GIS Mapping: Alcohol Outlet Density
Urban Site
The size of the urban site was estimated at 13.7 square kilometer (km2). A total of 147 licensed alcohol selling outlets were mapped within this area (see Fig. 1). Sixty five percent (65%) of the outlets (n = 95 ) were taverns/pubs or bars with the bulk of the remainder being liquor stores (n = 50) and two restaurants. Thus a total of 10.7 outlets were mapped per square kilometer. The ratio of an alcohol outlet to population was 1:438 with between 2 and 5 outlets per main road.
Twenty-four percent of the outlets did not have a sign for the legal age for alcohol consumption while only 3% posted their operating hours on the exterior of the buildings. Seventy-six percent (76%) had some form of advertisement outside of the venue. There were 15 stand-alone billboards and posters in the streets.
A total of 74 educational venues were mapped. These comprised 21 primary schools, 11 senior/secondary schools, one Further Education and Training College (Technical Training), two public libraries and 39 day care centers. Figure 2 presents a 500 m radius around each school since this is the proposed legal distance allowed for outlets to be situated away from educational institutions. This shows that almost all alcohol selling outlets are within a 500 m radius to schools—the minimum distance was 10 m.
Rural Site
The rural site total area was estimated at 17.6 km2. A total of 28 licensed alcohol selling outlets, 25 (89%) taverns and three liquors stores were mapped (see Fig. 3). There were 1.5 outlets per square kilometer. The ratio of an alcohol outlet to population was 1:743 with at least one outlet per tarred main road. A quarter of the outlets had a sign for the legal age while none had a sign with operating hours on the exterior of the buildings. Ninety-two percent (92%) had some form of alcohol advertisement outside of the venue. No stand-alone billboards and posters were found in the rural site.
A total of 11 schools were mapped—six primary and five secondary. No libraries could be found during the mapping exercise. Figure 4 indicates that 22 of the 28 outlets (79%) were within a 500 m radius to schools, closer than the legal distance. The minimum distance was 100 m and the maximum 700 m. Thirty-two percent (32%) of the alcohol-selling outlets sold groceries or had a grocery shop on the same premises, thus facilitating easy access of alcohol during school breaks.
Photovoice
A total of 27 youth participated in all the photovoice activities; 13 (six females and seven males) in the rural area and 14 (six females and eight males) in the urban area.
Alcohol Availability
The mapping findings were supported by the FGD data, with participants indicating that taverns and schools co-existed in close proximity. Figure 5 is a photograph of the proximity taken by youth in the urban site. According to the youth, underage drinking is widespread, including during school hours. In both communities, youth reported that alcohol was widely available to them through easy access to taverns where age verification checks were absent and youth below age 18 years were easily able to purchase alcohol.
Even though the rule is ‘not for sale for persons under 18’ but still if you can look around, like go around the taverns at night or like uhm… daylight… Not everybody is above the age of 18. These people [traders] they care about money not by how our lives get ruined by alcohol [All agree] (Male, mixed gender group, rural site).
There are schools and taverns like in the same street … the fact is we are exposed to it like in our daily lives (Female, mixed gender group, urban site).
Youth reported that it is easy to sneak alcohol onto school premises as there is no monitoring or checking of students as they enter the school premises. Alcohol sellers make little effort to dissuade underage purchase of alcohol. Youth spoke about purchasing alcohol during break time since it was sold at the same shop where they bought their lunch.
[They buy at] taverns obviously and most of the taverns are near the schools so it’s easy, even during break time (lunch) it’s easy for me to get alcohol… at the taverns! And [the students] hide it… (Male, mixed gender group, rural site).
The Influence of Alcohol Pricing on Youth Drinking Behavior
Alcohol is affordable to youth even if unemployed or with little available cash. This is enabled by discounts, such as the ubiquitous “Ladies’ Night” which happen at outlets regularly:
Female: “They say Ladies’ Night because ladies get their alcohol for free. Facilitator: And then the guys buy their own…? Female: Yes, hence they call it Ladies’ Night! Facilitator: And do you get a lot of girls there in attendance? Female: Yes… Yho, the whole community! Even if you are 14 years, as long as you’re a girl you get in and get your free drink.” (Mixed gender group, rural site).
Affordability is also enhanced by incentives and competitions where the more you buy the advertised product, the more you stand a chance to win various prizes, discounts and specials such as ‘return and save’ where bottles returned lead to a discount for the next drink. This perception of saving encourages purchases of the alcohol. Figure 6 shows a photograph taken by a young person in the rural site.
