Alcohol Advertising and Youth (Position Paper)
Although alcohol consumption decreased modestly among individuals 12-20 years of age between 1991 and 2005, alcohol use remains a major public health problem among youth.1 Current alcohol use among high school students remained steady from 1991 to 1999 and then decreased from 50% in 1999 to 45% in 2007. In 2007, 26% of high school students reported episodic heavy or binge drinking (consumption of at least five alcoholic beverages in a single sitting).2 Over 74% of high school students have had at least one alcoholic drink and over 25% tried alcohol before age 13.3 This is particularly worrisome because youth who begin drinking at age 15 are four times more likely to become alcoholics than those who begin drinking at age 21.4
Alcohol consumption among youth translates into significant morbidity and mortality. Motor vehicle crashes are the leading cause of death among those younger than 25 years old; alcohol is a factor in 41% of deaths in car crashes.5 In 2007, 11% of high school students reported driving a car or other vehicle during the past 30 days when they had been drinking alcohol. In addition, 29% of students reported riding in a car or other vehicle during the past 30 days driven by someone who had been drinking alcohol.1 The second and third leading causes of death in this age group are homicides and suicides, 20% to 40% of which involve alcohol.6 Overall, alcohol consumption is the third leading cause of death among Americans7, and it represents a financial burden on the United States of about $185 billion (1998 estimates) each year.8
Miller and Levy estimate that underage drinking accounted for at least 16% of all alcohol sales in 2001, leading to 3,170 deaths and 2.6 million other harmful events in that year alone. The annual economic costs in their analysis includes $5.4 billion in direct medical costs, $14.9 billion in work and other resource losses, and $41 billion in lost quality of life.9
A growing body of literature shows that alcohol advertising is an important factor related to alcohol consumption among youth. Research has now established that alcohol advertisements target youth, result in increased alcohol consumption, and add to morbidity and mortality.
Before graduating high school, students will spend about 18,000 hours in front of the television—more time than they will spend in school.10During this time they will watch about 2,000 alcohol commercials on television each year.10 Alcohol advertisements reach youth not only through television, but also through other varied media, such as billboards, magazines, sports stadium signs, and on mass transit such as subway systems. In all, youth view 45% more beer ads and 27% more liquor ads in magazines than do people of legal drinking age.11
According to the Center on Alcohol Marketing and Youth at Georgetown University, alcohol companies spend nearly $2 billion very year on advertising in the United States. Between 2001 and 2007, there were more than 2 million television ads and 20,000 magazine ads for alcoholic products. This heavy advertising effort leads to significant youth exposure.
The Center analyzed the placements of over 2 million alcohol advertisement placements on television between 2000 and 2007 and over 19,000 alcohol ads placed in national magazines between 2001 and 2006. In 2007, approximately 20% of television alcohol advertisements, almost all of which were on cable television, were on programming that youth ages 12 to 20 were more likely to view than adults of legal drinking age. In fact, alcohol advertising increased 38% between 2001 and 2007.12 For young people, large and increasing television exposure has unfortunately offset reductions in exposure in magazines in recent years.12,13
Many authors find that alcohol advertisements frequently reach or specifically target teens not only through television and magazines, but also through other varied media such as radio, P/PG movies, billboards, and sports stadium signs.14,15,16,17,18,19,20
For example, a 2009 Journal of Adolescent Health study found that the ratio of the probability of a youth alcoholic beverage type to that of a non-youth alcoholic beverage type being advertised in a given magazine increased from 1.5 to 4.6 as youth readership increased from 0% to 40% .17
Although the alcohol industry maintains that its advertising aims only to increase market share and not to encourage underage persons to drink, research suggests otherwise. Alcohol advertisements overwhelmingly connect consumption of alcohol with attributes particularly important to youth, such as friendship, prestige, sex appeal and fun.21
The alcohol industry used cartoon and animal characters to attract young viewers to alcohol in the 1990s, with frogs, lizards and dogs, which were overwhelmingly admired by youth. In 1996, for example, the Budweiser Frogs were more recognizable to children aged 9-11 than the Power Rangers, Tony the Tiger, or Smokey the Bear.22 Many alcohol advertisements use other techniques oriented toward youth, such as themes of rebellion and use of adolescent humor. A study of alcohol advertising in South Dakota, for example, found that exposures in 6th grade predicted future intention to use alcohol.23
It is telling that youth report alcohol ads as their favorites,24 especially when so many different products vie for their attention. These compelling advertisements become the new teachers of youth. One study found, in fact, that 8-12 year olds could name more brands of beer than they could U.S. presidents.24 In markets across the US, increased alcohol advertising exposure and dollars spent on these ads on television increased the consumption of alcoholic beverages among youth and young adults.25 It is not surprising that underage drinkers consume about 25 percent of all alcohol in the United States.1
