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:
More specifically, it is suggested that:
(2004) (2010 COD)
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Alcohol Advertising and Youth (Position Paper)