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Alcohol and Alcoholism Advance Access published January 14, 2009

Alcohol & Alcoholism, pp. 1–15, 2009 doi: 10.1093/alcalc/agn115

Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use:
A Systematic Review of Longitudinal Studies
Peter Anderson1,∗ , Avalon de Bruijn2 , Kathryn Angus3 , Ross Gordon3 and Gerard Hastings3
1 Universityof Maastricht, Maastricht, The Netherlands, 2 National Foundation for Alcohol Prevention, Utrecht, The Netherlands and 3 Institute for Social
Marketing, University of Stirling and The Open University, Stirling, UK
∗ Corresponding author: Apartat de Correus 352, 17230 Palamos, Girona, Spain. Tel: +34-972-662480; E-mail: peteranderson.mail@gmail.com

(Received 14 July 2008; first review notified 16 October 2008; in revised form 16 December 2008; accepted 17 December 2008)

Downloaded from http://alcalc.oxfordjournals.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15, 2014
Abstract — Aims: To assess the impact of alcohol advertising and media exposure on future adolescent alcohol use. Methods: We
searched MEDLINE, the Cochrane Library, Sociological Abstracts, and PsycLIT, from 1990 to September 2008, supplemented with
searches of Google scholar, hand searches of key journals and reference lists of identified papers and key publications for more recent
publications. We selected longitudinal studies that assessed individuals’ exposure to commercial communications and media and alcohol
drinking behaviour at baseline, and assessed alcohol drinking behaviour at follow-up. Participants were adolescents aged 18 years or
younger or below the legal drinking age of the country of origin of the study, whichever was the higher. Results: Thirteen longitudinal
studies that followed up a total of over 38,000 young people met inclusion criteria. The studies measured exposure to advertising and
promotion in a variety of ways, including estimates of the volume of media and advertising exposure, ownership of branded merchandise,
recall and receptivity, and one study on expenditure on advertisements. Follow-up ranged from 8 to 96 months. One study reported
outcomes at multiple time-points, 3, 5, and 8 years. Seven studies provided data on initiation of alcohol use amongst non-drinkers,
three studies on maintenance and frequency of drinking amongst baseline drinkers, and seven studies on alcohol use of the total sample
of non-drinkers and drinkers at baseline. Twelve of the thirteen studies concluded an impact of exposure on subsequent alcohol use,
including initiation of drinking and heavier drinking amongst existing drinkers, with a dose response relationship in all studies that
reported such exposure and analysis. There was variation in the strength of association, and the degree to which potential confounders
were controlled for. The thirteenth study, which tested the impact of outdoor advertising placed near schools failed to detect an impact on
alcohol use, but found an impact on intentions to use. Conclusions: Longitudinal studies consistently suggest that exposure to media and
commercial communications on alcohol is associated with the likelihood that adolescents will start to drink alcohol, and with increased
drinking amongst baseline drinkers. Based on the strength of this association, the consistency of findings across numerous observational
studies, temporality of exposure and drinking behaviours observed, dose-response relationships, as well as the theoretical plausibility
regarding the impact of media exposure and commercial communications, we conclude that alcohol advertising and promotion increases
the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol.

INTRODUCTION dependence and alcohol-related harm, including poorer mental
health, poorer education outcome and increased risk of crime
Adolescents are frequent users of alcohol and increasingly con- in early adulthood (Jefferis et al., 2005, Englund et al., 2008;
sume it in a risky fashion. For example, in Europe, nearly all Pitk¨anen et al., 2008). During adolescence, alcohol can lead
(over 9 in 10) 15- to 16-year-old students have drunk alco- to structural changes in the hippocampus (a part of the brain
hol at some point in their life (Currie et al., 2004), starting involved in the learning process) (De Bellis et al., 2000) and at
on average just after 121/2 years of age. Data from the 2003 high levels can permanently impair brain development (Spear,
European School Survey Project on Alcohol and Other Drugs 2002). Drinking by adolescents and young adults is associated
(ESPAD) found that the average amount of alcohol drunk by with automobile crash injury and death, suicide and depres-
15- to 16-year olds on the last drinking occasion was 60 g (six sion, missed classes and decreased academic performance, loss
drinks) (Hibell et al., 2004). Over one in eight (13%) of 15- to of memory, blackouts, fighting, property damage, peer criti-
16-year-old students reported being drunk more than 20 times cism and broken friendships, date rape, and unprotected sexual
in their life, and over one in six (18%) reported binge drinking intercourse that places people at risk for sexually transmitted
(5+ drinks on a single occasion) three times or more in the last diseases, HIV infection and unplanned pregnancy (Bonomo
month. Binge drinking in young people has increased across et al., 2001). Adolescents aged 14–17 years with alcohol use
much of Europe in the last 10 years, although more so in the disorders show substantially greater brain activation to alco-
early part of this period (Anderson and Baumberg, 2006). holic beverage pictures than control youths, predominantly in
Children and adolescents have greater vulnerability to alco- brain areas linked to reward, desire and positive affect (Tapert
hol than adults. As well as usually being physically smaller, et al., 2003). The degree of brain response to the alcohol pic-
they lack experience of drinking and its effects. They have tures is highest in youths who consume more drinks per month
no context or reference point for assessing or regulating their and report greater desires to drink.
drinking, and, furthermore, they have built up no tolerance to Alcohol advertising is one of the many factors that have the
alcohol. From mid-adolescence to early adulthood, there are potential to encourage youth drinking. For young people who
major increases in the amount and frequency of alcohol con- have not started to drink, expectancies are influenced by nor-
sumption and alcohol-related problems (Bonomo et al., 2004; mative assumptions about teenage drinking as well as through
Wells et al., 2004). Those with heavier consumption in their the observation of drinking by parents, peers and models in
mid-teens tend to be the ones with heavier consumption, alcohol the mass media. Research has linked exposure to portrayals of