African-American youth generally have increased exposure to alcohol advertisements as compared to the youth population as a whole.26,27 In 2004, African-American youth viewed 34% more magazine alcohol advertisements per capita than youth in general and heard 15% more radio ads. Further, they were also heavily exposed to alcohol ads on the top 15 highly viewed television shows viewed by African-American audiences.26 It appears that this increased exposure, at least through television, may be due in part by the viewing patterns of African-American youth rather than necessarily from targeted marketing by the alcohol industry.27
In addition to print media exposure, researchers have found that alcohol advertising is disproportionately concentrated in low-income minority neighborhoods.28 One study found that minority neighborhoods in Chicago have on average seven times the number of billboards advertising alcohol as do Caucasian neighborhoods.29 Another 2009 study in Chicago demonstrated that youth attending a school with 20% or more Hispanic students were exposed to 6.5 times more outdoor alcohol advertising than students attending schools with less than 20% Hispanic students.30 In a 2008 study, alcohol billboards in Atlanta, Georgia were more prevalent in neighborhoods that were 50% or more African-American.31
Such concentration of alcohol advertising and availability likely translates into increased problems associated with alcohol use in these communities, as well as increased intentions among exposed youth to use alcohol.32
There is ample evidence from experimental, economic, survey, longitudinal, and systematic review studies to demonstrate that the degree of youth alcohol advertising exposure is strongly and directly associated with intentions to drink, age of drinking onset, prevalence of drinking, and the amount consumed.25,32,33,34,35,36,37,38 A 2004 prospective study conducted by the University of Southern California showed that a one standard deviation increase in viewing television programs containing alcohol commercials in seventh grade was associated with an excess risk of beer use (44%), wine/liquor use (34%), and 3-drink episodes (26%) in eighth grade.37
In another large longitudinal study published in 2006 of individuals 15 to 26 years of age found a direct correlation between the amount of exposure to alcohol advertising on billboards, radio, television, and newspapers with higher levels of drinking and a steeper increase in drinking over time.39
Studies also find that adolescent exposure to alcohol-branded promotional items is associated with current drinking or predict future drinking.40,41,42 In one study, these students were three times more likely to have ever tried drinking and 1.5 times more likely to report current drinking.40
Statistical and economic analyses also support the relationship between alcohol advertising and consumption. In Sweden in the 1970s, a ban on alcohol advertising resulted in a 20% decrease in the consumption of alcohol.43 Expenditures on alcohol advertising have also been shown to parallel alcohol consumption in the United States.10 Early reviews of the literature concluded that alcohol advertising increases consumption, though the magnitude was (and remains) in question.44,45 A recent RAND corporation review affirms those conclusions, noting that early exposure to beer ads had subsequent effects in mid-adolescent consumption. This study also found that in-store beer displays and advertising seemed to have more attraction to youth who had never used alcohol, while young drinkers were more influenced by magazine and entertainment venue advertising and promotion.46
Studies have also concluded that alcohol advertising leads to increased morbidity and mortality associated with alcohol.47 One study used econometric data to estimate the specific impact of alcohol advertising on mortality caused by motor vehicle accidents in the United States.48The author concluded that, if a ban were placed on alcohol advertising on television, motor vehicle accident deaths would decrease by between 2,000 and 10,000 each year. The author further suggested that elimination of the tax benefits associated with alcohol advertising would likely result in a 15% decrease in alcohol advertisements, saving an estimated 1,300 lives annually, again due to a decrease in motor vehicle accident deaths alone. This author and others add that counter-advertising campaigns and educational efforts have been shown to diminish the effect of alcohol advertising.49
Considering the important public health concerns related to alcohol, the prevalence of underage drinking, and the association between alcohol advertising and alcohol use, it would be prudent to increase efforts to curb the negative effects of alcohol advertising. Such efforts should include a multifaceted approach with three primary goals:
- To reduce the total amount of alcohol advertising
- To remove content appealing to youth in remaining alcohol advertising
- To offer powerful educational programs and counter-advertisements painting more realistic pictures of the effects of alcohol
More specifically, it is suggested that:
- Federal, state and local authorities significantly limit alcohol advertising
- Tax advantages related to alcohol advertising be eliminated
- Alcohol advertising be strictly regulated, with removal of content and format geared toward underage audiences, minority groups and the poor
- Alcohol advertising be limited in public venues such as sporting events which are commonly attended by youth, as well as magazines and other media primarily viewed by youth
- More federal, state, and local funding be allocated to educational efforts that relate the negative effects of alcohol to children
- Media literacy programs helping youth to better understand and resist alcohol advertising counter-advertising campaigns illustrating the dangers of alcohol use
- Newes AG, et al. Alcohol Epidemiologic Data System, Surveillance Report #81: Trends in Underage Drinking in US, 1991-2005. National Institute on Alcohol Abuse and Alcoholism. Division of Epidemiology and Prevention Research. October, 2007.
