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Introduction, conflict of interest statement.

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Alcohol Marketing on Twitter and Instagram: Evidence of Directly Advertising to Youth/Adolescents

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Adam E. Barry, Austin M. Bates, Olufunto Olusanya, Cystal E. Vinal, Emily Martin, Janiene E. Peoples, Zachary A. Jackson, Shanaisa A. Billinger, Aishatu Yusuf, Daunte A. Cauley, Javier R. Montano, Alcohol Marketing on Twitter and Instagram: Evidence of Directly Advertising to Youth/Adolescents, Alcohol and Alcoholism , Volume 51, Issue 4, July/August 2016, Pages 487–492, https://doi.org/10.1093/alcalc/agv128

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Assess whether alcohol companies restrict youth/adolescent access, interaction, and exposure to their marketing on Twitter and Instagram.

Employed five fictitious male and female Twitter ( n = 10) and Instagram ( n = 10) user profiles aged 13, 15, 17, 19 and/or 21. Using cellular smartphones, we determined whether profiles could (a) interact with advertising content—e.g. retweet, view video or picture content, comment, share URL; and/or (b) follow and directly receive advertising material updates from the official Instagram and Twitter pages of 22 alcohol brands for 30 days.

All user profiles could fully access, view, and interact with alcohol industry content posted on Instagram and Twitter. Twitter's age-gate, which restricts access for those under 21, successfully prevented underage profiles from following and subsequently receiving promotional material/updates. The two 21+ profiles collectively received 1836 alcohol-related tweets within 30 days. All Instagram profiles, however, were able to follow all alcohol brand pages and received an average of 362 advertisements within 30 days. The quantity of promotional updates increased throughout the week, reaching their peak on Thursday and Friday. Representatives/controllers of alcohol brand Instagram pages would respond directly to our underage user's comments.

The alcohol industry is in violation of their proposed self-regulation guidelines for digital marketing communications on Instagram. While Twitter's age-gate effectively blocked direct to phone updates, unhindered access to post was possible. Everyday our fictitious profiles, even those as young as 13, were bombarded with alcohol industry messages and promotional material directly to their smartphones.

Longitudinal research consistently documents exposure to alcohol advertising as an influential factor on whether youth will initiate alcohol use, and the quantity they will consume if they already drink ( Ellickson et al. , 2005 ; Anderson et al. , 2009 ; Smith and Foscroft, 2009 ). Moreover, there appears to be a dose response–relationship between alcohol consumption and exposure to media and commercial communications, such that as exposure to alcohol advertising increases so too does the frequency of a drinker's consumption, as well as the odds of alcohol initiation ( Snyder et al. , 2006 ; Anderson et al. , 2009 ). In addition to simply considering overall exposure to media, it has been proposed that it is equally important to consider and assess how associated messages are perceived and interpreted ( Austin et al. , 2006 ). When perceived as likeable, alcohol advertisements effectively influence an adolescent's intention to purchase the brand and products promoted ( Chen et al. , 2005 ). Positive intentions and expectations of underage persons to drink alcohol are predicted by their attitudes and perceptions of promotional messages, which alcohol advertising effectively influences ( Fleming et al. , 2004 ). Expectancies of underage persons have been found to be not only influenced by logic, but also affect, such that individuals progressively internalize message and subsequently employ them in their eventual decisions and also emulate the portrayals observed ( Austin et al. , 2006 ). In other words, receptivity to advertising has been proposed to be a continuous iterative process in which youth go through cycles of exposure, internalization, and incorporation into their identity ( McClure et al. , 2013 ). In sum, ‘alcohol ad exposure and the affective reaction to those ads influence some youth to drink more and experience drinking-related problems later in adolescence’ ( Grenard et al. , 2013 , p. e369).

Self-regulation and youth exposure to alcohol advertising

Despite self-imposed regulations which call for limiting exposure of youth to alcohol advertising content and messages, there is evidence that the alcohol industry purposefully targets those under the minimum legal drinking age (MLDA; 18–20) ( Ross et al. , 2014 ). For instance, beer and liquor advertising appear more frequently in magazines with higher adolescent readerships ( Garfield et al. , 2003 ; King et al. , 2009 ). Additionally, placement of television advertising appears during television programs with higher percentages of youth viewers than is allowable under alcohol industry voluntary regulations ( CDC, 2013 ). Although alcohol brand websites require visitors to enter a birthdate—a content restriction practice known as an ‘age gate’—persons under the age of 21 represent large percentages (upwards of 50–60% for some brands) of the total in-depth visits to alcohol websites ( CAMY, 2004 ).

With the proliferation of internet and social media, the alcohol industry has considerably decreased its advertising expenditures in traditional media outlets (e.g. television, radio, magazine) while at the same time substantially increased expenditures for digital and online outlets ( FTC, 2014 ). This is concerning when you couple the alcohol industry's track record of advertising to youth with the fact that youth account for a large percentage of internet and social media adopters and users ( Pew Research Center, n.d. ). Approximately 95% of teenagers (12–17 years) use the internet ( Pew Research Center, n.d. ). Of these internet users, 81% engage with social media sites, the most popular of which include Facebook, Twitter, and Instagram ( Pew Research Center, n.d. ). As Casswell (2004) contends, new developments in alcohol marketing are most likely to impact adolescents and young adults, as they are more likely to adopt new technology.

With regard to self-regulation, the Distilled Spirits Council of the United States (DISCUS) developed the Guidance Note on Responsible Digital Marketing Communications ( 2011 ), which asserts: It should be noted that DISCUS is a trade association which represents the leading producers and marketers of distilled spirits in the USA.

Digital marketing communications are intended for adults of legal purchase age.

Digital marketing communications should be placed only in media where at least 71.6% of the audience is reasonably expected to be of the legal purchase age.

Digital marketing communications on a site or web page controlled by the brand advertiser that involve direct interaction with a user should require age affirmation by the user prior to full user engagement of that communication to determine that the user is of legal purchase age.

Current investigation

Considering (a) youth and adolescents are highly engaged with social media applications such as Twitter and Instagram, (b) alcohol advertisers are expanding their social media presence and (c) advertiser practices have targeted youth and adolescents across more traditional media platforms, it is essential to examine whether youth are able to interact with and/or be advertised to on social media platforms. The current investigation employed fictitious social media profiles between the ages of 13–21 in order to assess whether alcohol companies are adhering to the recommendations outlined in the DISCUS's Guidance Note on Responsible Digital Marketing Communications ( 2011 ) in their marketing practices on the social media platforms of Twitter and Instagram. Twitter and Instagram were specifically chosen for several reasons. First, the FTC (2014) contends that Facebook effectively restricts access to alcohol industry pages to those over the minimum legal drinking age, and that alcohol advertisements cannot be placed on the pages of persons who are younger than 21. Thus, existing data on Facebook practices eliminated it from consideration. Second, following Facebook, Twitter and Instagram are the most popular social media sites among youth between the ages of 12–17 ( Pew Research Center, n.d. ). Specifically, we examined whether youth could (a) view and interact with online social media alcohol advertising on Twitter and Instagram, and (b) follow and subsequently receive promotional materials/messages from alcohol brand profiles on Twitter and Instagram. Based on previous investigations into the efficacy of age gate technology employed on the social media site YouTube ( Barry et al. , 2015 ), we hypothesized that youth would have access to, and be able to follow, all alcohol advertising materials/promotions.

Creation of user profiles

We created five fictitious male and five fictitious female Twitter ( n = 10) and Instagram ( n = 10) user profiles, which were each assigned an age of 13, 15, 17, 19 and 21. For each social media platform there was a male and female profile for each age category. We specifically chose to have profiles begin at age 13 since nearly half of American 8th graders (44%) have tried alcohol ( Johnston et al. , 2005 ). Additionally, these age ranges were selected because they correspond with several different phases of life: middle-school (age 13), high school (ages 15 and 17), and college (ages 19 and 21). The profiles were assigned first and last names randomly selected from the 20 most popular names on the 2010 United States Census. Each fictitious profile was used to interact with both the Twitter and an Instagram social media channels which produced usage and engagement metrics. These metrics were assessed solely via mobile smartphone devices. Thus, it is possible user experiences would be different from those using a desktop/laptop/tablet computer. The only information that was entered during setup of the accounts on Twitter and Instagram was user name, age, and sex.

Inclusion and exclusion criteria

Data obtained from Twitter and Instagram provided information on the ability of youth to access, view, interact (e.g. re-tweet, ‘like’) and follow official alcohol brand pages. In order to identify what alcohol companies to examine, we selected the 25 alcohol brands that are most popular/consumed (i.e. highest prevalence of use within the past 30-days) by adolescents in the USA (see Siegel et al. , 2013 ). Brands were excluded if we were unable to identify their official Twitter and Instagram account. Of these 25 brands, only 22 had official pages on both Twitter and Instagram.

Data was collected in two phases using Twitter and Instagram mobile applications. Phase 1 focused on analyzing access and interaction. Specifically, for each of the 22 brands, all fictitious profiles attempted to view the official page of each alcohol brand. Next, users attempted to interact with the official page. Interaction was judged to occur if a profile could (a) retweet, (b) view video content, (c) view picture content, (d) like, (e) comment, (f) share URL, and/or (g) share content (e.g. retweet, regram). Phase 2 of data collection focused on whether our fictitious youth profiles could follow and receive direct updates from each of the 22 alcohol brands. Updates were considered any distinct post consisting of either a video, picture, or text. Updates were not classified by type; instead, each new post received was counted as an update. Each fictitious profile recorded data from both Twitter and Instagram for a period of 30 days. Phase 2 focused on the frequency with which an alcohol company sent updates (e.g. video, picture or text-based sentences) to our fictitious profiles. It is important to note that for each phase of data collection, all profiles entered their assigned fictitious birthdate when prompted. The Institutional Review Board determined this research to be exempt from review.

Phase 1 findings

All user profiles, both those under the MLDA of 21 and those of legal drinking age, were able to view, interact, and comment on advertising content from the alcohol companies on both Instagram and Twitter. In other words, all profiles, regardless of age (13–21), could fully interact with Instagram and Twitter content, such as view videos, comment on pictures, forward advertisements to others, like and retweet posts from alcohol industry feeds/pages. Table  1 presents a general overview of findings from Phase 1.