C The Author 2009. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved

perceive greater social ap. hand searches of . Amongst 10. Liking of specific elements featured in beer at time B. which typically use expenditure on more follow-ups. or econometric studies were excluded from this review. from 1990 to September 2008. parental drinking) are controlled for. significantly contribute to the overall likeability of these a causative relationship. benefit or reward from it—most fundamentally that they are vertisements in magazines. (1988) point out. whilst mass media advertising expenditure has been estimated to be £202.2 million (UK Cabinet Office. 1988). however. Experimental. Sociological ies take a snapshot of advertising exposure (awareness and/or Abstracts. since tentially very small changes in drinking patterns. 2006). any correlation indicates sic. radio. where ‘below the line’ activity) is thought to approach £800 million the legal drinking age of 21 years was taken as the cut-off. and PsycLIT. animation and popular mu. believe drinking is more common among As Aitken et al. Smith and Foxcroft (2007) moted by the advertisements (Chen et al. which are not possible for ethical reasons. Third. in mass media. the duration of advertising effects need to alcohol promotion and media exposure that contained alco- be taken into account: a powerful campaign may continue to hol advertisements. Mass media channels of communication have an effect years after it was first deployed. 2002). the measure of exposure to the intervention may bans have been introduced) so researchers are looking for po. however. alcohol use in the mass media with the development of positive between the two. Such investigations come in two Search strategy forms: cross-sectional and longitudinal. Provided potential confounders (such as peer and advertisements. (Drink Pocket Book. paying atten- peers and adults. Cross-sectional stud. Fourteen-year olds with greater exposure to ad. including portrayal of alcohol in the mass media. Austin et al. cross-sectional and time-series advertising. measures of the individuals’ drinking behaviours were then measured in one or amount of advertising. Casswell. 2005). To obtain this focus on young people. Fourth. such as humour. and Booth et al. as are teens who watch more TV. This review therefore focuses on lon- advertisements and subsequently to advertising effectiveness gitudinal studies with young people. ad. if advertising has an longitudinal studies in which individuals’ drinking behaviour effect. It builds on and extends re- indicated by an intent to purchase the product and brand pro. For ex. outdoor advertising. We included only metric methods. is advertising. views conducted by Jernigan (2006). Answering this question requires either experimental METHODS OF THE REVIEW studies. cross-sectional data can shed a beer advertisements and know adults who drink (Collins et al. It is hypothesized that. Young people with more bility that any correlation is as likely to reflect drinking encour- positive affective responses to alcohol advertising hold more aging young people to take an interest in advertising. However. as vice favourable drinking expectancies. amount of advertising tend to be minor (few comprehensive In practice. ample. Establishing such a link. Thus. receptivity or attitudes to alcohol amount of advertising. 1989. the Cochrane Library.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. the perceived likeabil. electronic communications and other were reviewed with the exception of US-based studies. drinking rates should shadow temporal variations in the and exposure to advertising. 2000). First. 2000. (2008).. Longitudinal studies take the debate a step further by mea- Downloaded from http://alcalc. and look for correlations plemented with searches of Google scholar.. because they cannot show whether drinking expectancies by children and adolescents (Austin and exposure preceded drinking uptake. or brand awareness were measured at baseline and problematic for a number of reasons. or systematic observation of real world effects. ity of beer advertisements is a function of the positive affec. pay attention to rewards (Aitken. include advertising delivered through television. We searched MEDLINE. it is necessary to do research directly with them. posters. drinking. etc. most importantly given our focus on adolescents. proval for drinking. and intend to drink more as adults (Chen and tion to advertising presupposes that the viewer is getting some Grube. however. Types of participants 2003). 1996) that might be industry. they leave open the possi- Knaus. and adolescents are exposed to many sources. Types of studies One approach to observation is to look for correlations be. implicated. news- vertisers deliberately try to enhance these long-term effects as papers. expenditure on promotion more generally (taking in Studies that included adolescents 18 years of age or younger point of sale promotion. Indeed.to 17-year olds. 1995. and adolescent drinking. and how this relates to drinking advertisements. the analysis depends on the construction of a complex model that ascribes values for all Types of intervention the different variables—including price. variations in the includes give-aways and items bearing alcohol industry logos. versa. do not establish whether alcohol advertising actually influences young people’s drinking be- haviour. Second.2 Anderson et al. We considered studies that examined the association between tween the amount of alcohol advertising and the amount of alcohol advertising and promotion. the portrayal of alcohol drinking taking place in a particular jurisdiction using econo. These studies. measures of Types of outcome measures the overall amount of advertising do not necessarily give an accurate picture of youth exposure. not discriminate between specific types of advertising. vary in the accuracy and inclusiveness. Alcohol promotion part of their effort to build brands.oxfordjournals. 2014 tive responses evoked by the specific elements featured in the suring exposure at time A. Saffer.. in the UK. Self-reported drinking status. drinking restrictions and disposable income—as well as advertising (Harrison and The ‘intervention’ is alcohol mass media advertising by the Godfrey. at sporting and music events and on doing the right thing by consuming the advertised product— television are more advertisement-aware than those with less and advertisers deliberately design their work to provide such exposure. Finally. sup- appreciation) and levels of drinking. useful light on the role of alcohol advertising in young people’s 2003).

Casswell et al. because the use at six schools.. for missing data (Ellickson et al. one study. recognition. The New Zealand study OR Newspapers(MeSH) OR Newspaper∗ OR Magazine∗ OR reported outcomes at multiple time points. et al... participants were followed up once after base- Television(MeSH) OR Televis∗ OR TV∗ OR Radio(MeSH) line. 2006). the survey methods. Two reviewers independently assessed relevant studies for 2006. The 13 studies included a variety of different age groupings Stacy et al. 2007. 2008).. 18 months.. reported questionnaires in seven studies (Robinson et al.. If the article could not be rejected with All studies measured alcohol use at follow-up. the methods of analyses. all elementary schools in a State (Collins duced to 29 on closer assessment of the abstract and full text. the baseline sample sizes and data available at all follow-up periods (Connolly et al. Alcohol sports or music events. 1998. Hanewinkel and Sargent. Pasch et al.. Baseline sample sizes ranged from 630 to 6522. Ellickson et al. 2008). were selected (Robinson et al. Sargent et al. and in store advertisements). Sargent et al. all other studies excluded participants with of alcohol advertising or promotion on adolescent drink... 2007). Subsequ∗ OR Wave∗ .org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. Henriksen et al. 3 years. ing behaviour. No additional methodological quality criteria were used participants selected for participation in an RCT (Ellickson in selecting papers for inclusion. 2004. Longi. one study. Wills et al.. 2005. 2008). the dinal cohort study (Fisher et al. 2005. (Casswell and Zhang. Pasch et al. with no information given on how the schools of alcohol at baseline was not accounted for (Wingood et al. recall and receptivity to alcohol marketing.. 1998.. two studies. 1994. the confounders anal. ran- The search strategy resulted in 810 titles. Ellickson et al. 1998.... domly selected schools with all participants invited to partic- lowing deletion of duplicates. (Robinson et al. 2. OR Radio OR Radios OR Motion picture∗ OR Movie∗ OR 24 months.. 2006). one in Belgium. 2002. the sample and study a longitudinal cohort study who had exposure and outcome designs. 1998). a range of market- OR Elementary school∗ OR High school∗ OR Highschool∗ ing exposure (including TV. McClure et al.. amongst baseline drinkers (Robinson et al. one study. Marketing Search Strat. 2007).. and abstracts reduced the number of papers to 131. 2005. missing data from the analyses. face-to-face interview and computer interview in one (Connolly . three studies. 2005. Casswell et al. Van den Bulck and Beullens.... and egy: Marketing(MeSH:NoExp) OR Marketing OR Advertising one study. Schools(MeSH) OR Primary school∗ OR Secondary school∗ alcohol use in motion pictures. Snyder et al. Ellickson et al.. 2007.. 30 months and 12–26 months. 2007. TV OR Alcoholic beverages(MeSH) OR Alcohol∗ beverage∗ OR alcohol commercials alone. further re. The years during publications for more recent publications. combined the following four sets of terms. ysed and the outcome at follow-up.. Hanewinkel inclusion. one study. 2006. by both studies were conducted in the United States. 2014 as Topic(MeSH) OR Advert∗ OR Promot∗ OR Sponsor∗ OR In 10 studies. Child Search Strat.oxfordjournals. the full text was obtained and screened by two provided data on initiation of alcohol use amongst non-drinkers reviewers. Table 1 summarizes the stud. Wills et al. 2005. McClure et al. 2007) and a sub-sample of drinking behaviour outcome measures. One study evaluated participants at four time points tudinal Studies Search Strategy: Longitudinal Studies(MeSH) and presents results for follow-up after 21 months taking the OR Longitud∗ OR Cohort∗ OR Follow-up∗ OR Prospectiv∗ OR multiple time points into account in the analysis (Snyder et al. 2008. brand Liquor∗ OR Spirits OR Alcohol∗ . 2007. 1994.. follow-up rates. jected if the title and abstract did not focus on the impact Wills et al. 1998. magazines. six studies on alcohol use of the total sample of non-drinkers type of ‘intervention’ and outcomes measured. Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use 3 key journals and reference lists of identified papers and key one in Germany and one in New Zealand. all participants criteria. The individual studies were Measurement of exposure and alcohol use were by self- not ranked for methodological quality. Ten Henriksen et al. 2008. Studies were combined using qualitative narrative synthe. and drinkers at baseline (Connolly et al. Studies identified in the electronic search were pre. 1998). the original sample of 2003).. One reviewer extracted data from included studies using a three studies on maintenance and frequency of drinking form and a second reviewer checked these data. two stud- Search Strategy: Alcohol drinking(MeSH) OR Alcohol∗ drink∗ ies. The duration of the follow-up was 12 months. 2007. volume of and expenditure on advertisements. One longitudinal study was excluded. Collins et al. concession stands at Or College∗ OR Universit∗ OR Young OR Youth∗ . 2008.. Casswell and 4. reduced to 729 fol. all middle and Sixteen publications reporting on 13 studies met the inclusion high schools in a city (Henriksen et al. ownership of alcohol branded merchandise.. that ranged between 10 and 21 years of age at baseline. Zhang. 2005) and sis because there was heterogeneity among study designs. 2008. Eight studies certainty. Attrition rates varied from 31% to 100% (the sample There were four stages in the review process: with 100% follow-up included and analysed all students with alcohol consumption measurements at baseline and follow-up 1. Collins et al. Collins et al. Fisher et al. all participants of a longitu- ies. 1998. Three studies used imputation screened for relevance by a reviewer... recall and liking of ad- Beer(MeSH) OR Beer∗ OR Wine(MeSH) OR Wine∗ OR vertisements. 2005. et al. describing the alcohol marketing and media exposures. The search strategy which data were collected ranged between 1985 and 2005. Downloaded from http://alcalc. 5 years and Mass media(MeSH) OR Internet(MeSH) OR Internet. Van den Bulck and Beullens. RESULTS Study samples included random samples of youth (Snyder et al. Stacy et al. 2002). 2008... 3. with a total of egy: Child(MeSH) OR Child∗ OR Schoolchild∗ OR School over 38..000 at follow-up across the 13 studies. Initial assessment of the titles ipate (Stacy et al... One study followed Film∗ OR Display∗ OR Billboard∗ OR Poster OR Posters up participants at 8. Articles were re. 8 years. Hanewinkel and Sargent. Casswell and Zhang.. 2006. outdoor advertising. 2008). 2008). 2004. 2004. age∗ OR Kid OR Kids OR Adolescent(MeSH) OR Adoles∗ OR Two studies investigated the impact of media exposure (tele- Teen∗ OR Boy∗ OR Girl∗ OR Minors(MeSH) OR Minors OR vision and music videos) on the use of alcohol. 16 and 24 months.. 2008).. and Sargent.

