Martinez had never organized a social media campaign and doesn’t consider herself social media savvy. But after ARG won the $100,000 grant, she was running focus groups, coordinating an advisory group of cancer organizations, building a team of co-investigators and partnering with the ARG communications specialist. “The young women made it very clear they did not want to be told what to do,” Martinez says of the focus groups. “’Drink less for your breasts’ felt more like a helpful suggestion.”

Planning for the social media campaign began just as the pandemic forced a national shutdown. As the pandemic dragged on, alcohol consumption rose, especially among women. Days of heavy drinking among women, defined as four or more drinks within a couple of hours, rose by 41 percent, according to a survey by the RAND Corporation. (The study compared a baseline survey of 1,540 adults conducted in the spring of 2019 with their responses during a follow-up in the spring of 2020.)

But pushing back against alcohol consumption isn’t simple. As the US found during a disastrous prohibition period from 1920 to 1933, opposing alcohol is not popular. When Sharima Rasanayagam, chief scientist for Breast Cancer Prevention Partners in San Francisco, gives talks about environmental causes of breast cancer, her audience is rapt—until she mentions alcohol. “People like to drink and they don’t like to hear that,” she says. She tells them that quantity matters: “At the very least, drink less.”

It’s a message she delivers with care, to avoid giving women a reason for self-blame if they develop breast cancer and wonder “Why me?” Cases of breast cancer can’t be tied to alcohol alone, because many factors, including genetics and environmental exposures, contribute to the disease, she explains in a YouTube video linked to the Breast Cancer Prevention Partners website. But Rasanayagam notes that risks add up—and alcohol is one that women can reduce. Fewer drinks, whether over time or in one day, mean less exposure to acetaldehyde and potentially less effect on estrogen. “It’s been shown that the less you drink, the lower your risk,” she says. (Breast Cancer Prevention Partners is an advisor to the Drink Less for Your Breasts campaign.)

It’s a nuanced message but, in its own way, a bold one, as framed in a social media campaign, says David Jernigan, an alcohol policy expert at Boston University, who has been working in the field for 35 years. “What Priscilla is doing in California is groundbreaking,” he says.

Jernigan asserts that the harm from alcohol—which also includes drunk driving and an association with violence—warrants a large-scale response similar to anti-tobacco efforts. He notes that in Estonia, a campaign urging “Let’s drink less by half!” actually lowered per capita consumption by 28 percent. (Estonia’s alcohol policy also included restrictions on advertising, more enforcement of driving-under-the-influence laws, higher taxes, and a focus on treatment.)

The World Health Organization is also developing a global action plan; the current draft sets a goal of reducing per capita consumption by 20 percent by 2030 (with 2010 consumption levels as the baseline). It urges nations to develop and enforce “high-impact policy options,” such as higher alcohol taxes, restrictions on advertising, and emphasizes awareness of health risks.

Jernigan calls that effort a good step that doesn’t go far enough. He favors the development of an international treaty on alcohol, similar to the “Framework Convention on Tobacco Control,” the first such negotiated through the World Health Organization. It has been signed by 168 countries that committed to taking steps to restrict tobacco advertising, raise cigarette taxes, and prevent youth smoking.