Ability of users (aged 13–21) to view and interact with official pages of 22 alcoholic brands on Twitter and Instagram

Phase 2 findings

As you will note from Table  1 , Twitter's age-gate only prevented underage profiles from following each of the official alcohol company pages, and subsequently from receiving direct updates/promotional advertising. However, this feature was not employed on Instagram; thus, all profiles (13–21) on Instagram could receive alcohol industry advertisements directly to their smartphones. Figure  1 outlines the cumulative number of Instagram updates received by all profile users over a period of 30 days (total n = 3620). On average, each user received 362 Instagram updates directly to their smartphone within a month. Given Twitter's age gate preventing under-age profile users from following and receiving updates from alcohol companies, only our two legal drinking age profiles received direct to consumer promotional material (total n = 1836) via their Twitter account during the 30 days of data collection (male n = 917; female n = 919).

Cumulative number of Instagram updates sent from 22 alcohol companies to users (13–21) over a 30-day period.

On average, all Instagram profiles received 12–13 updates from alcohol companies each day (approximately 91 per week), regardless of age. Figure  2 outlines the average number of Instagram updates sent to of-age and underage profiles as a function of day of the week. Frequency of alcohol advertising updates increased as the week progressed, reaching its peak on Thursday and Friday.

Comparison of average weekday Instagram updates received by of-age profiles and underage profiles within 30-day period.

Fortuitous findings

In the process of evaluating the main hypothesis proposed in this study, there were noteworthy exploratory findings that were not considered a priori. As noted above in Phase 1, to fully determine the level of access that our profiles had to alcohol industry pages we sought to see if it was possible to view and interact with (e.g. like, comment, share) promotional material. As a result of this interaction we learned that entities who maintained and controlled the alcohol brand pages would directly interact/correspond with our underage profiles. As noted in Fig.  3 , the representative/controller of alcohol brand Instagram accounts would respond directly to our underage profiles. Secondly, alcohol advertisers, representatives, and/or enthusiasts ‘followed’ our underage profiles. Each of the underage profiles included in this investigation received follow notifications from separate, distinct, and uninitiated alcohol advertisers, representatives, and/or enthusiasts that were not part of our sample of 22 alcohol brands.

Examples of alcohol industry direct communication/correspondence with underage profiles.

While there exists a plethora of scholarly investigations which have examined the impact of alcohol advertising transmitted through traditional mediums (i.e. television, radio, newspapers), there is much less peer-reviewed literature which examines alcohol advertising on emerging social media platforms. To date, we are aware of only two studies (see Winpenney et al. , 2014 ; Barry et al. , 2015 ) that have attempted to examine the accessibility of alcohol content to underage persons via social media. Unlike these previous studies, however, this investigation examined Instagram and Twitter in lieu of Facebook and YouTube. Overall, our findings point to the unobstructed accessibility youth have to alcohol advertising and promotion via both Instagram and Twitter. In other words, there was no restriction to viewing and interacting with the content posted on alcohol brand pages. Moreover, in the case of Instagram, age-gate technology did not restrict underage profiles from receiving updates directly to their smartphones. These findings echo Nicholls’ (2012) contention of ‘everyday, everywhere’, such that everyday our fictitious profiles, even those as young as 13, were bombarded with messages and post directly to their personal smartphones.

As alcohol companies are cutting down on traditional advertising, they appear to be increasing their efforts towards online or digital advertising ( FTC, 2014 ). This is concerning for several reasons. First, youth and adolescents represent a large percentage of internet and technology users ( Pew Research Center, n.d. ), which would disproportionately expose them to digital alcohol advertisements above and beyond of-age drinkers. Second, the self-imposed regulations established by the alcohol industry have failed to protect and/or limit youth from exposure to their advertising content via traditional mediums ( Anderson, 2009 ; Tanski et al. , 2015 ). In fact, due to the relative ineffectiveness of the industry's self-regulation, public health researchers and government officials in some countries are considering implementing a ban on alcohol advertising (see Jernigan, 2013 ; Parry et al. , 2014 ). Others have called for imposing a levy on alcohol advertising in order to establish a fund which can be used to develop counter-advertising messages (see Harper and Mooney, 2010 ). Third, previous research has found systemic code violations with regard to the content depicted in alcohol industry advertising ( Vendrame et al. , 2010 ; Babor et al. , 2013 ), as well as the content on their respective websites ( Gordon, 2011 ). While this investigation focused exclusively on access, interaction, and exposure to alcohol advertising on social media, our findings highlights the need for future research examining the content of the messages sent to underage consumers on social media. In an examination of the marketing content posted on 12 of the leading UK alcohol brand Facebook pages, Nicholls (2012) documented the use of interactive games, links to product advertisements encouraging viewers to suggest alternative endings to their commercials, as well as messages encouraging drinking—regardless of the day of the week. To date, however, examinations of the content on social networking platforms such as Twitter and Instagram are unavailable.

The current investigation highlights the alcohol industry's use of social media platforms to send direct to consumer advertisements regardless of age. In other words, the industry has violated their own marketing code restrictions and ultimately failed to restrict access and exposure of underage persons to their advertising content. Moreover, representatives/controllers of their alcohol brand pages are actually communicating directly with persons under the MLDA. We did not, however, measure level of interaction among each of our respective profiles and the alcohol brand pages. Instead, to address our initial research question, we sought to simply determine whether profiles could view and interact with alcohol brand pages. The lack of a measure of interaction for each of our profiles (i.e. how many times each profile liked a post, posted a comment) prohibits us from determining whether involvement resulted in differing quantities and frequencies of updates directly received. Future research, therefore, should seek to determine whether differing levels of engagement and interaction among social media users results in altered levels of exposure to alcohol industry promotions.

The findings reported herein highlight not only an American public health issue, but an international health concern given the borderless reach of digital media. In fact, in their Global Strategy to Reduce the Harmful Use of Alcohol the World Health Organization called for a reduction in the number of youth exposed to alcohol advertising ( WHO, 2010 ). Given that alcohol advertising is one of the factors influencing the beliefs and behaviors of young people, and contributing to their decision to consume alcohol despite being below the MLDA ( Grube, 2004 ), our findings demonstrating the ineffectiveness of age-gate technology should serve as a call for (a) greater political advocacy from public health officials and researchers, and (b) additional research examining how emerging social media technologies are being leveraged by the alcohol industry in the marketing of their products.

The authors have no conflicts of interest (financial or otherwise) to report.

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Alcohol Advertising: What does the evidence show?

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Economic Affairs (43.2)

The Mirage of Swedish Socialism: The Economic History of a Welfare State

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Introduction, the impact of alcohol advertising bans.

“Saffer’s finding of significant negative associations between advertising bans and alcohol consumption and cirrhosis and motor vehicle deaths are generally refuted when cultural traits of individual countries are accounted for, consumption is disaggregated, and more appropriate statistical models are employed. Indeed, the results are often the opposite of what would be expected if advertising bans are actually effective.”

Alcohol Advertising Expenditure and Consumption

“Advertising is found to have had no significant effect upon the ‘product composition’ or ‘level’ of total alcoholic drink consumption in the UK over the period from 1964-1996, and this result is robust with respect to variations in the specification of functional form. The consumption of alcoholic drink is affected by relative prices, total consumer budgeted expenditures and, to some extent, by autonomous shifts in tastes. These results imply that manipulation of the aggregate level of alcohol consumption (and its distribution between beer, spirits and wine) is not an easy matter for policy makers to achieve.”

Advertising exposure and consumption: observational studies

“For instance, if teenagers assume it is socially ‹cool’ to remember many ads or to drink beer on weekends, they may give high scores to both questions (giving rise to a correlation), regardless of how they actually behave. Another common version of this bias is that participants may try to guess the purpose or the research question of the study and then deliberately give answers that ‹confirm’ the question by the researchers. (E.g., if teenagers guess that researchers are studying the relationship between advertising and alcohol consumption, they may deliberately say that they have seen numerous ads and consumed a lot of alcohol, regardless of the actual number of ads seen and amount of alcohol consumed).”

“If alcohol advertising could actually induce people to drink (who were otherwise not so inclined), one would expect a profit-maximising firm to advertise in a wider variety of media read by different consumers than the ones who consume the media firms currently use.” (ibid.)

Randomised controlled trials

• A Cochrane Review is a systematic review of randomised controlled trials. Cochrane Reviews are widely considered to be the ‘gold standard’ of evidence in healthcare and health policy.
• i.e. lower rates of alcohol consumption and the implementation of alcohol advertising bans can both be independently attributed to a third variable (public opposition to alcohol).
• Non-susceptible young people are defined as those who tell the researchers that they definitely will not drink alcohol in the near future.
• Another study by these researchers, which did not appear in the review, found ‘no evidence that exposure to alcohol advertising increases consumption in the short or long term’ (Kohn et al. 1984).
• Although public health academics often assume that an increase or decrease in per capita consumption will lead to a commensurate change in alcohol-related health harms, this has often been contradicted by real-world evidence (Snowdon 2022).

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• > Journals
• > Journal of Law, Medicine & Ethics
• > Volume 50 Issue 2: Commercial Speech and Commercia...
• > Commercial Advertising of Alcohol: Using Law to Challenge...

Article contents

• Introduction
• Strategies for Marketing Alcohol
• The Relationship between Alcohol Marketing, Consumption, and Harm
• Regulating Alcohol Marketing in the Public Interest
• Legal Strategies to Challenge Regulation of Alcohol Marketing

Commercial Advertising of Alcohol: Using Law to Challenge Public Health Regulation

Published online by Cambridge University Press:  27 July 2022

In most countries, the alcohol industry enjoys considerable freedom to market its products. Where government regulation is proposed or enacted, the alcohol industry has often deployed legal arguments and used legal forums to challenge regulation. Governments considering marketing regulation must be cognizant of relevant legal constraints and be prepared to defend their policies against industry legal challenges.