325 (California) initiation of alcohol use prospective survey included Gender (36%) non-drinkers began drinking. only P Living situation and 15 on average and maximum (65%) 13 and again at 15 subsequent alcohol growth computer survey interviews at values reported Occupation amounts of alcohol consumed on an (analysed consumption and development at 18 years ages 13.008) Average amount of alcohol consumed on an occasion. the number of commercial during a year.5) drinking among existing schools students Ethnicity gender. There serving).09 videotape viewing. 2014 . alcohol analyses. predicted and entertainment media average (P = 0.047) and maximum amounts of beer (P = 0.18)].oxfordjournals. Summary of included studies Study [reference] Study objective Sample/study Survey method Baseline sample Follow-up Analysis Covariates/ Outcome at follow-up Country Alcohol marketing and design size (months) confounders analysed Baseline survey date media exposure Follow-up Age group (years) Drinking behaviour rate outcome measurea Connolly et al. both alcohol initiating drinking [OR=1. but not 13. radio) Number of moderation relationship with wine and spirit including commercial messages recalled consumption. During the Frequency of lifetime alcohol to calculate 18-month follow-up. ethnicity and the exposure drinkers with Hours of other media watched to other media. Each 1-h increase per computer and video game media day in watching music videos use on typical school and exposure associated with a 31% increased weekend days Logistic risk for initiating drinking regression [OR=1. (1994) New Impact of recall of Participants in a Face-to-face 667 who 60 and 36 Multiple Gender Impact of number of commercial Zealand alcohol-related mass multi-disciplinary interview at 13 were present for regression Socio-economic status advertisements recalled at ages 13 435/667 1985 media material on longitudinal study of and 15 years. frequency of adjusted for were no significant associations drinking in past main between media exposure and 30 days confounders maintenance of drinking Downloaded from http://alcalc.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. consumed on an occasion females. There was no significant media (e. predicted frequency of consumed across all beer consumption (P = 0. For males.01–1.g. 4 Table 1. total frequencies of beer and other drinks (wine and spirits) consumed Robinson et al. maximum advertisements recalled at age 13. of typical amounts but not 15.31 (1. number of advertising (product Number of hours of TV watched commercial advertisements recalled advertising.47)].6 (0. sponsorship) at age 15. use and (1.029) drinking locations. 322 (51%) drinking (a typical single odds ratios drinkers continued drinking. TV. For Anderson et al. 15 and Peer approval of people who occasion and on frequency of sample) Alcohol portrayals in mass 18 years drink drinking. (61%) 1994 and maintenance of across six public high 1533 Controlling for the effects of age. each 1-h increase Exposure to TV.17–1. music videos complete per day in TV viewing associated (on music channels and data on with a 9% increased risk for rental videotapes). Mean age (SD) 14. (1998) USA Impact of media exposure on Non-randomized Paper survey 2609 18 1583/2609 Analysis Age During the 18-month follow-up.

Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use hotel. college and Perceptions of adults’ alcohol use odds of consuming three or more professional basketball.oxfordjournals.6)] someone else’s home. (1994) above New allegiance at age 18 years longitudinal study of face-to-face drank beer at age restricted to analysis to three items: ‘alcohol Zealand 1990/199118 on drinking and growth and supplementary 18 years those who advertisements have plenty of alcohol-related aggression development interview provided action’. which of cinema advertising and follow-up the following you most agree with?’ sponsorship) Liking of alcohol advertisements at age 18 predicted beer consumption Combined average volume of at age 21 [standardized coefficient beer drunk at own home. tavern or bar.g. development interview alcohol at ages Sample Parental consumption action’. T = 6. Exposure to alcohol at baseline ‘Comparing alcohol adverts advertising (e. sports clubs and nightclubs over previous year. 21 quantities of alcohol consumed per Frequency of drinking over occasion for both men and women past year and typical and 26 years over the age 18–26 years. Same To identify developmental Participants in a Computer-based Sample restricted to Trajectories Trajectory analysis Gender The measure of liking of alcohol sample as Connolly et al. which years 714 Age of onset of regular drinking ‘Comparing alcohol adverts predict these trajectories participants generally with other ads. ‘alcohol advertisements at age 21 years information show the type of people I admire’. (2002). and on subscription sports channel in previous months Frequency of drinking alcohol in last 30 days. which of Exposure to alcohol who were the following you most agree with?’ advertising (undefined/no drinkers of Liking of alcohol advertisements at examples given) alcohol at age 18 did not project trajectories of ages 18. General TV viewing frequency drinks on one occasion (95% CI: professional soccer and Ad memorability (cued-recall and drawing) 8%–48%) during previous 30 days hockey. advertisements.0706) but not for women over the age 18–26 years Stacy et al.6. 2014 . Access to licensed premises to three items: ‘alcohol Zhang (1998) above 26 years and to identify growth and supplementary drinkers of months (2001) Living arrangement advertisements have plenty of New Zealand 1990/1991 variables at age 18.Casswell and Zhang (1998). frequency of ‘3-drink episodes’ (≥3 drinks of typical serving size in a row over couple of hours) in past 30 days (Continued ) 5 Downloaded from http://alcalc. TV. 21 and 26 restricted to Level of education show the type of people I admire’. trajectories of drinking multi-disciplinary questionnaire and 714 participants of drinking using method of Ease of access to alcohol advertising was based on responses (1994) and Casswell and between the ages of 18 and longitudinal study of face-to-face who were over 96 Jones et al.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. and generally with other ads.36 (SE = 0. hotel. 0. 34% increase in odds popular TV series. P = sports clubs and nightclubs 0.06. and confounders Perceived peer approval of alcohol use of wine/liquor drinking (95% CI: during professional Intentions to use alcohol 17%–52%) and 26% increase in baseball. tavern or bar. drinking for men (OR = 1. Impact of liking for alcohol Participants in a Computer-based Sample restricted to 36 Structural equation Gender The measure of liking of alcohol Same sample as Connolly advertising and brand multi-disciplinary questionnaire and 630 of those who Sample modelling advertising was based on responses et al. radio. whether ever experienced problems with aggression associated with drinking alcohol Casswell et al. Liking of quantity consumed per alcohol advertisements at age 18 drinking occasion at own marginally predicted being in a home. (2004) USA Impact of TV alcohol Randomized prospective Paper survey 2998 12 Logistic regression Gender Each 1 standard deviation increase in (California) 2000 commercials on alcohol survey across 20 2250/2998 to calculate Ethnicity alcohol advertising exposure US seventh grade (normally use middle schools (75%) odds ratios School associated with 44% increase in 12–13 years) Exposure to TV adverts for adjusted for Participation in team sports odds of beer drinking (95% CI: alcohol aired during 20 main Perception of friends’ alcohol use 27%–61%). someone else’s higher trajectory for frequency of home. ‘alcohol advertisements 18 including liking of alcohol 18.

