHSA aligned the 5-step Strategic Prevention Framework (SPF) with the Precede-Proceed model to develop a situational analysis, intervention and evaluation plan to change the social acceptability of alcohol abuse.   A popular social marketing campaign entitled “Taotao Bud” (Bud People or Bud Nation) was identified as a major enabling factor reinforcing the widespread acceptability of alcohol abuse as part of the Pacific Islander culture.  This campaign uses cultural identity, valued images and concepts to promote the consumption of beer; Beer cans were stamped with the names of each of the Micronesian islands (e.g. “Bud Guam”).  Using community-based participatory methods, a counter-marketing campaign was developed following CDC’s Health Communication process, using multi-level strategies that disassociated the Pacific Islander culture from alcohol consumption.  The “One Nation Campaign” evolved as Guam’s counter marketing response to the “Taotao Bud” campaign. The underlying theme is “One Nation to prevent alcohol abuse: Embrace & Respect our island culture & families.”  The campaign utilized educational outreach, media advocacy and community mobilization with a cross-representation of local spokespeople (youth, elders, military, lesbian/gay/bi-sexual/transgender (LGBT) college students, musicians, and Micronesian families) to re-shape the policy and social environment. 

Conclusions: The One Nation Campaign was successful in raising Guam’s minimum legal drinking age from 18 to 21 years and establishing alcohol-free parks and beaches.  In 2008, the Association of Pacific Island Legislators (APIL) adopted a resolution calling on the alcohol industry to cease and desist using the “Taotao Bud” campaign as it “inaccurately suggests that these islands are peopled by alcoholics and unceasing drinkers of Budweiser; …and that this description is derogatory and racist.”  Today, the Bud Nation beer cans are not found at local stores; and there is a growing acceptance of alcohol-free family activities and youth pledging to be alcohol-free.

Implications for research and/or practice: Guam’s “One Nation” campaign, founded on sound theory demonstrated the effectiveness of social marketing, media advocacy and community mobilization in achieving environmental change to re-shape social norms in relation to alcohol abuse.  Undertaken within a resource-challenged setting, it presents a feasible model that other islands and jurisdictions can replicate.