1. Introduction

The marketing of alcoholic beverages is pervasive and problematic, yet few countries have adequately responded to this significant public health issue. Using digital media, more channels are available than ever before for the marketing of alcohol. This proliferation of alcohol promotion has occurred at the same time as knowledge has grown about the harms of alcohol consumption and the role that exposure to alcohol marketing plays in the occurrence of such harm, especially amongst young people. Reference Jernigan 1 Alcohol is commonly among the top 10 risk factors for ill-health or early death. Reference Murray 2 The level of harm attributable to alcohol approximately doubles when alcohol’s harm to others (such as through family violence) is taken into account. Reference Bonomo 3

The marketing of alcohol has become increasingly globalized. According to the market research firm Euromonitor, the top ten transnational alcohol corporations (TNACs) in global alcohol sales revenue sold over one-third (35.5%) of commercial alcoholic beverages in 2019, with the global market being most concentrated for beer (64.5%) and least for wine (13.8%). Reference Amis and Silk 4 With TNACs, an international team, combining cosmopolitan marketing expertise with knowledge of specific target cultures, often manages the promotion of an alcohol brand, in accordance with a global positioning strategy. 5

In the face of this evidence, the World Health Organization has repeatedly called for controls on alcohol marketing to protect minors and other at-risk groups. In 2010, the WHO Global Strategy to Reduce the Harmful Use of Alcohol expressed “serious concern” about the prevalence of alcohol marketing and its impacts on young people. 6 Restrictions on alcohol marketing have been recognized by the WHO as one of the three most effective interventions for reducing alcohol-related risks. 7 In May 2022, the WHO member states, meeting as the World Health Assembly, approved an alcohol action plan for 2022–2030 which calls on member states to implement “comprehensive and robust restrictions or bans across multiple types of media.” 8 The action plan also calls on relevant economic actors, such as alcohol producers, importers, and retailers, to “take concrete steps towards eliminating the marketing and advertising of alcoholic products to minors…”, 9 while avoiding “the targeting of new consumer groups with alcohol marketing, advertising and promotional activities…”. 10

Our analysis reveals that industry has made use of international and domestic law in its arguments, and although rights-based arguments (human rights or constitutional rights) have been prominent, a range of areas of law have been utilised by the industry in its efforts to defeat the making or application of alcohol marketing regulation. Our analysis also shows that legal arguments have been used against particular features of alcohol marketing regulation: restrictions on “truthful” marketing (eg, the price of the product), health claims, no or low alcohol advertising, and “lifestyle” advertising; comprehensive advertising bans; and cross-border marketing regulation.

Acting to reduce the prevalence of alcohol marketing is no small undertaking for governments. It requires regulatory astuteness, given the creativity and resources of the industry in the production of new forms of marketing. It also demands strong political commitment, in the face of certain opposition from the alcohol, media and other interested industries. Reference McCambridge, Mialon and Hawkins 11 Legal capacity is also essential as it is not uncommon for the industry to use legal arguments and legal forums, including litigation, to oppose public health measures around alcohol that are not to the industry’s liking. This is a strategy which has been used extensively in respect of other public health regulation, including tobacco control. Reference Zhou 12 It is, of course, important that governments act lawfully in carrying out their public health functions. However, supervising government exercises of power in the public interest is arguably not the purpose of industry litigation and legal claims against public health policy. Rather, industry is pursuing its private interests and using law as just one more tool to achieve its commercial goals. In fact, there are instances, where unmeritorious legal arguments and threats of litigation have been made against government regulation, including against the government alcohol warning label scheme in the Yukon Territories. Reference Stockwell 13 Such threats can nonetheless be a powerful influence in the policy-making process, potentially making regulators less keen to tackle the public health problem for fear that litigation, with all its attendant costs and difficulties, may ensue. Reference Milsom 14 One of the issues is that it is always difficult to know the extent of the use of legal claims to oppose public health regulation. However, where arguments are ventilated in open legal forums, it is possible to gain some greater insight into the industry’s concerns about public health regulation and the way in which industry leverages law to resist regulation. Reference Barlow 15

In this article, we examine case studies from several jurisdictions where the alcohol industry has openly used law to oppose controls on alcohol marketing (Part 5). Our analysis reveals that industry has made use of international and domestic law in its arguments, and although rights-based arguments (human rights or constitutional rights) have been prominent, a range of areas of law have been utilized by the industry in its efforts to defeat the making or application of alcohol marketing regulation. Our analysis also shows that legal arguments have been used against particular features of alcohol marketing regulation: restrictions on “truthful” marketing (eg, the price of the product), health claims, no or low alcohol advertising, and “lifestyle” advertising; comprehensive advertising bans; and cross-border marketing regulation. This article places this analysis in the current context in which alcohol marketing is occurring: the marketing techniques deployed by industry interests (Part 2); the evidence of marketing’s connection to consumption and harm (Part 3); and current regulatory efforts to control alcohol marketing (Part 4). In the conclusion (Part 6), we discuss the implications for future alcohol marketing regulation.

2. Strategies for Marketing Alcohol

WHO’s Global Alcohol Strategy defines marketing as “any form of commercial communication or message that is designed to increase, or has the effect of increasing, the recognition, appeal and/or consumption of particular products and services.” Reference Macnamara 16 Traditional alcohol marketing strategies through “paid” media — such as television, radio, cinema, product placement in television and films, and print media — remain prominent and have been well-documented. Reference Jernigan and Ross 17 Sponsorships of sporting, cultural and community enterprises and individuals have long been used as marketing vehicles by the industry, providing a way to create a positive, emotional relationship between the brand and consumers. Reference Zerhouni, Begue and O’Brien 18 Packaging and labelling of alcohol products also offer a valuable means to market the product to particular consumer segments, as they are “travel” with the product and are more visible to purchasers and consumers than any other form of marketing.

There has also been widespread uptake of the internet, and later social media, often serving to extend marketing campaigns beyond traditional media or to amplify the effect of such campaigns, for example, with sponsored events being live streamed on the internet. Social media influencer (SMI) and user-generated marketing are intrinsic to digital media. Reference Enke and Borchers 19 The use of digital technologies has also increased the alcohol industry’s capacity to collect, store and analyze data, and has led to increasingly sophisticated and targeted alcohol marketing strategies. Reference Carah and Brodmerkel 20 This process of categorizing and targeting marketing is referred to as “market” or “customer” segmentation and generally involves “segmentation” based on geographic, demographic, psychological and behavioral characteristics of sub-groups of consumers. Reference Goyat 21 Heavy drinkers 22 and abstainers Reference Jernigan and Babor 23 (especially women Reference Atkinson 24 in new markets in low- and middle-income countries Reference Esser and Jernigan 25 ) are important targets for personalized alcohol advertising. The prospect of creating these new cohorts of drinkers informs the development of new alcohol products (e.g., low calorie, and no-and low-alcohol beverages), as well as branding and promotional strategies. Reference Feeney 26

3. The Relationship between Alcohol Marketing, Consumption, and Harm

There is a strong evidence base suggesting that alcohol marketing exposure leads to immediate, short- and medium-term increases in alcohol consumption, particularly among adolescents. 27 For instance, Stautz and colleagues conducted a systematic review of studies concerning the impact of alcohol marketing exposure on immediate consumption, finding that viewing alcohol advertisements led to small, but significant, increases in immediate consumption. Reference Stautz 28 Similarly, longitudinal studies examining the impact of marketing exposure on subsequent alcohol consumption have also reported significant positive associations. 29 Most of the research to date has focused on the impact of traditional marketing; however, emerging evidence regarding the impact of digital marketing also provides evidence of a significant positive association. Reference Noel, Sammartino and Rosenthal 30 Despite evidence of a causal relation between alcohol marketing exposure and consumption, the reported effect sizes are often small. Reference Nelson 31 A recent study examining the effect of a total ban on alcohol marketing implemented in Norway in 1975 found that the ban resulted in a 7.4% reduction in population-level consumption. 32

Concern about alcohol marketing tends to focus on the position of minors, although they are not the only sub-group who are at particular risk from exposure to alcohol marketing. Another such group is heavy and dependent drinkers. A common research finding is that “alcohol-dependent patients report a stronger urge to drink alcohol when confronted with alcohol-related cues,” Reference Mainz 33 such as alcohol marketing. Furthermore, the recent targeting of alcohol marketing to LMICs to build new markets raises concerns for health equity now and in the future. These countries currently have low prevalence of alcohol consumption and high abstention rates, but they also experience greater “harm per liter of alcohol” than high income countries. 34 Increased consumption resulting from increased exposure to alcohol marketing has the potential to escalate the harms already being disproportionately experienced in LMIC countries. 35

4. Regulating Alcohol Marketing in the Public Interest

Many governments have controls on alcohol marketing, with the focus on the minimization of minors’ exposure to alcohol industry marketing. 36 However, where national or subnational regulation exists, it is generally not very strong. Responses from 156 national reference points to the WHO’s inquiry concerning the level of statutory regulation of alcohol marketing in 2016 found that, in half of the responses, the national level of regulation was slight (15%) or less than that (35%). The level of regulation was classified as “very” or “most” restrictive in just 24% of the national responses. In almost half the countries, there was no restriction at all on internet or social media marketing of beer. 37 A study of policies to reduce risk factors for non-communicable diseases in 151 countries found that restrictions on marketing for alcohol were among the weakest compared to restrictions for other NCD risk factors. Reference Allen 38

The strong preference of industry interests, of course, is for industry self-regulation, particularly if it can take the place of an independent government regulator. Industry self-regulation of alcohol marketing is common at the international and domestic levels, despite its demonstrated ineffectiveness. Reference Noel and Babor 39 At the international level, the International Alliance for Responsible Drinking (IARD), with a primary membership of 12 TNACs, promotes commitments on such topics as limiting accessibility of marketing communications to children and promotion of “responsible drinking” messages. 40 At the national level, there may be self-regulation of marketing, operated by the industry or by other commercial interests, notably broadcasting companies. Or in many jurisdictions, there is a system of co-regulation, with both a government agency and representatives of the industry involved, although the former often plays a subsidiary role. 41

Complete bans on alcohol advertising, other than in Muslim-majority countries where the sale of alcohol is also banned, have not been common. Lithuania and Norway are notable examples of complete bans. More often, there have been bans in a particular medium — for instance, television in France. Or there have been bans directed to particular marketing content (such as advertising appealing to children) Reference Pettigrew 42 or to particular times (such as bans on alcohol advertising on television until after 9.30pm) or places (such as bans on advertising on billboards near schools) at which marketing might appear. But such partial bans mean that the advertising budget for an alcohol brand is still intact and can simply be used in another medium or a different place or time. So, the effects of partial bans on alcohol consumption levels have tended to be minor, 43 as marketing shifts to the unregulated or under-regulated media.

5. Legal Strategies to Challenge Regulation of Alcohol Marketing

In this Part, we examine some examples of law being deployed against governments that have proposed to tighten their regulation of alcohol marketing or have enacted and applied regulation to alcohol advertising. We take case studies from the European Union, Lithuania, South Africa, Thailand, and the United States. These case studies are not exhaustive, but they demonstrate some of the major points of tension in alcohol marketing regulation. As would be expected, the industry opposes comprehensive bans on alcohol marketing, but it also resists bans on “truthful” marketing (such as about pricing), bans on health claims and no- and low-alcohol advertising, and bans on “lifestyle” advertising. Cross-border marketing regulation has also been a particularly vexing issue for the EU. These case studies reveal the capacity of the industry to source legal advice and representation to craft legal arguments, using a range of areas of law at the domestic and international levels, and to launch legal action to protect their interests.