P > 0. 77% of 1905 alcohol in the past year grade 7 drinkers consumed alcohol (five options ranging from in the previous year at grade 9.05) did not Downloaded from http://alcalc. magazines with football and basketball and Playing sports alcohol advertisements (OR = 1. P < 0. TV viewing between 7 am Drinking at baseline t = 3. disco.12. whereas advertisements (aired Deviance exposure to TV beer adverts (OR = during professional Impulsivity 1. whereby youth who watch more TV have fewer Frequency of drinking opportunities to drink. exposure to beer exposure to a prevention School grades concession stands at sports or music programme mitigates any Religiosity events predicted drinking onset for such relationship Parental monitoring non-drinkers in previous 12 months Exposure to TV beer Alcohol beliefs (OR = 1.10. P < 0. P > 0.004) and 1 am Number of alcoholic drinks usually drank when going out (to a bar. (2005) Impact of exposure to Randomized controlled Paper survey 3780 30 Regression models Gender 48% of 1206 grade 7 non-drinkers USA (South Dakota) 1997 different forms of alcohol trial of an alcohol use 3111/3780 accounting for Ethnicity consumed alcohol in previous year Seventh grade (age advertising on the prevention (82%) covariates TV viewing at grade 9. P < 0.073.09. magazines with 0. including exposure to and the frequency of 41 middle schools in Adult approval of drinking all different types of advertisement drinking amongst existing South Dakota Peer drinking and the impact of the prevention Anderson et al. alcohol advertisements. during four late-night Exposure to prevention programme P > 0.05).05) and exposure to in-store advertisements (coefficient = 0.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. 2014 . Controlled for main 12–13 years) initiation of alcohol use programme involving Adult drinking confounders. 0 to +20 times) Exposure to beer concession stands at sports or music events predicted the frequency of drinking amongst existing drinkers in previous 12 months (coefficient = 0.05. as did exposure to magazines with alcohol advertisements (coefficient = 0.05.001) and programmes and normal covariates Smoking status music video exposure (β = 0.06. frequency of going out Ellickson et al. Weekly TV viewing. controlled for alcohol advertisement beer concession stands and exposure. whereas exposure to TV beer adverts (coefficient = −0. was inversely related to in-store advertisement the onset of drinking.42. etc. Continued Study [reference] Study objective Alcohol Sample/study Survey method Baseline sample Follow-up Analysis Covariates/ Outcome at follow-up Country Baseline marketing and media design size (months) confounders analysed survey date Age group exposure Drinking Follow-up (years) behaviour outcome rate measurea Van den Bulck and Beullens Impact of TV and music Randomized prospective Paper survey 2546 12 Multiple Age Quantity of alcohol consumed while (2005) Belgium video exposure on the use survey across 15 1648/2546 regression School year going out at the follow-up period 2003 of alcohol whilst going out secondary schools (65%) analyses Gender related to overall TV viewing (β = 13 and 16 years of age Exposure to music video TV accounting for Pubertal development status 0. P = 0.05). P = 0.05) did not.02. P > group).05). explained as a displays ‘babysitter’ effect. P > 0.46. drinkers. t = 3. party.068. and whether Peer approval of drinking programme.) ranging from never to ≥9.01.05) and exposure to in-store shows popular with age advertisements (OR = 1.05). 6 Table 1.oxfordjournals.

(2006) USA Impact of alcohol advertising Randomized survey Telephone interviews 1872 21 Multi-level linear Gender For those aged <21 years.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. liquor and CI: 1.14).35. radio listening promotional items (hats. on radio.01.8% (event rate ratio = 1. in Friend approval programming 24 h a day) 1. Industry data on previous month by 2.13 (0. average quantity of drinks per day and maximum quantity of drinks on one occasion Sargent et al. Twenty percent of youth in 75th percentile of alcohol marketing exposure at grade 6 reported past year beer drinking at grade 7.oxfordjournals. 95% CI: (consumption. Seeing more or fewer advertisements in a particular Number of alcoholic drinks in month than he or she typically saw the past months calculated is a predictor of drinking (event rate from the frequency of ratio = 1.03 (0. magazine reading Ownership of alcohol Impulsivity 0. P < 0. other sports (97%) Peer drinking dedicated to broadcasting and programmes. 95% Exposure to beer. movies content-coded for non-drinkers at covariates Self-esteem Analysis with quadratic exposure on-screen alcohol use baseline in 15 middle Maternal support effect (OR = 0. 95% CI: drinking alcohol (past 4 1.06).83–1. each 1999 expenditures and the sample from 24 588/1872 modelling to Age additional alcohol advertisement 15–26 (52% <21) degree of exposure to Nielsen media (31%) calculate event Ethnicity seen increased the number of drinks alcohol advertisements on markets rate ratio School status consumed in the previous month by alcohol use Alcohol sales per capita 1% (event rate ratio = 1. with 3577 non-drinkers 12–26 (average Multi-level logistic Grade 357/2406 (15%) initiated drinking (New Hampshire and use in motion pictures on the sectional survey with follow-up 17 months) regression to Gender alcohol. and from three TV sources: F(3.40).23–2.Snyder et al. 28) = 8. Exposure predicted use of Vermont) initiation of alcohol use longitudinal telephone interview 2406/3577 calculate ORs Parental education alcohol during the follow-up period 1999 10–14 Exposure to US box-office hit follow-up on (67%) adjusted for School performance (OR = 1.37). 33) = 3. beer concessions posters or T-shirts) Sports participation 1.028. magazines advertisements increased the and billboards in the past number of drinks consumed in the month.001–1.52). 95% CI: 1. (2007) USA Impact of exposure to alcohol Longitudinal survey Paper survey 1786 12 Multivariate with Gender 17% reported past year beer drinking (South Dakota) 2000 marketing on beer use across 39 schools 1699/1786 logit and Ethnicity at grade 7.87–1. (2006) USA Impact of exposure of alcohol Randomized cross Paper survey.08 magazines. compared with 13% in 25th percentile (Continued ) 7 Downloaded from http://alcalc.13).05.76 (1.002. radio. 95% CI: Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use amount spent on alcohol advertisements 1.95–1.17 (1.003) weeks).996. other TV beer ads in-store displays Deviance 1.992–0. at School grades (0.15.06–1. Religiosity 1.00–1. 2014 .36.25). implied schools Maternal control 0.01 (0.001–1.19 (1. P < 0. other TV Parent approval producing sports-related programmes).34).021). year Grade 6 beer drinking Joint effect of exposure to ads from all sources: F(8.91–1.0001.01–1.002–1. other sports beer ads concessions stands and on Depressed mood 1.42). in-store beer Weekly TV viewing displays 1.999) showed that the possession and purchase of Rebelliousness relationship between exposure of alcohol) Sensation seeking alcohol use in motion pictures and Smoking status the initiation of alcohol use was Initiation of alcohol drinking stronger among adolescents in (unknown to parents) lower exposure categories Collins et al.056).92–1. beer Beer drinking over the past Parental education promotional items 1.96 (0. Each additional premixed drink advertising dollar spent on alcohol on TV. OR (95% CI) for beer Grade 6 (11–12) Exposure to beer ads on TV (95%) and logistic Parental monitoring drinking were: ESPN cable network (on subscription sports 1740/1786 regression Adult drinking (an American cable TV network channel.