Female: “…Do you see there on top…it shows you that you bring back the bottle and maybe they give you back R3?… Yes, you get R3 and you may have spent only R10! Facilitator: Aah, so looking at this as a young person, would you want to buy it? Female: It is not our stuff but that return for deposit is pretty impressive… Male: You would [want to buy it].” (Mixed gender group, urban site).
The Influence of Alcohol Marketing on Youth Drinking Behavior
Youth are exposed to multiple forms of alcohol marketing. These include sports sponsorship, television, social media, outdoor advertising (billboards and posters), competitions and promotional events such as comedy and music shows.
The advertisements on the billboards that we see around when maybe you are travelling… It’s the thing that attracts us to alcohol… it’s like uhm… they are not showing the negative effects. And if you watch Generations on TV for an example, when it goes to an advert, maybe 3 or 4 of those adverts, it’s alcohol… (Male, mixed gender group, rural site).
Female 1: So there are Facebook pages where there are competitions for example you would win a phone or what what. So you become eager and drink the [brand name removed] to a point of being so drunk so you can win that phone… Female 2: Others they share on the Facebook. The thing is you will get a notification of some promotion. Without your knowledge of how or why, you just get a notification that it [promotional event] is happening at such and such a place. So [even] if you do not follow their page then they will notify you of what what event!” (Female group, urban site).
Female 1: “Yes, we find them on the newspapers, magazines or so but here … is a rural area and not everybody can afford a newspaper or a magazine but most households have television. So, that’s where we get most of the information. Female 2: Yes, yes!! Female 3: Even on social media… they say on Facebook and Twitter! Male: Instagram…Twitter. Female 3: Facebook, Instagram, Twitter.” (Mixed gender group, rural site).
When reflecting on specific alcohol adverts from the media and within their local communities, it emerged strongly that youth perceive them as enticing and appealing, making them want to try the advertised beverages. Figure 7 shows a photograph taken by a young person in the rural site.
… So, you want to go for it and taste this thing and once you taste, you will end up being drunk and you want to do that forever. So, advertisements are the ones that bring us to alcohol or lead youth to alcohol (Male, mixed gender group, rural site).
Other elements of the adverts that attracted youth were bright colors, bold fonts, popular music, creative and enticing slogans and appealing images, scenery or settings such as the beach and ice to refresh.
Female 1: “People who sell alcohol, they make alcohol to seem like a cool thing… look at their facial expression as well, you know it seems like this thing makes them happy… another thing is that people advertising alcohol, make these cool slogans… Male:…Attractive! Female 1: Ja, they make them in bold letters and the important message is put in small letters…” (Mixed gender group, rural area).
Youth also indicated that alcohol adverts play on young people’s aspirations for the future. Advertisements often linked alcohol to ambition or success.
Male 1: “Ooh well. Yah! Alright yah, it means like, it means if you drink this one, like you dream big. Like you have that mindset of, your mind like it starts to open up to see bigger things. Yah you have a bigger picture in your mind after you have drank. Male 2: And you would say again like ‘Brewed for the dreamers” If you have dreams and then it gives you the courage to take action towards achieving your dreams. You see neh!” (Mixed gender group, urban site).
Participants highlighted the gendered nature of alcohol marketing. Sweet and colorful Alco-pops (flavored alcohol) and cider were seen to target young women by using attractive women in advertisements. On the other hand, men were targeted through beer adverts using symbols portraying conventional notions of masculinity such as strength, success and aspiration. Often colors reflected the target audience with softer and brighter colors for women and darker colors for men. Finally, youth in our study readily pointed out that these adverts were blatantly misleading. Based on their own observations and experiences, drinking was not always a fun and rewarding experience.
Male 1: “They are not showing the bad effects of alcohol, also… and obviously there will be fights, there will be one night stands after everything…Male 2: They are not showing the consequences…they are only showing the positive part that with alcohol there will be fun… And they don’t tell you…Female 1:… what happens after the fun. Male 2: …they don’t show you what happens after the fun ends.” (Mixed gender group, rural site).