A. Restrictions on “Truthful” Alcohol Advertising — United States

A complete prohibition on alcohol marketing means that consumers cannot be provided with any information about the product, except by way of the product itself and at point of sale. This form of regulation of alcohol marketing raises questions about whether at least “truthful” advertising should be allowed, such as information about the product name, type, volume, alcohol content, price, and source/country of origin. On the one hand, this information enables consumers to make informed choices about different products, but there is also an argument that this information drives harmful alcohol consumption. The banning of such information might further public health goals but sits uneasily in many legal systems where the control of consumer information is directed to protecting “rational” consumers and only ensuring they are not mislead or deceived in their purchasing decisions.

This issue has been litigated in the US. A ban on price was implemented by the Rhode Island authorities, and was subject to a constitutional challenge by the offending liquor store, 44 Liquormart. In the case of Liquormart Inc v. Rhode Island in 1996 (“ 44 Liquormart ”), Reference O’Neill 44 the US Supreme Court found that a price ban infringed the First Amendment to the US Constitution which prohibits Congress from “abridging the freedom of speech”. First Amendment protection had been extended to commercial speech in 1976 in Virginia State Board of Pharmacy v. Virginia Citizens Consumer Council . 45 In the 44 Liquormart case , a liquor store had advertised alcohol, cigarettes, snacks and mixers. Specific prices were listed for all of the products, except the alcohol brands, which had the word “WOW” next to each of them. The regulator had fined 44 Liquormart $400.00 for breaching the ban on showing the price of alcohol products in its advertising.

In finding the ban to be unconstitutional, the US Supreme Court applied a more exacting standard of review — “intermediate scrutiny” — to the government’s ban than it would to other forms of speech, Reference Schauer, Stone and Schauer 46 because the speech in question was “truthful” speech (ie, price information). The Supreme Court found against the ban on two bases: 47 (1) because the government did not provide sufficient evidence that the suppression of pricing information would reduce consumption; 48 and (2) there were a range of regulatory options besides a ban on speech that could have achieved the government’s “temperance” goal but would have been less interfering with commercial speech, including setting taxes, limiting purchase amounts and education campaigns.

B. Restrictions on Health Claims — European Union

Related to the issue of “truthful” marketing is the use of health claims in alcohol advertising. Often these health claims appear on the product label and are repeated in the product marketing across multiple media. Information about the sugar, carbohydrate, caloric, gluten, animal content of a product is potentially useful to the consumer in their decision-making about whether to purchase or consume a particular brand. As with “truthful” marketing, health claims also raise a tension between the provision of accurate, useful information to consumers Reference Mylly 49 and the way in which this information might nonetheless drive consumption and harm. Most regulators resolve this tension by opting to stringently control the use of health claims in relation to alcohol, either prohibiting their use entirely or limiting the health claims which can be made (eg, allowing energy, carbohydrate and gluten claims only). 50

Such a health claim was in issue in the Deutches Weintor case before the Court of Justice of the European Union (CJEU) in 2012. In that case, a wine label stated that the product was “easily digestible” followed by a statement about acidity levels. The relevant government authority in Rhineland-Palatinate claimed that this was a health claim, which are prohibited for alcohol products above 1.2% alcohol content under the relevant EU regulation. 51 The government authority’s claim was contested by Deutches Weintor eG (the wine-growers’ cooperative) and questions were referred to the CJEU about the interpretation and application of the regulation.

The CJEU found that the information that the wine was “easily digestible,” followed by a statement about acidity levels, amounted to a “health claim” because it “implies the absence or reduction of effects that are adverse or harmful to health and which would otherwise accompany or follow such consumption.” 52 The prohibition on such health claims were also found to be compatible with the fundamental rights found in the Lisbon Treaty of 2009 and the European Charter of Fundamental Rights, in particular the high level of protection given to human health in the EU Charter. The CJEU emphasized the “risks of addiction and abuse as well as the complex harmful effects known to be linked to the consumption of alcohol.” 53 The freedom to choose an occupation and the freedom to conduct a business were found to be restricted by the prohibition on health claims, but the restrictions were directed to achieving the health objective and were not a disproportionate interference with those rights. The CJEU also found that those rights were maintained by the fact that alcohol was still able to be produced and marketed through other means.

C. Restrictions on “Lifestyle” Advertising — Thailand

Many jurisdictions have restrictions on “lifestyle” advertising. “Lifestyle” advertising is where the producer uses words, images, and other strong aesthetic design features to make connections between the product and consumers’ ideas about their actual (or more often, desired) lifestyle. Reference Belk and Pollay 54 The use of imagery of attractive people enjoying positive occasions involving alcohol are common forms of lifestyle marketing. Popular actors, sports people and other celebrities often feature in lifestyle advertising. Lifestyle advertising can operate in a subtle manner and speak to consumers’ unconscious or unarticulated desires about the “good life.” Most jurisdictions regulate lifestyle advertising in some manner, often through prohibitions on alcohol being marketed in connection with high-risk activities such as driving or watersports, and on claims that the consumption of alcohol brings about social, sexual, financial, professional or sporting success. 55 The industry is often able to creatively navigate its way around such restrictions on “lifestyle” advertising, but will strongly resist any attempts to completely disable its use of this highly effective form of marketing. Reference Alemanno 56

Such industry opposition was seen in respect of Thailand’s 2015 ban on certain forms of “lifestyle” marketing on the product label. The ban has a broad ambit and includes prohibitions on label promotions that use pictures of athletes, singers, movie stars or actors; that use cartoons; or that link alcohol and activities such as music, sports, contests or recreation. The ban aroused considerable opposition in the World Trade Organization Committee on Technical Barriers to Trade (TBT Committee). Reference Mitchell and O’Brien 57 In the Committee, member states repeatedly argued that the Thai law infringed various WTO rules, including intellectual property protections and rules prohibiting unnecessary barriers to international trade. Reference O’Brien and Mitchell 58 The Thai ban has not been subject to formal dispute settlement in the WTO, and Thailand has managed to resist demands in the TBT Committee for the law to be repealed. However, the pressure brought to bear in the WTO TBT Committee has resulted in some softening of the interpretation and application of the law by Thailand. 59

D. Comprehensive Bans — South Africa

As discussed above, comprehensive bans on alcohol marketing are relatively uncommon. However, in 2013, South Africa released a new proposal for the regulation of alcohol marketing, which if it had passed, would have been one of the most comprehensive bans on alcohol marketing in the world. South Africa proposed the banning of all alcohol marketing (except for price information at point of sale), alcohol sponsorships and all gifts, competitions and associated strategies used by alcohol companies. Reference Bertscher, London and Röhrs 60 The law has never been passed. It seems that the industry lobbied extensively against the proposal, Reference Bertscher, London and Orgill 61 including arguing that the regulations would breach human rights by impairing rights to free expression for producers and consumers, to engage in trade and commerce, and to be treated with dignity. 62 Although international human rights law does not recognize corporations or non-natural persons to be rights-holders, the Constitution of South Africa includes a bill of rights which is extended to non-natural persons. South Africa’s bill of rights has been used in the past to argue (unsuccessfully) against a ban on tobacco advertising of a similar scope to South Africa’s proposed ban on alcohol advertising. 63

In respect of the claim about freedom of expression, Bertscher, London and Röhrs argue that, drawing on the jurisprudence relating to the right as found in Article 19 of the International Covenant on Civil and Political Rights , 64 the proposed South African alcohol advertising law would not have violated human rights law standards. The right to free expression is clearly engaged by restrictions on alcohol marketing, which limit both a producer’s right to convey information to consumers and a consumer’s right to receive information about the product. However, under both international law and the South African Constitution, rights may be limited as provided by law and as necessary for a circumscribed set of purposes, such as the protection of national security or of public order ( ordre public ), or of public health or morals. 65 A strict necessity and proportionality test is applied to restrictions on the right to free expression, meaning that laws which affect free speech must be tightly drafted and must represent the least restrictive means of achieving the goal in question, Reference Hamilton, Stone and Schauer 66 including where the law in question is enacted in pursuit of the realization of another human right, such as the right to health in the case of alcohol marketing. 67 As with the analysis in the US constitutional context (see above Part 5a), the compatibility of alcohol marketing restrictions with human rights will turn on (i) the extent of the contribution that the marketing restrictions make to fulfilment of the public health goal of reducing alcohol-related consumption; and (ii) the availability of any less restrictive measures. Compared to tobacco, Reference Cabrera and Gostin 68 these two issues may be more difficult, but not impossible, for a government to argue in respect of alcohol, given that there is not the strongest evidence of the impacts of marketing restrictions on consumption (see above Part 4) and given that many jurisdictions have not introduced other interventions to reduce alcohol consumption.

E. Restrictions on Advertising Non-Alcoholic Beverages — Lithuania

An issue which has recently emerged is whether restrictions on alcohol marketing should apply to the marketing of non-alcoholic beverages. As discussed above, there has been a proliferation of no and low alcohol beverages into many markets. “Surrogate marketing” is common with respect to no- and low-alcohol beverages — they are generally packaged and labelled in the same livery as the alcoholic version of the product, and the marketing often adopts the same designs, colors, symbols for both products. Reference Miller, Pettigrew and Wright 69 It has been argued that the packaging, labelling and marketing of non-alcoholic beverages in the same manner as alcoholic beverages serves to indirectly advertise the company’s alcoholic products, with companies using the non-alcoholic beverages to evade restrictions which apply to the marketing of alcoholic beverages. Reference Kaewpramkusol 70 However, there is still work to be done to fully understand how consumers perceive and use no and low-alcohol products. Reference Anderson, Kokole and Jané Llopis 71

The issue of how to regulate no-alcohol products has been agitated in Lithuania in two recent cases. The issue arises in the context of Lithuania having banned alcohol advertising since 2018. Reference Rehm 72 In 2021, the Supreme Administrative Court of Lithuania upheld a decision of the Department of Drug, Tobacco and Alcohol Control that Vilnius Degtine had breached the ban on alcohol advertising by the company’s marketing of its product, “epkeli” non-alcoholic cranberry soft drink. The breach arose from the company’s actions in placing a product on the market with a trademark and design which was essentially identical to those used for its alcoholic bitters, and by including that trademark and design in advertising on billboards and on internet sites. 73

However, in January 2022, the court seemed to change its position on no-alcohol marketing. The Supreme Administrative Court of Lithuania quashed a finding of the Department of Drug, Tobacco and Alcohol Control that the company, Švyturys-Utenos alus, had breached the prohibition on alcohol advertising through the company’s promotion of its non-alcoholic beers, Utenos and Kronenbourg 1664. 74 The appearance of the non-alcoholic beers was essentially identical to that of the company’s alcoholic beers, with the only difference being the inclusion of the words “non-alcoholic” on the label in several places. The Supreme Court rejected the argument that the advertising of the non-alcoholic beer intended to, or did, in fact, promote the alcoholic beer. The court placed emphasis on the absence of any evidence that consumers associate or confuse non-alcoholic beverages with alcoholic beverages. There was considerable concern expressed by the court about overreach in the interpretation of the alcohol advertising prohibition, in a situation where no laws have been expressly enacted to control branding and marketing of non-alcoholic products.