include the frequency of P = 0.74 (1. did Content-coded on a predict at eighth grade intentions to 22-item system for use (e. Exposure to other forms of alcohol students followed up were Chicago schools on controlled trial of an paper survey of advertising non-users of alcohol at baseline.77) for girls and 0. alcohol completed Cigarette smoking with those who did or would not. on 61 public schools in not predict alcohol behaviour billboards.51–1.79 Anderson et al. f = 4.g.16–2. P = 0. 11. Exposure to alcohol advertisements. including programme involving advertisements at sixth grade did at bus shelters/benches. outside liquor. (2007) USA Impact of ownership of or Non-random prospective Postal survey 16. a alcohol (62.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. stores or outside bars. promotional item (e.62. but alcohol use alcohol use alcohol use and Awareness of outdoor advertising the initiation of alcohol use was not Outdoor alcohol prevention intentions Prevention programme reported. 8 Table 1.882 logistic Pubertal status boys (17%) initiated alcohol use.33) for boys for those who Exposure to alcohol comprised 5511 non-drinkers Global self-esteem owned or were willing to use an advertisements or TV non-drinkers who Scholastic self-esteem alcohol promotion item compared commercials. f = 6. amongst sixth grade non-users. frequency of drinking ≥5 drinks over past 2 weeks Downloaded from http://alcalc.36–2. (2007) USA Impact of exposure of Sixth grade students in Digital camera and 4137 24 Mixed-effect Gender On average.37–2.5%) models School socio-economic status feet (457 m). Continued Study [reference] Study objective Alcohol Sample/study Survey method Baseline sample Follow-up Analysis Covariates/ Outcome at follow-up Country Baseline marketing and media design size (months) confounders analysed survey date Age exposure Drinking Follow-up group (years) behaviour outcome rate measurea Fisher et al. each school site had 14. or convenience and non-users at eighth grade. but.01 and Drinking behaviour measures outcome expectancies.g. ever binge drinking owned or were willing to use an (≥5 drinks in few hours) alcohol promotion item compared in past year with those who did or would not Pasch et al. ‘do you think you will be theme(s) drinking alcohol in the next month’). 2014 . 2027/2586 (78%) 1500 feet (457 m) of 63 randomized advertisements.oxfordjournals. alcohol questions Family composition 149/611 drinking girls (24%) and T-shirt.19) for girls and 1. The Siblings <21 drinking odds ratio of binge drinking Initiation of alcohol drinking Peer drinking amongst drinkers was 1. bag) ownership in 1998 and 1999 Family dinner at home 112/384 drinking boys (29%) and willingness to use Adults drink at home engaged in binge drinking. 11–18 promotional item on the drinking children of completed (70%) regression Race The odds ratio of alcohol initiation initiation of alcohol use mothers in Nurses’ follow-up in Analysis Geographical area during the 12-month period was and subsequent binge Health Study II 1998 and 1999.29.03 drinking alcohol over past 30 days.834/16. confined to Social self-esteem 1. Chicago amongst sixth grade alcohol users grocery.8 (Chicago) 2003 outdoor alcohol project Northland GPS positioning of 2586/4137 regression Ethnicity alcohol advertisements within 1500 Mean age 12.882 recruited in 12 Multivariate Age 611/3283 girls (19%) and 384/2228 1998–1999 willing to use alcohol cohort study of never 1996.48) for boys for those who drink).87 serving of alcoholic consumption (0. hat. (ever sipped or had whole Attitudes and beliefs about alcohol (1.834 11.78 drinking Sample the 511 Athletic self-esteem (1.2 years advertisements within Chicago.

28) for Q3 and 2. brand recall. a Self-reported grades recall and recognition no longer sunglasses) longitudinal study statistically significantly predicted primarily of smoking alcohol initiation Initiation of alcohol use initiation (either finished a serving of alcoholic drink ever. on-screen alcohol use grade students TV in bedroom Compared with quartile 1. OR = Exposure to alcohol high schools in Tracy Peer drinking 1.37) for Q4.27–3. DVD and video (1. and for binge Initiation of alcohol drinking drinking 1.65–2. the (consumption.oxfordjournals.44 (0.929) in the Survey Perceived peer approval of drinking OR = 1. about Retail Unsupervised hours after school alcohol marketing was controlled.42 (1.15 initiation of alcohol use three middle and two Parental drinking (1. T-shirt.77 (1.02–1.4) Exposure to Germany’s Schleswig–Holstein. vodka mix products) and 56.16–1.Henriksen et al.05–1. 2005 use participated in adjusted for Parental drinking pattern Thirty-three percent of students 10–16 (mean age 12.48) predicted to alcohol branded items of Teen Opinions Risk taking initiation.16 (1. (unknown to parents).23 binge drinking (≥5 drinks (1. hat or Environments. Friend drinking knowledge and 14% binge drinking content-coded for 85% of all fifth–ninth School performance (five or more drinks within 2 h). matches.29).27–1. 10–15 promotions on the adolescents from (71%) odds ratios Ethnicity Brand recognition.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. When receptivity to (e. 1.17) for Q2.29) and high advertising (beer and California (pop Perceived peer drinking receptivity to alcohol marketing.74) for Q2.69–2. School socio-economic status divided into four quartiles.48–3. subsequently Germany the initiation of alcohol secondary schools (79%) log link. lighter. implied surveyed TV watching time adjusted RRs (95% CI) for drinking possession and purchase of Sensation seeking/rebelliousness without parental knowledge were alcohol) including viewing 1. OR = 1. ever 1.94 on TV.g.2 h.0) for Q3 and 2. (2008) USA Influence of alcohol Non-random Paper survey 1527 non-drinking 12 Logistic regression Grade 29% of never drinkers at baseline had Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use (California) 2003 advertising and longitudinal survey of students 1080/1527 to calculate Gender initiated alcohol use at follow-up.37) for Q4 in a row within 2 h) (Continued ) 9 Downloaded from http://alcalc.95 (1.0 (1. clustering Parenting style initiated drinking without parental box-office hit movies a State of Germany. in last 30 days or last 7 days) and transition to current drinker (finished ≥1–2 servings of alcoholic drink in last 30 days) Hanewinkel and Sargent Influence of exposure to Random selection of 42 Paper survey 3432 never drinkers 12–13 months Generalized linear Age The estimated mean movie alcohol (2008) alcohol use in movies on schools of which 27 2708/3432 models using Gender exposure was 3. 2014 .96–2.