- CDC. Youth Risk Behavior Surveillance – United States, 2007. MMWR. 2008;57(SS-4):1–131.
- CDC. Youth Risk Behavior Surveillance – United States, 2005. MMWR. 2006;55(SS05):1-108.
- Grant BF, Dawson DA. Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence. Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse. 1997;9:103-10.
- CDC. Fact sheet: alcohol-related traffic fatalities. Available at: http://www.cdc.gov/od/oc/media/fact/alctrfa.htm.
- Smith GS., Branas CC, Miller TR. Fatal non-traffic injuries involving alcohol: A meta-analysis. Ann Emerg Med. 1999;33(6):659-68.
- McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA. 1993;270(10); 2207-12.
- National Institute on Alcohol Abuse and Alcoholism. 10th Special Report to the US Congress on Alcohol and Health. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 2000.
- Miller TR, Levy DT, Spicer RS, Taylor DM. Societal costs of underage drinking. J Stud Alcohol. 2006; 67(4): 519-28.
- Strasburger VC. Children, adolescents, and television. Pediatrics in Review. 1992;13(4):144-51.
- Center for Alcohol Marketing and Youth. Overexposed: youth a target of alcohol advertising in magazines. Washington, DC: Center for Alcohol Marketing and Youth of Georgetown University; 2002.
- Jernigan, David. Intoxicating brands: alcohol advertising and youth. Multinational Monitor. 2008;30(1).
- Newman, Eric. “Study: Kids See Fewer Alcohol Ads.” AdWeek Online. December 20, 2007.
- Dal CS, Worth KA, Dalton, MA, Sargent JD. Youth exposure to alcohol use and brand Appearances in popular contemporary movies. Addiction. 2008;103(12):1933-1936.
- Greenberg BS, Rosaen SF, Worrell TR, Salmon CT, Volkman JE. A portrait of food and drink in commercial TV series. Health Commun. 2009;24(4):295-303.
- Chung PJ, Garfield CF, Elliott MN, Ostroff J, Ross C, Jernigan DH, Vestal KD, Schuster MA. Association between adolescent viewership and alcohol advertising on cable television. Am J Public Health. 2010;100(3):555-62.
- King C, Siegel M, Jernigan DH, Wulach L, Ross C, Dixon K, Ostroff J. Adolescent exposure to alcohol advertising in magazines: An evaluation of advertising placement in relation to underage youth readership. J Adolesc Health. 2009;45(6):626-633.
- Jernigan DH, Ostroff J, Ross C, O’Hara JA. Sex differences in adolescent exposure to alcohol advertising in magazines. Arch Pediatr Adolesc Med. 2004;158(7):629-634.
- CDC. Youth Exposure to Alcohol Advertising in Magazines – United States, 2001-2005. MMWR. 2007;56(30):763-7.
- CDC. Youth Exposure to Alcohol Advertising on Radio – United States, June-August 2004. MMWR. 2006;55(34):937-40.
- Grube JW, Wallack L. Television beer advertising and drinking knowledge, beliefs, and intentions among schoolchildren. Am J Public Health. 1994;84(2):254-59.
- Lieber L. Commercial and character slogan recall by children aged 9 to 11 years: Budweiser frogs versus Bugs Bunny. Berkeley, CA: Center on Alcohol Advertising; 1996.
- Collins RL, Ellickson PL, McCaffrey D, Hambarsoomians K. Early adolescent exposure to alcohol advertising and its relationship to underage drinking. J Adolesc Health. 2007;40(6):527-34.
- Taylor, P. Alcohol advertisements encourage alcohol abuse. In: Wekesser C, editor. Alcoholism. San Diego, CA: Greenhaven Press; 1994. p. 111-21.
- Snyder LB, Milici FF et al. Effects of alcohol advertising exposure on drinking among youth. Arch Pediatr Adolesc Med. 2006;160:18-24.
- Center on Alcohol Marketing and Youth. Fact Sheet: African-American Youth and Alcohol Advertising. Available athttp://camy.org/factsheets/index.php?FactsheetID=11.