F. Cross-Border Alcohol Marketing — European Union (Sweden)

The regulation of cross-border marketing (ie, marketing that is created or published in one country and that reaches audiences in another country) can be legally complex and these complexities have, on occasion, been exploited by the alcohol industry. Particular difficulties with regulating cross-border alcohol marketing have arisen in the EU context, with the application of the EU internal market law and the state of establishment principle. 75

Sweden has encountered problems at times with both legal requirements, 76 as it has attempted for many years to place extensive restrictions on alcohol marketing. 77 In 2001, its ban on alcohol advertising in periodicals was found to “have a potential and indirect influence upon the free movement of goods and/or services” Reference Bartlett and Garde 78 and was therefore caught by the Treaty for the Functioning of the European Union and required justification. 79 The question of whether the ban was justified on public health grounds was decided by the Swedish courts which found that the ban was disproportionate and therefore unjustified. Reference Bartlett 80

More recently, Sweden’s regulation of alcohol marketing on television has fallen foul of the state of establishment principle because of the existence of the EU’s Audiovisual Media Services Directive (“the Directive”) which sets basic standards for the regulation of alcohol marketing in audiovisual media in the EU. Reference Bartlett and Garde A 81 Members are obliged to ensure “freedom of reception and shall not restrict retransmissions on their territory of audiovisual media services” from other EU members “for reasons which fall within the scope of [the] Directive” (Art 3.1). The state of establishment rule prevented Sweden from applying its stricter rules on alcohol marketing to two broadcasters who had established themselves in the United Kingdom, starting in 1987, and who broadcast in Swedish to Sweden in a manner that was inconsistent with Sweden’s alcohol advertising rules. Sweden notified the European Commission to take measures against the two broadcasters under Swedish law. In 2018, the European Commission ruled that Sweden “could not derogate from the State of Establishment principle and rejected the claim that the broadcasters had established themselves in the United Kingdom in order to circumvent the stricter Swedish alcohol advertising rules.” Reference Garde 82 However, when the UK left the EU in 2020, the two broadcasters returned to Sweden and again became subject to the Swedish restrictions on alcohol advertising on TV. 83

6. Conclusion

The alcohol industry is very resistant to increased regulation of its commercial activities and prefers that interventions to address harms from alcohol focus on the duty of individuals to “drink responsibly.” The industry has made some use of legal arguments and litigation to stymie new policy proposals for alcohol marketing regulation and to limit the impacts of regulation where it exists. As our study of several jurisdictions demonstrates, some of these attempts have been successful and some have not. However, the alcohol industry is certain to continue to explore ways in which to use law to protect its interests, especially if the current momentum for alcohol policy reform at the global level flows down to regional and national contexts. 84 This likelihood points to the need for governments to carefully evaluate the legality of policy measures that they are considering and pursue measures which have a sound basis in basis in law. At the same time, governments need to be cognisant that even legally sound measures may be subject to legal challenge as part of industry’s strategy to derail new policies. This may occur where there is genuine disagreement about the legality of the measure or where the legal claim by the industry is thin. In both scenarios, governments need to resource themselves with excellent legal advice to defend such challenges. The case studies in this article also show that a further critical requirement is a solid evidence base to be able to demonstrate the problem being addressed and the capacity of the contested measure to contribute to ameliorating the problem. Finally, even with all of these material resources at its disposal, governments needs to steel themselves and support each other against attacks on public health by the alcohol industry.

Acknowledgements

With thanks to Casey Haining for excellent research assistance and to Laura Miščikienė for her generous assistance with the case study on Lithuania.

The authors have no conflicts to disclose.

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• Volume 50, Issue 2
• Paula O’Brien (a1) , Robin Room (a2) and Dan Anderson-Luxford (a2)
• DOI: https://doi.org/10.1017/jme.2022.48

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The comprehensive alcohol advertising ban in lithuania: a case study of social media.

1. Introduction

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Galkus, L.; Lange, S.; Liutkutė-Gumarov, V.; Miščikienė, L.; Petkevičienė, J.; Rehm, J.; Štelemėkas, M.; Tran, A.; Vaitkevičiūtė, J. The Comprehensive Alcohol Advertising Ban in Lithuania: A Case Study of Social Media. Int. J. Environ. Res. Public Health 2022 , 19 , 12398. https://doi.org/10.3390/ijerph191912398

Galkus L, Lange S, Liutkutė-Gumarov V, Miščikienė L, Petkevičienė J, Rehm J, Štelemėkas M, Tran A, Vaitkevičiūtė J. The Comprehensive Alcohol Advertising Ban in Lithuania: A Case Study of Social Media. International Journal of Environmental Research and Public Health . 2022; 19(19):12398. https://doi.org/10.3390/ijerph191912398

Galkus, Lukas, Shannon Lange, Vaida Liutkutė-Gumarov, Laura Miščikienė, Janina Petkevičienė, Jürgen Rehm, Mindaugas Štelemėkas, Alexander Tran, and Justina Vaitkevičiūtė. 2022. "The Comprehensive Alcohol Advertising Ban in Lithuania: A Case Study of Social Media" International Journal of Environmental Research and Public Health 19, no. 19: 12398. https://doi.org/10.3390/ijerph191912398

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• A-Z Publications

Annual Review of Public Health

Volume 39, 2018, review article, open access, policy approaches for regulating alcohol marketing in a global context: a public health perspective.

• Marissa B. Esser 1 , and David H. Jernigan 2
• View Affiliations Hide Affiliations Affiliations: 1 Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA; email: [email protected] 2 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA; email: [email protected]
• Vol. 39:385-401 (Volume publication date April 2018) https://doi.org/10.1146/annurev-publhealth-040617-014711
• Copyright © 2018 Marissa B. Esser & David H. Jernigan. This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See credit lines of images or other third-party material in this article for license information.

Alcohol consumption is responsible for 3.3 million deaths globally or nearly 6% of all deaths. Alcohol use contributes to both communicable and noncommunicable diseases, as well as violence and injuries. The purpose of this review is to discuss, in the context of the expansion of transnational alcohol corporations and harms associated with alcohol use, policy options for regulating exposure to alcohol marketing. We first provide an overview of the public health problem of harmful alcohol consumption and describe the association between exposure to alcohol marketing and alcohol consumption. We then discuss the growth and concentration of global alcohol corporations and their marketing practices in low- and middle-income countries, as well as in higher-income societies. We review the use and effectiveness of various approaches for regulating alcohol marketing in various countries before discussing challenges and opportunities to protect public health.

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Bringing together evidence, policy and practice to reduce alcohol harm

A question of intent: Alcohol advertising campaign case studies make for sobering reading

12th November 2019 | By Nason Maani Hessari

Producing and selling alcohol remains very good business in the UK, contributing around 2.5% of total UK GDP in 2014, around £46 billion . However, it also remains a business associated with a wide range of acute and chronic physical and mental health burdens for consumers , and for those around them . Perhaps cognizant of this, the alcohol industry has repeatedly claimed for many years that it aims to promote ‘responsible drinking’ and combat harmful drinking . However, there is a disparity between these stated aims and the figures, as the bulk of alcohol sales come from those drinking at harmful and hazardous levels .

An extension of this disparity plays out in how the industry has responded to policy debates on alcohol advertising, stating repeatedly that the goals of alcohol industry advertising are focused on brand competition, not increasing consumption, targeting non-drinkers or heavier drinkers. Whatever the claimed impact, this advertising does not come cheap. In terms of expenditure, it is orders of magnitude greater than voluntary contributions to industry-funded education charities like Drinkaware (annual income around £6 million), with total spend for all alcohol advertising in the UK in the region of £800 million . By way of comparison, the World Health Organisation has a total biennial budget of around £3.4 billion .

Advertising therefore represents a large amount of spend for an industry that makes a significant proportion of its sales to those drinking at harmful or hazardous levels. Understanding the aims, mechanisms, goals and target groups of alcohol advertising campaigns are vital in determining if these campaigns may be contributing to harmful population health effects. However, finding this type of information is difficult, because this type of commercial activity is often not in the public domain, a point acknowledged by PHE in their rapid evidence review .

We recently identified a new source of data to address this gap in the evidence. It is a series of evaluative advertising industry case studies, published by the Institute of Practitioners in Advertising in 23 volumes from 1981-2016. These are particularly interesting because they represent relatively unrestricted descriptions of the goals, nature, and outcomes of advertising campaigns for a variety of well-known alcohol brands. Through an analysis of these case studies , we sought to assess industry claims regarding advertising. The results make for sobering reading (see Table 1).

Table 1. Five common alcohol industry claims and example quotes about the effects of advertising on consumption, along with top-level findings from our analysis of advertising case studies

Perhaps most strikingly, the targeting of heavy drinkers by adverts and the reliance on them for sales is not just obvious, it is explicitly discussed, particularly for whiskey. For example, in the context of the Famous Grouse, the author notes: ‘As is the case in many post-mature markets, whisky brands are very reliant on a small number of heavy, and increasingly ageing, consumers, to provide the majority of volume. The Famous Grouse was no exception. Our first advertising task was to protect and build this core drinker base by persuading existing consumers and drinkers of competitive blends to choose The Famous Grouse more often. In the longer term we had to attract more younger drinkers – the heavy-using loyalists of tomorrow…’ (Famous Grouse, 2006)

In the case of the Scottish Leader whisky campaign (2003) also had a target market of heavy drinkers:

‘Blended whisky suffers from an ageing customer profile. Figure 1 shows that 62% of heavy users are aged 55+ and 39% over retirement age. Parts of the market are literally dying off, whisky tumbler in hand….

‘…As with many other markets, the Pareto principle applies: 20% of drinkers account for 80% of sales. So, rather than struggle to make whisky appeal to younger consumers like the premium brands, we chose to focus on the core audience of heavy users. We knew that they were older. We knew they were primarily male. We knew that unlike malt users they tended to be down-market’ (Scottish Leader Whisky, 2003)

It is hard to read these quotes and be left with any doubt that advertising campaigns have engaged in targeting of older, heavy drinkers to drive sales. Other case studies we report show similar targeting of young heavy drinkers. The case studies also offer examples of the wide-ranging effects that alcohol advertising can have on individual preferences and behaviours, brand perception, growth of new markets, and social norms.