drinking and aged 10–14 years interviewing months.49–3. ever Rebelliousness (HR = 1.32) a Although some included studies measured additional outcomes.54). alcohol use predicted in a row). Region effects of movie exposure at caused when someone baseline.6–3.44.31. 35 min at 8 ever use of alcohol. 95% CI: 0. et al. Movie alcohol movies content-coded for months. (2008) above USA merchandise (ABM) on adolescents aged telephone. clothing. Downloaded from http://alcalc.01). implied at 24 months School performance at 8 months (coefficient = −0. 95% Extracurricular activities CI: 0. but not Parent report education initiation of binge drinking between Household income 8 and 16 months (HR = 1.35) and initiation of binge drinking at 16 months (HR = 2. possession and purchase Availability of alcohol at home but did predict alcohol problems at of alcohol) Friend’s use of alcohol 16 months (coefficient = 0. Peer drinking susceptibility and ABM ownership. 95% CI: 1. Expectancy about alcohol Movie alcohol exposure between 8 Initiation of alcohol drinking Parental use of alcohol and 16 months predicted alcohol use (unknown to parents). 95% CI: 1. pens) ownership Parent drinking Ownership of ABM at baseline did Alcohol availability at home not have a significant direct impact Initiation of alcohol drinking Sensation seeking on alcohol initiation at 8 months (unknown to parents). (2008) USA Influence of exposure to Random longitudinal Telephone survey with 6522 8. shot glasses.08).31). 95% CI: 0. New ownership of ABM at 8 months had a significant direct impact on alcohol initiation at 16 months (HR = 2. 95% CI: 1. recent binge Family income alcohol problems and there were drinking. binge survey of adolescents telephone. but did on initiation School performance of binge drinking at 8 months (HR TV viewing length of time = 1.03). There was a headwear. whether Urbanicity significant indirect and independent experienced problems Anderson et al.99–2.g. this systematic review was concerned with longitudinal studies measuring self-reported drinking behaviour at follow-up.90–2. 8 and 16 months on drinks alcohol alcohol problems at 24 months McClure et al.80. Parenting (maternal responsiveness and Movie alcohol exposure at baseline alcohol-related problems procedure 5019 (77%) maternal monitoring) predicted alcohol use at 8 months Exposure to US box-office hit at 16 Rebelliousness (coefficient = 0. Sensation seeking exposure between baseline and 8 on-screen alcohol use 4574 (70%) Self-regulation months did not predict alcohol use (consumption. 10 Table 1 Continued Study [reference] Study objective Alcohol Sample/study Survey method Baseline sample Follow-up Analysis Covariates/ Outcome at follow-up Country Baseline marketing and media design size (months) confounders analysed survey date Age group exposure Drinking Follow-up (years) behaviour outcome rate measurea Wills et al. Thus. 16 and 24 Structural equation Age Viewed alcohol use in movies averaged 2003 10–14 alcohol use in movies on digit dial telephone computer-assisted 5503/6522 modelling Gender 31 min at baseline.57. 30 min at 16 months. (77%) at 16 expectancies) 8-month periods.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15.oxfordjournals. jewellery. Influence of ownership of Random digit dial Telephone survey with 4309 non-drinkers 8 and 16 Logistic regression Age ABM ownership increased from 11% Same sample as Wills alcohol branded telephone survey of computer-assisted 3762/4309 to estimate Gender at baseline to 20% at 16 months.41. ever Parental education at 16 months (coefficient = 0.13).1).22. (84%) at 8 analysis Ethnicity months.98–2. binge drinking (≥5 drinks Family structure At all times. binge drinking (≥5 drinks Parenting (maternal responsiveness and nor on alcohol initiation between 8 in a row) maternal monitoring) and 16 months (HR = 1. key months Exposure to movie alcohol use reciprocal relationship between chains.5). posters. (2008). (87%) at 8 hazards ratios Ethnicity 10% of adolescents tried drinking 2003 the initiation of alcohol 10–14 years interviewing months (HR) Susceptibility to alcohol use (response to for the first time and 5% tried binge 10–14 use and binge drinking procedure 3317/4309 peer offers. 2014 . intentions and positive drinking during each of the two ABM (e.28–2. it is the only outcome measure detailed in this table.

P = 0.05). who were alcohol drinkers at ages 18. Two-thirds of students (64%) watched same cohort. (1994) investigated the impact of the number 48%) during the previous 30 days.05. fewer opportunities to drink. predicted average (P = 0.01–1. consuming three or more drinks on one occasion (95% CI: 8– Connolly et al. and Forty-eight percent of 1206 grade 7 non-drinkers consumed found that liking of alcohol advertisements at age 18 did not alcohol during the previous year at grade 9. but not to wine/liquor drinking or amongst 667 participants in a multi-disciplinary longitudinal three or more drinks on one occasion.17–1.04–1.073. although the re- Downloaded from http://alcalc. 12 months (OR = 1. Self-reported frequency of expo- on average and maximum amounts of alcohol consumed on an sure was also positively associated with beer drinking. but not 15.oxfordjournals. the prevalence was 18% reported drink.068.001) and music video exposure (β = The measure of liking of alcohol advertising was based on 0. Sargent et al. whereas exposure to TV beer sure (TV. Controlled for of alcohol advertisements at age 18 marginally predicted being main confounders. controlling for covariates of commercial advertisements recalled at ages 13 and 15 years related to drinking behaviour. (1998) studied the impact of media expo.6. and the ex. including exposure to all different types in a higher trajectory for the frequency of drinking for men of advertising and the impact of the prevention programme. One study used was associated with a 44% increase in odds of beer drinking digital photography and GPS positioning to ascertain exposure (95% CI: 27–61%). 2002).05). OR = occasion and on the frequency of drinking and age 18 years 1.09. Based on the in Flanders. 2007)... Although significant relationships and music video exposure on the use of alcohol whilst going out were detected. ‘babysitter’ effect. (2002) studied 714 participants such relationship amongst US adolescents aged 12–13 years. a 34% increase in odds of wine/liquor and self-reported questionnaire for consumption data (Pasch drinking (95% CI: 17–52%) and a 26% increase in odds of et al. P = 0.21 (95% CI: 1.18)]. 2008. there at age 15. advertisements (OR = 1. P > 0.31 (1. P = 0. responses to three items: ‘alcohol advertisements have plenty Ellickson et al. P < risk for initiating drinking [OR = 1.to 13-year-old school tising expenditures and the degree of exposure to alcohol ad- children in California.05).and fourth-year secondary school students for more than 35 statistical tests were reported.004). each one standard deviation increase in alcohol ad- telephone interview in three (Snyder et al. P > 0.0706). Weekly tele- to 15-year olds from six public high schools in California. 2007) and computer-aided follow-up. For females. as did exposure to magazines with alcohol advertise- 18-month follow-up. t = 3.05) and exposure to and the maintenance of drinking. t = 3. Snyder et al. P > 0. sociated with a reduced risk of beer use (OR = 0. P < 0. 2014 For males. Belgium. (2005) studied the impact of exposure to dif- of action’. tionships found a signicant impact of all types of alcohol ad- sion for both men and women over the age 18–26 years. ethnicity.05) and exposure to in-store nance of drinking among existing drinkers amongst 1533 14. 21 and 26 years. explained as a initiated drinking and 322 (51%) drinkers continued drinking. music video and videotape viewing. they could have been due to chance. Casswell et al.to 26-year olds in 24 Nielsen 12-month follow-up. Seventy-seven percent of 1905 posure to other media.86. predicted the drinking onset for non-drinkers in the previous Robinson et al. vision viewing. and found that liking of watched daily. Casswell and Zhang (1998) followed 630 aged music videos at least several times a week. Stacy et al.46. recalled at age 13.. each 1-h increase per day in television grade 7 drinkers consumed alcohol in the previous year at viewing was associated with a 9% increased risk for initiating grade 9. was one exception. the draw-an-event memory test being as- imum amounts of beer (P = 0. At baseline.06. Casswell et al. 1998.008) consumed on an occa. Bivariate rela- predict trajectories of quantities of alcohol consumed per occa.75–0. There was test and draw-an-event memory test did not show significant no significant relationship with wine and spirit consumption. 325 (36%) baseline non-drinkers was inversely related to the onset of drinking. the number of commercial advertisements 0. use and the frequency of drinking amongst existing drinkers.. (2004) studied the impact of TV alcohol commer. 2006. controlled for alcohol advertisement exposure.47)]. but not 13. 0.42. Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use 11 et al.06. ing beer. Wills et al. At 1-year by postal survey in one (Fisher et al.09 (1. but not for women over the age 18– exposure to beer concession stands at sports or music events 26 years. Each 1-h increase per day events predicted the frequency of drinking amongst existing in watching music videos was associated with a 31% increased drinkers in the previous 12 months (coefficient = 0. 322 (51%) drinkers continued drinking.047) and max. Casswell and Zhang.41). predicted the frequency of beer Van den Bulck and Beullens (2005) studied the impact of TV consumption (P = 0. Exposure to beer concession stands at sports or music drinking [OR = 1..05).org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. since results amongst 2546 first.. radio. P > 0. (2006) studied the impact of alcohol adver- cials on alcohol use amongst 2250 12.12. relationships with any of the outcomes. P < 0. in-store advertisements (coefficient = 0. 95% CI: sion. During 0.. At on alcohol use amongst 15. and about one-third 18 beer drinkers until age 21 years.36 (SE = 0.05) did not. The cued-recall memory study of growth and development in New Zealand.02. 1994.01.99). During 18-months follow-up. whereby youth who watch more TV have Controlling for the effects of age.05. gender. 16% reported drinking beer. ‘alcohol advertisements show the type of people I ferent forms of alcohol advertising on the initiation of alcohol admire’. ‘Comparing alcohol adverts generally with other ads. and computer adverts (OR = 1. magazines with alcohol adver- and video game use) on initiation of alcohol use and mainte. (OR = 1.6)]. T = 6.10. whereas exposure to TV There were no significant associations between media exposure beer adverts (coefficient = −0.05) did not. ments (coefficient = 0.029). vertising exposure as measured by the watched TV shows index 2006.. Liking vertisement exposure on initiation of drinking. P > 0. 20% wine and 12% three-drink episodes. The quantity of alcohol consumed while going alcohol advertisements at age 18 predicted beer consumption out at follow-up period related to overall TV viewing (β = at age 21 [standardized coefficient 0. outdoor advertising and magazines) 15% wine and 8% three-drink episodes in the past month. 2008). McClure et al. which of the following you most agree with?’ Based on the and whether exposure to a prevention programme mitigates any same cohort. vertisements (TV. local geographical media markets (a company that tracks media . and. the number of commercial advertisements recalled lationships were in the direction of positive associations. tisements (OR = 1.