Alcohol, High-Risk Sexual Behavior and Sexual Assault
The youth who participated in this study in both urban and rural areas clearly identified the link between alcohol consumption and risky sexual behavior. They indicated that alcohol commonly led to dis-inhibition, sex that was later regretted and unprotected sex. They also reported poor decision making after consuming alcohol, which included decisions about who they go home with and the decision to have sex. Sexual dis-inhibition after drinking at taverns was reported as a common experience by young women who said they would have made different choices had they not consumed alcohol and sometimes later experienced confusion as to the consensual nature of the sexual encounter. Having unprotected sex when drunk was also common since using condoms was often overlooked, sometimes due to a diminished ability to negotiate condom use when intoxicated. Figure 8 shows a photograph taken by a young person in the rural site.
Female: “Some crave [for sex] and they call you to come [to a tavern]… and [say] I will buy you alcohol… and then at the end you end up not knowing what you are doing… He takes you and leaves [the tavern] with you…” (Female group, rural site).
Male: “…and these guys also decided to buy them [alcohol] as well. These guys like to take advantage when these girls are drunk. And these girls are young. And I don’t think that when the tavern closes they will want to go or walk home alone, just the two of them. Obviously they will offer to accompany them and that will be the start of things.” (Male group, rural site).
Alcohol consumption and drinking spaces were identified at both sites as being linked to transactional sexual relationships that could place young women at increased sexual risk. When alcohol was bought for a woman at a tavern, there was an implicit message that she would have sex with the person who bought the alcohol. Exchanging alcohol for sex was considered an acceptable transaction in the tavern setting.
Female: “Like you get used to drinking [over the] weekend, for you Friday, Saturday and Sunday you are on it [All: Yah] you don’t want to be home and just want to go out… because you can’t afford to buy alcohol every weekend, these are some of the things that make people to go to Sugar Daddys… then… they want you to sleep with them…” (Female group, urban site).
Male: “Yah and you tend to think that because you bought her alcohol. Now she owes you. So it becomes a problem.” (Male group, urban site).
Young women said that once the exchange of alcohol had occurred there were few options available to her if she did not want to have sex with the buyer of the drink. If she ‘ran away’ from the tavern, there was a strong belief that she would be sexually assaulted by the man at a later time. Paying back the drinks money was not an option since she was unlikely to have enough money to adequately reimburse the buyer for the drinks purchased. She would then feel compelled to have sex even if unwillingly.
Female 1: “you don’t even have money to go back home and he will be telling you that I am leaving you to cover the bill. What are you going to pay that with and he tells you let us just go and just do it, it will be quick and we will be done. Female 2: And then you end up leaving with him like that because you don’t have the money. Female 1 interrupts: Yah obvious… because you have to pay him off …you have to!” (Female group, urban site).
Youth reported that drinking in taverns was associated with a greater risk of sexual assault particularly for women. This risk was believed to be from the vulnerability of a woman who is drunk and hence less able to assert herself as well as from the risk associated with walking to and from the tavern, particularly in the rural site, where transport was scarce and desolate, and open spaces were
common. Figure 9 shows a photograph taken by a young person in the urban site.
Female 1: “… when they realize that you want to run, they are going to kick you and if they get you they are going to rape you … Female 2: when you are intoxicated, you are unable to fight him back. They say alcohol hits you in the knees and you are not able to fight him off.” (Female group, urban site).
Female: “Yes. So some end up getting killed… like you will find that taverns are far or the one where everything is happening [entertainment] is far. People leave this side to go over that side… when they pass here, like you see there are no people here it’s just an empty field, there is no one and nothing… And then you find that bad things happen, some get killed, some get raped…” (Female group, rural site).
Benefits of Alcohol
Participants cited various benefits of alcohol. These were income for recycling alcohol bottles, alcohol sponsorships, job creation, and social elements of having fun as well as providing a sense of confidence and bravery. However several felt that there are no real benefits to alcohol.
Recycling
Male: “I like the way he did the bottles. He is my neighbour this one… He took them and did something beautiful. He decided to recycle the bottles and decorated his yard.” (Male group, rural site).
Sponsorship
Male: “It’s having a positive impact but here, the… They act as sponsors to the teams that were playing… They just acted as sponsors, there’s nothing wrong… I don’t see any mistake here…” (Mixed gender group, rural site).
Sales from trading
Female 1: “Maybe one of those who sell alcohol. I am sure they benefit from the money they make [talking at the same time]. Female 2: Yah, it is them who benefit.” (Female group, urban site).
Social confidence
Male: “Some people when they drink alcohol, they say it removes shyness… S/he will think that if they drank then they will not be afraid of anyone, and that’s the benefit because they go there and are brave and not scared of anyone.” (Male group, rural site).