As uncomfortable as this realization might be, it is entirely in keeping with the broader evidence and the incentive structures in place. There is an unquestionable logic in this targeting from a business perspective, when key performance indicators are focused on increasing sales (as one would expect and as the case studies repeatedly demonstrate). Previous research has demonstrated that there is a clear conflict of interest between maintaining and growing industry revenue and reducing harmful drinking in the UK and many other countries . Our findings, based on industry data, show that advertising has been used as a powerful tool to further these interests.

So where do we go from here? Future evaluations and systematic reviews of the effects of alcohol advertising should take into account this new source of advertising goals, mechanisms and effects. That in turn should inform our conversations about what regulation in this area should aim to do, and how to ensure it meets those aims. For anyone with an interest in public health, or in creating a more responsible alcohol industry, it is time to leave claims of the innocuous goals of alcohol advertising aside and instead treat it with the regulatory attention it requires.

Written by Nason Maani Hessari (Twitter: @spidermaani ), a public health researcher interested in the commercial and structural determinants of health. He is currently a Harkness Fellow at Boston University School of Public Health, and a Visiting Fellow at the London School of Hygiene and Tropical Medicine. With thanks to Dean Sandro Galea and Professor Mark Petticrew for their input.

All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.

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The Comprehensive Alcohol Advertising Ban in Lithuania: A Case Study of Social Media

Affiliations.

• 1 Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania.
• 2 Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada.
• 3 Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 33 Ursula Franklin Street, Toronto, ON M5S 2S1, Canada.
• 4 Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON M5T 1R8, Canada.
• 5 Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, 47181 Kaunas, Lithuania.
• 6 Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada.
• 7 Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
• 8 Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany.
• 9 Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Trubetskaya Str., 8, b. 2, 119992 Moscow, Russia.
• PMID: 36231698
• PMCID: PMC9566760
• DOI: 10.3390/ijerph191912398

Alcohol advertising exposure is a risk factor for earlier alcohol initiation and higher alcohol consumption. Furthermore, engagement in digital alcohol marketing, such as liking or sharing an ad on social media, is associated with increased alcohol consumption and binge or hazardous drinking behavior. In light of these challenges, Lithuania has enacted a total prohibition on alcohol advertising, including social media. This study monitored the two most popular social media networks, Facebook and Instagram, to determine compliance with current legislation. In total, 64 Facebook and 51 Instagram profiles were examined. During the 60-day study period, 1442 and 749 posts on the selected Facebook and Instagram profiles, respectively, were published. There were a total of 163 distinct social media alcohol-related posts. Alcohol-related posts accounted for 5.9 percent of total Instagram posts and 8.3 percent of total Facebook posts. Alcohol advertisements accounted for 1.4 percent of all posts (infringement of the Alcohol Control Law). Influencers were responsible for nearly half (45.5 percent) of all observed alcohol-related Instagram posts. The study demonstrates high compliance with Lithuania's total alcohol advertising ban on social media and emphasizes the importance of adequately monitoring the growing prominence of influencers on social media.

Keywords: Facebook; Instagram; alcohol advertising; exposure; social media.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses or interpretation of data; in the writing of the manuscript or in the decision to publish the results.

The flowchart of the study…

The flowchart of the study design process.

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National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking; Bonnie RJ, O'Connell ME, editors. Reducing Underage Drinking: A Collective Responsibility. Washington (DC): National Academies Press (US); 2004.

Reducing Underage Drinking: A Collective Responsibility.

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11 Alcohol in the Media: Drinking Portrayals, Alcohol Advertising, and Alcohol Consumption Among Youth

Joel W. Grube *

W idespread concern exists about the potential effects that media portrayals of drinking, alcohol product placements, and alcohol advertising may have on alcohol consumption and problems among young people. Television, radio, film, and popular music are often identified as potential sources through which young people learn about alcohol and as potential influences on young people's drinking and drinking problems (e.g., American Academy of Pediatrics, 1996 ; Gerbner, 1995 ; Stockdale, 2001 ; Strasburger, 1993a , b ; Villani, 2001 ). In particular, public health advocates routinely call for stricter self- or governmental regulation of television, film, music, and alcohol advertising (e.g., American Academy of Pediatrics, 1996 ; Hacker and Stuart, 1995 ; Hill and Casswell, 2001 ; Mosher, 1994 ; Strasburger, 1993a , b ). Community action is frequently focused on reducing local alcohol advertising (e.g., Center for Science in the Public Interest, 1992 ; Woodruff, 1996 ). The effects of alcohol portrayals and advertising on young people (e.g., Atkin, 1993 ; Strasburger, 1993a , b ) and targeting of youth ( Center of Alcohol Marketing, and Youth, 2000a , 2000b , 2003 ) and minority communities by advertisers (e.g., Abramson, 1992 ; Alaniz and Wilkes, 1995 ; Scott, Denniston, and Magruder, 1992 ) have been raised as particularly salient issues. Recent changes in alcohol advertising policies, such as the decision by distillers to end a self-imposed ban and begin advertising on television, has raised further concerns about alcohol advertising and its potential effects on young people ( Snyder, Fleming-Milici, Mitchell, and Proctor, 2000 ).

• DRINKING PORTRAYALS IN THE MEDIA

Adolescents are heavy users of television. Extrapolating from recent data obtained from a nationally representative survey, 11- to 13-year-olds watch 27.7 hours and 14- to 18-year-olds watch 20.2 hours of broadcast and taped television programming each week ( Roberts, Foehr, Rideout, and Brodie, 1999a ). As a result, they are immersed in drinking portrayals and alcohol product placements. A recent content analysis of primetime television from the 1998-1999 season, for example, indicates that 71 percent of all programming depicted alcohol use and 77 percent contained some reference to alcohol ( Christensen, Henriksen, and Roberts, 2000 ). Among those programs most popular with teenagers, 53 percent portrayed alcohol use; 84 percent of TV-14-rated programming, 77 percent of TV-PG programming, and 38 percent of TV-G programming depicted alcohol use. More episodes portrayed drinking as an overall positive experience (40 percent) rather than a negative one (10 percent), although negative consequences were mentioned or portrayed in 23 percent of episodes. Underage drinking was relatively rare. Only 2 percent of regular characters under the age of 18 were depicted drinking alcohol. In another recent content analysis, however, characters between the ages of 13 to 18 were found to account for 7 percent of all alcohol incidents portrayed ( Mathios, Avery, Bisogni, and Shanahan, 1998 ). When it occurs, youthful drinking or expressed desire to drink is often presented as a means of appearing to be adult and grownup ( Grube, 1995 ). Other research suggests that drinkers tend to be regular characters, of high socioeconomic status, attractive, and glamorous ( Mathios et al., 1998 ; Wallack, Grube, Madden, and Breed, 1990 ), although youthful drinkers are depicted in a less favorable light than older drinkers. Drinking is often treated as humorous and is associated with valued outcomes such as camaraderie ( Hundley, 1995 ). Although common when considered at the program level, the prevalence of drinking characters is considerably below that for the U.S. population. Thus, in a recent analysis of primetime programming, only 11 percent of characters over the age of 34 were drinkers compared with 52 percent of similarly aged adults in the U.S. population ( Long, O'Connor, Gerbner, and Concato, 2002 ). Only 14 percent of characters between ages 18 and 34 drank and only 2 percent of those under 18 drank, compared with 61 percent and 19 percent, respectively, for the U.S. population in these age groups.

Little research has addressed the potential effects of exposure to drinking on television on young people's drinking beliefs and behaviors. Generally speaking, correlational studies have found small, but statistically significant, relations between television viewing and alcohol-related beliefs and behaviors. Thus, Tucker (1985) found that high school boys who were heavier television viewers drank more than lighter viewers. Similarly, Neuendorf (1985) reported that television viewing was related to beliefs about drinking among 10- to 14-year-old adolescents: Heavier viewers were more likely than lighter viewers to agree that people who drink are happy and you have to drink to have fun at a sporting event.

More recently, in a prospective study of 1,533 ninth-grade students, it was found that television viewing was related to initiation of drinking over an 18-month period ( Robinson, Chen, and Killen, 1998 ). Specifically, each 1-hour increase in television viewing at baseline was associated with a 9 percent increased risk of initiating drinking during the following 18 months (OR = 1.09), after controlling for age, gender, and other media use. Unexpectedly, however, each hour of watching taped programming and movies on video was associated with an 11 percent average decrease in drinking initiation. Moreover, drinkers and nondrinkers did not differ in weekly hours of television viewing at baseline, and television viewing was not associated with increases in consumption among those young people who were already drinkers at baseline. A final study investigated reported television viewing and scores on a risky behavior scale that included drinking for a sample of 14-to 16-year-old adolescents ( Klein et al., 1993 ). Although significant positive relations were found between viewing and involvement in risky behaviors for specific genres (e.g., cartoons), the results were inconsistent across genres and no effect was found for overall TV viewing. Moreover, data relating specifically to drinking were not presented.

These correlational studies suffer from potentially serious conceptual and methodological problems. Conceptually, none of the studies directly measured exposure to televised drinking portrayals. Rather, they relied only on measures of overall television viewing. The problem with such measures is that children watching equal amounts of television may be differentially exposed to alcohol portrayals depending on their program preferences and attention levels. More importantly, all of these studies used correlational analyses that cannot provide evidence for the direction of the relationship between television viewing and drinking beliefs and behaviors. Some unconsidered third variable may influence both viewing and drinking. This interpretation cannot be entirely discounted, even for the single longitudinal study.

In addition to the correlational studies, the influence of televised portrayals of drinking on young people has been addressed in experimental studies ( Kotch, Coulter, and Lipsitz, 1986 ; Rychtarik, Fairbank, Allen, Foy, and Drabman, 1983 ). In both of these studies, children who were shown videotaped segments from popular television series containing drinking scenes expressed more favorable attitudes and beliefs about drinking than did children exposed to similar segments without drinking.

Although these studies are suggestive, they are problematic. First, the effects were small and selective. In one case ( Kotch et al., 1986 ) significant effects were found for boys but not girls, and then only for a few of the measures of alcohol beliefs that were obtained. Second, the possibility exists that the children may have perceived the drinking in the video as representing the experimenter's expectations regarding their task in the experimental situation. Thus, they may have been responding to what they believed the experimenter wanted them to do, rather than the actual drinking scenes. Third, the experimental situation in both cases is highly artificial, making it difficult to generalize the results to the real world. Self-selection, differential attention, and other factors that operate in the natural viewing situation are not present. A major concern is the fact that exposure to the drinking portrayals in these studies is brief. The experimental situation simply cannot provide a parallel to the real world where exposure occurs more or less regularly over relatively long periods of time. It is likely that the cumulative effects of such long-term exposure are far more important than any effects of short-term exposure.