40). (2008) found a positive dose–response rela- Fisher et al.78 (1.8 alcohol advertisements within 1500 feet (457 m).01–1. 149 (24%) and out of 384 drinking lation.01. Hanewinkel et al.52).8% (event rate ratio = 1. 1.37) for Q4. Estimated nal survey that evaluated the impact of exposure of alcohol mean movie alcohol exposure was 3. but. Out of 611 drinking girls. ingness to use an alcohol promotional item on the initiation Wills et al. A previous survey had shown that 83% of use.16–2. other TV beer ads 1. and 2. attrition was greatest among the heaviest drinking segment alcohol at baseline. P = 0.62.37–2.28) for Q3. 2014 (from 1872 at wave one to 588 at wave four).0001.74) for Q2.996. Local ge.96–2. 95% CI: and 0. The relatively low exposure adolescents.27–1. radio listening 1.021).79 (1. Seventeen percent reported past year drinking without parental knowledge and 14% initiated binge beer drinking at grade 7.34). For those aged <21 years.g. 357 (15%) initiated tion. P < 0.to 13-month drinking were ESPN cable network (an American cable televi. boys for those who owned or were willing to use an alcohol ographical markets were systematically selected from the top promotion item compared with those who did or would not.0) for Q3. this was probably due to risk F(3.002. 28) = 8.08 (0. 112 (29%) engaged in binge drinking.13).17 (1. did predict at eighth grade intentions to use (e. The (1.to vided into four quartiles. OR = 1. 1. to evaluate vey to investigate the influence of alcohol advertising and pro- the impact of exposure to alcohol use in popular contemporary motions on the initiation of alcohol use amongst 1080 non- movies and incident alcohol drinking.76 (1. P < 0. The odds ratio of alcohol initiation during the 12-month movies viewed by the sample. 611 (19%) and of 2228. 95% CI: 1.001–1. and for confusing had 14. 384 boys (17%) initiated alcohol 10. Smart.16– related programming 24 h a day) 1.48) for boys for those who owned or were 1.05. prospective evidence did not predict alcohol behaviour amongst sixth grade alcohol on alcohol advertising effects on youth drinking.19 (1.27–3. including 57% of movies rated . The exposure to alcohol advertisements at sixth grade although the study provided associational.03 (0. each school site Downloaded from http://alcalc.06–1.6 h. 2027 (78%) students followed up were non-users of ever. amongst 3432 never drinking German adolescents.29). compared with 13% in the other than their excessive media exposure. Exposure predicted the use of alcohol during 1. in the previous month by 2.51–1. amongst sixth grade limitations of other research.056). other sports 1. each additional alcohol ad.13 (0.2 h. The Northland Chicago.12 Anderson et al. (2008) studied the impact of exposure to alco- of alcohol use and binge drinking (five or more alcohol drinks hol use in movies on ever use of alcohol.14).92–1. of alcohol use in motion pictures and initiation of alcohol use Hanewinkel and Sargent (2008) studied the impact of ex- was stronger among adolescents in lower exposure categories. a randomized controlled trial of an alco- study has been criticized for the attrition in the study sample hol use prevention programme.95 magazine reading 0.42 (1. subsequently di- marketing on beer use amongst 1786 grade 6 students (11. OR = 1. posure to alcohol use in movies on initiation of alcohol use Collins et al.03.5]. When receptivity to alcohol analysis with quadratic exposure effect (OR = 0. Twenty-nine percent of never drinkers at sure to alcohol use in 601 movies was 8. Seeing more or fewer advertisements in a outdoor alcohol advertisements within 1500 feet (457 m) of 63 particular month than he or she typically saw was a predictor of Chicago school sites of 61 schools that were part of Project drinking (event rate ratio = 1.87 (0. (2007) conducted a non-random.65–2.05– drinking alcohol.29. Each additional dollar per capita spent on alco.74 (1. cross-sectional survey. and from three TV sources: the highly exposed adolescents.94 (1. exposure) in USA. brand recall.01 (0.6–13. drinking students. and ported.77) for girls the previous month by 1% (event rate ratio = 1.23 (1. f = 4. [inter-quartile range baseline had initiated alcohol use at follow-up.25). Compared with quartile 1. Individuals were randomly sampled within period was 1. 75 media markets in the US representing 79% of the popu.23–2. you think you will be drinking alcohol in the next month’). OR = 1.91–1. of 2586. and high receptivity to alcohol marketing. because the attenuation was larger for F(8. The odds ratio of vertisement seen increased the number of drinks consumed in binge drinking amongst drinkers was 1.29).992–0. suggesting under-estimation in the findings. ‘do exposure measures based on self-reporting (Snyder and Slater.33) for households and households within media markets. it addressed users and non-users at eighth grade. (2006) conducted a randomized school-based P = 0.15 (1. particularly the unreliability of non-users. in-store beer displays dose–response curve showed that the response was greatest for 1. How. The un-adjusted 1. Baseline median expo. Out of 2406 students. In another study.999) showed that the relationship between exposure tistically significantly predicted alcohol initiation.003).77 the follow-up period (OR = 1.69–2. 2006.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15.48–3.001–1.to 14-year olds. Out of 3283 alcohol-related problems amongst a random sample of 6522 US girls. (2007) carried out a school-based longitudi.95–1. Twenty percent of youth in the 75th factors for alcohol use tending to cluster among the high ex- percentile of alcohol marketing exposure at grade 6 reported posure adolescents who are at risk for alcohol use for reasons past year beer drinking at grade 7.36–2. 95% Pasch et al. the adjusted RRs (95% sion network dedicated to broadcasting and producing sports.35.01. 25th percentile. boys. binge drinking and over a few hours at least once over the past year).42).44 (0.002–1.028. The odds ratios (95% CI) for beer drinking (five or more drinks within 2 h) over 12. and for binge drinking 1. and outcome expectancies.83–1. Brand recogni- (IQR) = 4. and 2.02–1. Out correlation with causality (Schultz.16 (1.96 (0. prospective tionship between lack of parental movie restriction and risk of cohort study to investigate the impact of ownership of or will. 95% CI: 1. 2006).oxfordjournals. follow-up.36. One-third (33%) of students initiated 12-year olds) 1 year later.17) for Q2. Adjusting for covariates joint effect of exposure to advertisements from all sources: accentuated this effect. for Q4.87–1. beer concessions 1. beer promotional items 1. with longitudinal follow-up amongst Henriksen et al. On average.48) predicted initiation.0 (1.06). (2008) used a non-random longitudinal sur- 2406 non-drinkers at baseline 12–26 months later. (2007) investigated the impact of exposure of CI: 1. 33) = 3.00– (1.19) for girls and 1. recall and recognition no longer sta- 0. but initiation of alcohol use was not re- of the sample. willing to use an alcohol promotion item compared with those hol advertisements increased the number of drinks consumed who did or would not.15.37) beer ads 1. initiation of binge drinking amongst the same sample. Sargent et al. f = 6. 95% CI: marketing was controlled. 2006). CI) for drinking without parental knowledge were 1.37).