- Ringel JS, Collins RL, Ellickson PL. Time trends and demographic differences in youth exposure to alcohol advertising on television. J Adolesc Health. 2006;39(4):473-480.
- Alaniz ML. Alcohol availability and targeted advertising in racial/ethnic minority communities. Alcohol Health and Research World. 1998;22(4):286-89.
- Hackbarth DP, Silvestri B, Casper W. Tobacco and alcohol billboards in 50 Chicago neighborhoods: market segmentation to sell dangerous products to the poor. Journal of Public Health Policy. 1995;16(2):213-30.
- Pasch KE, Komro KA, Perry CL, Hearst MO, Farbakhsh K. Does outdoor alcohol advertising around elementary schools vary by the ethnicity of students in the school? Ethn Health. 2009;14(2):225-36.
- Moore H, et al. Alcohol advertising on billboards, transit shelters, and bus benches in inner-city neighborhoods. Contemporary Drug Problems. 2008;35(2-3):509-532.
- Pasch KE, Komro KA, Perry CL, et al. Outdoor alcohol advertising near schools: what does it advertise and how is it related to intentions and use of alcohol among young adolescents? J Stud Alcohol Drugs. 2007;68(4):587-96.
- Anderson P, deBruign A, Angus K, Gordon R, Hastings G. Impact of alcohol advertising and media exposure on adolescent alcohol use: A systematic review of longitudinal studies. Alcohol Alcohol. 2009;44(3):229-243.
- Smith LA, Foxcroft DR. The effect of alcohol advertising, marketing, and portrayal on drinking behaviour in young people: systemic review of prospective cohort studies. BMC Public Health. 2009;9:51.
- Collins RL, Ellickson PL, McCaffrey D, Hambarsoomians K. Early adolescent exposure to alcohol advertising and its relationship to underage drinking. J Adolesc Health. 2007;40(6):527-534.
- Ellickson PL, Collins RL, Hambarsoomians K, McCaffrey DF. Does alcohol advertising promote adolescent drinking? Results from a longitudinal assessment. Addiction. 2005;100(2):235-46.
- Stacy AW, Zogg JB, Unger JB, Dent CW. Exposure to televised alcohol ads and subsequent adolescent alcohol use. Am J Health Behav. 2004;28(6):498-509.
- Baar A. Minors under the influence. AdWeek Online. January 3, 2006.
- Burke MG. As alcohol advertising increases, so does youthful drinking. Contemporary Pediatrics. 2006;23(3):28.
- Hurtz SQ, Henriksen L, Wang Y, Feighery EC, Fortmann SP. The relationship between exposure to alcohol advertising in stores, owning alcohol promotional items, and adolescent alcohol use. Alcohol Alcohol. 2007;42(2):143-9.
- McClure AC, Dal CS, Gibson J, Sargent JD. Ownership of Alcohol-Branded merchandise and initiation of teen drinking. Am J Prev Med. 2006;30(4):277-83.
- McClure AC, Stoolmiller M, Tanski SE, Worth KA, Sargent JD. Alcohol branded merchandise and its association with drinking attitudes and outcomes in US adolescents. Arch Pediatr Adolesc Med. 2009;163(3):211-7.
- Romelsjo, A. Decline in alcohol-related problems in Sweden greatest among young people. British Journal of Addiction. 1987;82:1111-24.
- Atkin CK. Survey and experimental research on effects of alcohol advertising: The Effects of Mass Media on the Use and Abuse of Alcohol. In: Martin SE, Mail P, editors. The effects of the mass media on the use and abuse of alcohol. NIAAA research monograph 28. NIH publication number 95-3743. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 1995; p. 39-68.
- Lastovicka JL. A methodological interpretation of the experimental and survey research evidence concerning alcohol advertising effects. In: Martin SE, Mail P, editors. The effects of the mass media on the use and abuse of alcohol. NIAAA research monograph 28. NIH publication number 95-3743. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 1995; 69-81.
- Forging the link between alcohol advertising and underage drinking. RAND Health Research Highlights. Rand Corporation, Santa Monica CA 2006.
- Wyllie A, Zhang JF, Casswell S. Responses to televised alcohol advertisements associated with drinking behavior of 10 to 17-year-olds. Addiction. 1998;93(3):361-71.
- Saffer H. Alcohol advertising and motor vehicle fatalities. The Review of Economics and Statistics. 1997:79(3):431-442.
- American Association of Pediatrics, Committee on Communications. Media Education. Pediatrics. 1999;104(2):341-343.
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