In sum, the available evidence regarding the influence of televised alcohol portrayals on young people is inconclusive, at best. Further research using more sophisticated research designs and analytic techniques will be necessary to provide a more definitive answer to this question.

Adolescents spend considerably less time viewing movies and movie videos than they do television. Extrapolating from recent national survey data, 11- to 13-year-olds spend an average of 6.2 hours per week and 14- to 18-year-olds spend an average of 4.7 hours per week watching movies ( Roberts et al., 1999a ). In terms of alcohol content in films, recent content analyses indicate that alcohol was shown or consumed in 93 percent of the 200 most popular movie rentals for 1996-97 ( Roberts, Henriksen, and Christensen, 1999b ). Underage use of alcohol occurred in only about 9 percent of these films. Alcohol and drinking were presented in an overwhelmingly positive light. Drinking was associated with wealth or luxury in 34 percent of films containing alcohol references, and pro-use statements or overt advocacy of use occurred in 20 percent of these films. Anti-use statements appeared in 9 percent of films with alcohol references; 6 percent contained statements on limits as to when, where, and how much alcohol should be consumed; and 14 percent depicted refusals to drink. Drinking in film is often associated with risky activities such as crime or violence (38 percent), driving (14 percent), and sexual activity (19 percent).

Portrayals of negative consequences of drinking are relatively rare. In all, 57 percent of films with alcohol references portrayed no consequences to the user. Similar findings have emerged from other content analyses. Thus, at least one lead character drank in 79 percent of the top money-making American films from 1985 to 1995 ( Everett, Schnuth, and Tribble, 1998 ). Moreover, 96 percent of those films contained references supportive of alcohol use whereas only 37 percent contained references discouraging alcohol use. Surprisingly, an analysis of all G-rated English-language, animated feature films available on video cassette revealed that 47 percent (38 of 81) depicted alcohol or drinking ( Thompson and Yokota, 2001 ). Of the 81 films, 13 contained scenes set in bars or nightclubs. In 15 of the 38 films containing alcohol, some consequences were depicted, but in most cases these consequences were minor (hiccupping, staggering, flushing). None of the films contained an overt health warning about alcohol use, and good or neutral characters accounted for the majority of drinking portrayals (67 percent).

Studies on the effects on youth of exposure to depictions of drinking in films are rare. In one study ( Bahk, 2001 ), college students were exposed to one of two versions of A Star Is Born , one of which depicted negative consequences of drinking for the lead character (e.g., performing poorly at a concert, fighting, dying in a drinking-related crash) and the other with the negative consequences edited out, leaving primarily positive consequences. The results indicated that viewing the positive consequences version, relative to the negative consequences version, led to more favorable attitudes toward drinking and to stronger intentions to drink. The effects were strongest for attitudes toward drinking for tension reduction and amusement and intentions to drink for stress management.

In a similar study ( Kulick and Rosenberg, 2001 ), college students were exposed to a series of eight film clips with or without depictions of spirits consumption. Participants were randomly assigned to one of three conditions: a negative portrayal condition, a positive portrayal condition, or a control condition. In the negative portrayal condition, five of the clips contained drinking scenes portraying undesirable outcomes. In the positive portrayal condition, six of the clips contained drinking scenes with desirable outcomes. In the control condition, none of the clips contained drinking scenes. After viewing all of the clips twice, the participants completed measures of intentions to drink spirits and alcohol expectancies. Results indicated that participants in the positive portrayal condition had significantly more positive alcohol expectancies compared with controls, although they did not differ significantly from those in the negative portrayals condition ( p < 0.09). The negative portrayals condition did not differ significantly from controls. In terms of negative expectancies, participants in both the positive and negative portrayals conditions had higher scores than the controls, but did not differ from one another. The groups did not differ in intentions to drink spirits in the next week.

In sum, alcohol portrayals are common in films, even in those with ratings indicating they are intended for children and adolescents. These portrayals are typically positive or neutral and drinking is associated with desirable outcomes and characteristics. Few studies have investigated the effects of film portrayals of drinking on young adults, adolescents, and children. The findings from these studies are mixed. Although evidence from one study shows that such portrayals can have small effects on drinking attitudes and intentions, the results from a second study are ambiguous. In addition, as with experimental studies of alcohol portrayals on television, it is not clear how relevant these studies are to the real-world viewing situation because they address only the short-term effects of limited and brief exposures in an artificial setting. Experimental demand also remains an issue for these studies.

Music and Music Video

Music, either radio or recordings, is a popular form of entertainment for young people. Thus, 11- to 13-year-olds spend 11.2 hours per week and 14- to 18-year-olds spend 9.3 hours per week listening to music on radio, CD, or tape ( Roberts, 1999a ). Research on alcohol-related content in song lyrics is comparatively rare. A recent content analysis ( Roberts et al., 1999b ) examined 1,000 of the most popular songs in 1996-97 across five genres of music popular with youth. This study found that 17 percent of all the lyrics contained references to alcohol and that alcohol was mentioned more frequently in rap music (47 percent) than in other genres such as country-western (13 percent), top 40 (12 percent), alternative rock (10 percent), and heavy metal (3 percent). Overall, 22 percent of songs with alcohol mentions referred to beer or malt liquor, 34 percent to wine or champagne, 36 percent to hard liquor or mixed drinks, and 31 percent to generic terms such as “booze.” A common theme was getting intoxicated or high (24 percent), although drinking was also associated with wealth and luxury (24 percent), sexual activity (34 percent), and crime or violence (13 percent). Consequences of drinking were mentioned in only 9 percent of the songs with alcohol references, and anti-use messages occurred in only 3 percent. Product placements or brand-name mentions occurred in 30 percent of them and were especially common in rap music (48 percent).

An analysis of alcohol depictions in rap music ( Herd, 1993 ) found the portrayal of alcohol use to convey elements of disinhibition, rebellion, identity, pleasure, sensuality, and personal power. Similar to the ambivalent attitudes toward alcohol use expressed in country-western music ( Chalfant and Beckley, 1977 ; Connors and Alpher, 1989 ), rap music vacillated between pro-drinking and anti-drinking attitudes. This analysis further associated the commodification of rap music by the malt liquor industry with an increase in malt liquor portrayals in rap songs.

DuRant et al. (1997) analyzed 518 music videos from MTV, BET, CMT, and VH1 for portrayals of alcohol and tobacco use. They found that portrayals of substance use varied by network and music genre, with MTV having the highest percentage of videos that portrayed alcohol and tobacco use, and CMT with the lowest percentage of tobacco use in videos. In terms of music genre, rap music videos contained the highest percentage of depictions of alcohol use, whereas rhythm and blues videos showed the least alcohol use. Additionally, alcohol use was found in a higher proportion of music videos that had any sexual content than in videos that had no sexual content.

In one of the only studies to address the relationship between music video viewing and alcohol use, Robinson et al. (1998) examined the association between media exposure and self-reported alcohol use. They collected baseline and 18-month follow-up data on media usage (television watching, video watching, playing computer or video games, and watching music videos) and lifetime and 30-day alcohol use for a sample of ninth graders. They found a 31 percent increased risk of drinking initiation within the next 18 months for each 1-hour increase in watching music videos. Although longitudinal in nature, causality is an issue in this study and the possibility remains that both exposure to music videos and initiation to drinking are related to a third unmeasured predisposing factor.

• ALCOHOL ADVERTISING

In part, concern about alcohol advertising may stem from its pervasiveness. In 2000 the alcoholic beverage industries spent $1.42 billion advertising alcohol in the U.S. ( Center for Science in the Public Interest, 2002 ). Most of these expenditures ($893 million) were concentrated in broadcast media (see Figure 11-1 ). Beer advertising accounted for the majority of alcohol advertising expenditures ($910.3 million). Overall, 95 percent of all televised beer advertising expenditures are in sports programming, more than half of televised beer advertisements appear on Saturday or Sunday afternoons, and more than a third appear during primetime, when large segments of the audience are underage ( Snyder et al., 2000 ). Moreover, alcohol advertising expenditures in the United States ( Figure 11-2 ) have risen steadily in recent years. Thus, for example, between 1995 and 2000, these expenditures rose 37 percent, from $1.04 billion to $1.42 billion ( Center for Science in the Public Interest, 2002 ). Whether young people are deliberately targeted by alcohol advertisers or not, they are exposed to alcohol advertising on television, in print media, and on radio (Center for Science in the Public Interest, 2000a, b; 2003). Estimates show, for example, that televised alcohol advertising reached 89 percent of the youth audience, with an average underage television viewer being exposed to 245 alcohol advertisements annually and the 30 percent heaviest viewers being exposed to 780 alcohol advertisements (Center for Science in the Public Interest, 2000b).

FIGURE 11-1

Alcohol advertising expenditures by beverage by medium, 2000. SOURCE: Center for Science in the Public Interest (2002).

FIGURE 11-2

Alcohol advertising expenditures, 1995-2000. SOURCE: Center for Science in the Public Interest (2002).

Images in Alcohol Advertising

Content analysis suggests that many alcohol advertisements link drinking with valued personal attributes such as sociability, elegance, and physical attractiveness and with desirable outcomes such as success, relaxation, romance, and adventure (e.g., Atkin and Block, 1981 ; Postman, Nystrom, Strate, and Weingartner, 1988 ; Strickland, Finn, and Lambert, 1982 ). Moreover, young people find some alcohol advertising appealing and are attracted to it. In a recent study ( Chen and Grube, 2001 ; Martin et al., 2002 ), 450 fifth through eleventh graders were asked to rate 20 beer and soft drink advertisements. Overall, soft drink advertisements were rated more favorably than beer advertisements. Nonetheless, the young people identified some beer advertisements as being among their favorites in the 20 ( Figure 11-3 ). In fact, the most liked advertisement overall was for beer and featured the Budweiser ® lizards and ferret. More than 90 percent of the young people liked this advertisement. Other beer advertisements were also popular, including a Bud Light advertisement featuring a computer-animated mouse (76 percent) and a Budweiser advertisement featuring the Clydesdale horses and Dalmatian dogs (84 percent). In general, children and adolescents find alcohol advertising with celebrity endorsers, humor, animation, and popular music to be particularly appealing ( Atkin and Block, 1983 ; Chen and Grube, 2001 ; Martin et al., 2002 ). Adolescent boys are especially attracted to alcohol advertisements depicting sports ( Slater et al., 1997 ; Slater et al., 1996 ). In general, adolescents and adults find lifestyle or image-oriented alcohol advertising to be more appealing than alcohol advertisements that promote only product quality ( Covell, Dion, and Dion, 1994 ; Kelly and Edwards, 1998 ; Kelly, Slater, and Karan, 2002 ). Image advertising is especially preferred among younger adolescents (e.g., seventh graders) and particularly by younger males ( Kelly and Edwards, 1998 ). Lifestyle or image-oriented advertising also appears to result in more favorable attitudes toward alcohol brands and products among young people when compared with strictly product-oriented or informational advertising ( Kelly et al., 2002 ).