therefore. Hanewinkel and Sargent. As explained in the introduction.01).. 2006. 95% CI: 1.13). are likely to underestimate any effects.1). While some of the found a dose–response relationship. 95% CI: 0. 2006. example. youth in the 75th significant direct impact on alcohol initiation at 8 months (HR percentile of alcohol marketing exposure at grade 6 were 50% = 1. the most recent estimate for expenditure impact of exposure on initiation of drinking included an inter. (2007) found a dose–response relationship between ex- consumption among existing drinkers. 2005) of the three studies that measured the impact of ex- dicted alcohol use at 8 months (coefficient = 0. For example. (2006) found a linear association between movie and 244 alcohol brand appearances (Cin et al. Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use 13 as acceptable for child viewing. 1998. At all times. finally. ation of drinking without parental knowledge and binge drink- able movies. 2005..6–3.6 h of movie use Sargent et al. 2003. included an interval level exposure measure.57.49–3. the number of drinks consumed increased by ownership. researchers posure to alcohol use from popular contemporary movies and controlled for key confounding variables. Ellickson 16-month follow-up. ABM ownership ciated with a 44% increase in odds of beer drinking. There was a reciprocal relationship between susceptibility vertisement seen.41.03) but did (Ellickson et al. Henriksen et al.... a 34% increased from 11% at baseline [the 8-month measurement pe.. Downloaded from http://alcalc. For example. but not on initiation of binge drinking between 8 the intention to drink (although. 2014 alcohol use predicted alcohol problems and there were signif. in the study by Stacy et al. the greater initiation of binge drinking at 8 months (HR = 1.. 95% drinking.. and all seven studies of that for alcohol promotion as a whole. Stacy et al.. Hanewinkel et al. effort that is put behind alcohol products.32). 2007). for instance. CI: 1. in the study by Pasch et al. this study found no impact on and 16 months (HR = 1. Therefore..99–2. and all studies found a dose–response relationship. none looked at the cumulative impact that .oxfordjournals. in the study by Snyder et al. and relevant demographic variables. amongst other factors. including one in five (19%) of child accept..44. 95% CI: the exposure to outdoor advertising near schools. As noted in the intro- 2008.g. there was a dose–response well as advertising. 34 min at 8-month follow-up.. for each additional ad- ods.28–2. 2005) found a dose–response relationship with predict alcohol problems at 16 months (coefficient = 0. the greater 1. 1998. the study by exposing the adolescents on average to 5. Two (Robinson et al. et al.. Twelve of the thirteen McClure et al.. 2005. 2008). nor on alcohol initiation between more likely to be drinking at grade 7 than youth in the 25th per- 8 and 16 months (HR = 1.80.. This study found an impact of Furthermore. Hurtz et al. In the exposure portraying alcohol use and onset of alcohol use from impact study. 2007) on alcohol use of the total sample of non-drinkers and icant indirect and independent effects of movie exposure at drinkers at baseline included an interval level exposure mea- baseline. which is only a part of the promotional et al.08). Advertising influences youth drinking. 2008.. 1994. including family and alcohol use without parental knowledge and binge drinking in peer drinking. 8 and 16 months on alcohol problems at 24 months.. containing at least one alcohol brand appearance. although only providing a snapshot of advertising exposure and levels of drinking. For Using the same cohort. (2007). sure. drinking behaviour. (2008)] to 20% 16 months later.org/ at Biblioteca Centrala Universitara din Cluj-Napoca on September 15. (2008) studied the im.22. cross-sectional studies. 95% CI: 0. Snyder et al. studies found evidence that such exposure predicts both the 2007). that longitudinal studies demonstrate that alcohol initiation at 16 months (HR = 2. 2008) of the eight studies that measured the duction. of schools (Pasch et al. odds of consuming three or more drinks on one occasion dur- Ten percent of adolescents tried drinking for the first time and ing the previous 30 days. because they focus prin- Seven (Robinson et al.31. ership of ABM at 8 months had a significant direct impact on It is clear. (2006) 5% tried binge drinking during each of the two 8-month peri. depicted alcohol use. 2006. both cross-sectional and longitudinal studies exposure on intentions to drink in the next month. but did on centile. each one standard pact of ownership of alcohol branded merchandise (ABM) on deviation increase in alcohol advertising exposure was asso- initiation of alcohol use and binge drinking.. Pasch et al. Wills et al.5). consistently reported correlations between increased exposure gated the relationship between adolescent exposure to alcohol and greater likelihood of current drinking (see Kuo et al. despite their inherently weaker design. The ownership of ABM at baseline did not have a 3%. 2006. possibly due to a lack of statistical power). 2004. 95% CI: 0. that did not find an effect on behaviour examined the impact cross-sectional studies do corroborate the effects found by lon- of exposure to outdoor advertising placed within 453 metres gitudinal studies.31).98–2. New own. In each case. on alcohol advertising in the UK is actually only a quarter val or continuous level exposure measure.54). Six of the seven studies (Connolly Movie alcohol exposure between 8 and 16 months predicted et al. 2007. The study Germany. Movie al. in the study selected studies looked at promotion (e.. McClure et al. steeper for low hours of exposure than higher. advertising and promotion and drinking. Movie alcohol exposure at baseline pre. and 30 minutes at exposure reached 11 h. posure on maintenance of drinking amongst baseline drinkers cohol exposure between baseline and 8 months did not pre. the frequency of drinking. encourages youth and initiation of binge drinking at 16 months (HR = 2. ing. (2004). with relationship between hours of movie alcohol exposure and initi- over half (52%). of US individuals aged 15–26 years. merchandising) as by Hanewinkel and Sargent (2008). Sargent cipally on advertising. the cross-sectional study of Hanewinkel onset of drinking amongst non-drinkers and increased levels of et al. have This review identified 13 longitudinal studies that have investi.35) alcohol advertising. Van den Bulck and Beullens alcohol use at 16 months (coefficient = 0. and for each additional dollar spent per capita on alcohol peer offers. (2007). intentions and positive expectancies) and ABM advertisements. Sargent et al. this review focused on lon- gitudinal studies because the dimension of time makes them a particularly powerful way of untangling cause and effect. the number of drinks consumed increased by to alcohol use (three survey items that assessed response to 1%. Ellickson et al.90–2. increase in odds of wine/liquor drinking and a 26% increase in riod reported by Wills et al. one of which dict alcohol use at 8 months (coefficient = −0. in the study by Collins et al. DISCUSSION Nonetheless. viewed alcohol use in movies averaged 31 min zero incidence at zero exposure to an incidence of 20% when at baseline.

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