FIGURE 11-3

Percentage of fifth to eleventh graders who strongly like alcohol and soft drink advertisements.

Does alcohol advertising increase alcohol consumption and problems among youth? This question is addressed here by reviewing the recent research on alcohol advertising and by critically considering the evidence about the effects that exposure to these advertisements may have on alcohol beliefs and attitudes and on the prevalence of drinking and drinking problems among young people.

Does Alcohol Advertising Affect Drinking or Drinking Problems?

Earlier reviews have concluded that the evidence for the effects of alcohol advertising on drinking beliefs and behaviors is limited at best (e.g., Atkin, 1995 ; Calfee and Scheraga, 1994 ; Fisher, 1993 ; Nelson, 2001 ). The available research on the effects of alcohol advertising can be grouped into three types of studies: (1) experimental or laboratory studies, (2) ecological studies, and (3) survey and other correlational studies. Each of these types of studies will be considered in turn.

Experimental Studies

Experimental studies investigate the effects that short-term exposure to alcohol advertising under controlled conditions has on drinking beliefs and behaviors. Typically, a group of experimental participants will be exposed to one or more alcohol advertisements embedded within a television program, within a series of “neutral” advertisements, or, in the case of print advertising, within a booklet or magazine. The drinking beliefs or behaviors of this experimental group are then compared to a control group that watches the same program, sees the same collection of advertisements, or reads the same booklet, but without the embedded alcohol advertisements. The results of earlier experimental studies have been mixed with some studies finding no effects (e.g., Kohn, Smart, and Ogborne, 1984 ; Sobell et al., 1986 ) and other studies finding small or short-term effects for some study participants (e.g., Kohn and Smart, 1987 ).

Apparently only a single recent study has been published that experimentally manipulated exposure to alcohol advertising ( Lipsitz, Brake, Vincent, and Winters, 1993 ). This study was intended to investigate the effects of television beer advertising on alcohol expectancies among young people who were not yet regular drinkers. Groups of fifth and eighth graders were exposed to videotapes containing five beer commercials, the same five beer commercials plus two antidrinking public service advertisements, or five soft drink commercials. Results of a memory task indicated that the children paid attention to the advertisements and remembered seeing the beer and soft drink commercials. Despite the attention given to the advertisements, however, neither exposure to the beer advertisements alone nor to the beer advertisements in combination with the antidrinking PSAs affected scores on the alcohol expectancy scales.

The results of these experimental studies offer only very limited evidence that alcohol advertising promotes more favorable drinking beliefs or increases consumption. Laboratory studies of alcohol advertising effects, however, can be criticized on at least four grounds (cf. Atkin, 1995 ; Grube, 1993 ; Lastovicka, 1995 ; Thorson, 1995 ). First, although laboratory experimental studies can control for extraneous factors and allow for strong causal inferences, they often lack realism. In the typical study, respondents will be exposed to alcohol advertising in an artificial setting (e.g., school-room) that does not resemble the natural viewing situation. As a result, it is difficult to draw conclusions about the “real-world” effects of alcohol advertising on beliefs and behaviors based on these laboratory studies.

Second, it has been noted that advertisers target specific audiences with particular advertisements ( Thorson, 1995 ). If the stimulus advertisements do not contain images, themes, or music that appeal to the participants in a specific study, then it is unlikely that any effects will be observed.

Third, laboratory experiments on the effects of alcohol advertising can only address the effects of short-term exposure to a limited number of advertisements. The relevance of such studies for understanding the cumulative effects of exposure to hundreds or thousands of alcohol advertisements over many years is questionable. Laboratory studies may be more appropriate for studying short-term disinhibitory or priming effects than ascertaining if advertising has long-term effects on beliefs or behaviors. That is, this research paradigm may be most relevant to understanding if exposure to alcohol advertising elicits immediate and short-term increases in consumption among those already favorably predisposed to drinking (e.g., Kohn and Smart, 1987 ).

Fourth, it may be naive to expect alcohol advertising experiments, as typically implemented, to produce significant effects on beliefs or behaviors. In particular, it seems unlikely that exposure to a handful of alcohol advertisements in a laboratory setting could produce a measurable effect against the high background rates of such advertising to which respondents are already exposed in their everyday lives.

Ecological Studies

Generally, ecological or econometric studies have focused on the relationship between alcohol industry advertising expenditures and aggregated (e.g., per capita) alcohol consumption, sales, or problems. A few studies have investigated the effects of alcohol advertising restrictions or bans.

Advertising Expenditures

In a recent study ( Saffer, 1997 ), the relationship between variations in local television, radio, and outdoor alcohol advertising and motor vehicle fatalities was investigated using data for the years 1986 to 1989 in the top 75 media markets in the United States. Alcohol advertising was represented as the sum of expenditures over media types (television, radio, outdoor) weighted for relative media impact based on the estimated number of people exposed to each. Alcohol advertising was found to be significantly related to total and nighttime vehicle fatalities, although the effects appeared to be greater for older than for younger (18- to 20-year-old) drivers. The effect of variations in the cost of advertising on motor vehicle fatalities was also investigated in separate analyses. The cost of advertising was found to be negatively related to motor vehicle fatalities, presumably because higher costs reduce the amount of advertising and thus consumption.

This study has a number of strengths and offers the strongest ecological evidence that alcohol advertising might influence drinking problems. The investigation of local variations in advertising and including a consideration of different media types are important innovations that have not been duplicated in other ecological studies. They are important because the lack of variation in advertising expenditures when aggregated across media at the national level may make it difficult to detect advertising effects (e.g., Saffer, 1995 ). Nonetheless, making causal inferences based on this study is problematic. Even though important background and demographic variables were controlled, the possibility that the relationship between alcohol advertising and motor vehicle fatalities is spurious and results from some third variable such as differences in regional drinking norms cannot be entirely discounted.

The remaining recent ecological studies of alcohol advertising expenditures have generally produced null findings regarding the effects of advertising on overall consumption and problems. Thus, for example, using annual data from the United States from 1964 to 1990, Nelson and Moran (1995) investigated the effects of real advertising expenditures for beer, wine, and spirits on consumption of these beverages. Although the results varied somewhat among estimation procedures, none of the same beverage advertising coefficients were significant for beer or spirits. The same-beverage coefficients for wine, however, were significant and positive. That is, wine advertising was related to increased wine consumption. All of the advertising effects, however, were quite small. Moreover, wine advertising decreased spirits consumption while spirits advertising decreased wine consumption. Alcohol advertising expenditures were unrelated to total alcohol consumption once income, price, age structure, and advertising for all other goods were controlled. Overall, these results were interpreted as indicating that alcohol advertising does not increase total consumption, but rather reallocates market shares among brands and beverages.

Similar conclusions were reached in a study of the effects of brand-level advertising on spirits consumption in the United States from 1976 to 1989 ( Gius, 1996 ). Specifically, it was found that brand advertising was positively related to own-brand consumption for spirits, whereas rival brand advertising was not significantly related to own-brand consumption. This pattern was interpreted as indicating that alcohol advertising does not change overall consumption of spirits, but rather leads simply to a reallocation of market shares.

The effects of advertising on alcohol consumption and on spirits consumption also have been investigated using national data from the United States for the years 1959 through 1982 ( Goel and Morey, 1995 ). This study found that the effects of both current and lagged (previous year's) advertising expenditures for alcohol were negative. That is, advertising appeared to decrease consumption. These effects were interpreted by the authors as indicating that alcohol advertising leads to a redistribution of market shares without increasing overall demand. One further possibility is that the alcohol manufacturers may increase advertising when demand begins to decrease. That is, advertising may be a function of sales as well as sales being a function of advertising (cf. Saffer, 1995 , 1996 , 1998 ).

Beer, wine, and spirits advertising were investigated using quarterly data from 1963 to 1992 for the United Kingdom ( Duffy, 1995 ). This study did not consider cross-beverage advertising effects, but did allow for the possibility that changes in advertising do not immediately affect consumption, but rather may have lagged or delayed effects. Advertising was represented in this study by quarterly per capita expenditures on television, radio, and press. Alcohol consumption was measured by quarterly consumer expenditures on beer, wine, and spirits. The effects for wine and spirits advertising were occasionally positive and significant in some models, but were small and most often nonsignificant. The advertising effects for beer advertising were not significant and positive in any of the models, although a small negative effect was found in one model. When the most stable and best predictive model was considered, one advertising coefficient for spirits was significant and positive, but small. Although this study has many strengths, aggregating advertising across media types and the lack of consistency among the models raise some issues.

Fisher and Cook (1995) , using U.S. data for the years 1970 to 1990, investigated changes in per capita consumption as a function of changes in advertising as well as cross-sectional associations. Considering the cross-sectional analyses first, they found that expenditures on magazine advertising were associated with increased spirits consumption. This finding is consistent with the fact that spirits advertising in the U.S. is primarily through print media ( Center for Science in the Public Interest, 2002 ; Snyder et al., 2000 ). They also found that total wine and spirits advertising (across all media) increased wine, spirits, beer, and total consumption. Interestingly, total beer advertising decreased spirits consumption, as would be expected if market shares were being shifted. Overall, the authors concluded that these findings provided some support for the effects of advertising on consumption, and in some cases the observed advertising effects were substantial. When models of change, rather than static models, were considered, no evidence that changes in advertising expenditures were related to changes in consumption was found. Spirits advertising, however, was found to decrease wine market share. The findings of this study provide little or no evidence that changes in alcohol advertising increase overall alcohol consumption, although it may realign market shares.

Other recent ecological studies reach similar conclusions. Thus Coulson, Moran, and Nelson (2001) report a series of analyses using quarterly advertising expenditures, taking into account the relative audience reach of different media types. Some significant effects of alcohol advertising were found, although they were quite small. Thus, spirits advertising had a positive effect on spirits consumption one quarter (3 months) later, and a contemporaneous positive effect on wine consumption. Wine advertising, however, had a negative effect on spirits consumption after one quarter and a positive contemporaneous effect on wine consumption. It was concluded that the effects of alcohol advertising on overall consumption were negligible.

Similar results have been reported for advertising expenditures on per capita alcohol consumption in Ontario, Canada ( Larivière, Larue, and Chalfant, 2000 ). Although the results were unstable and varied considerably depending on model specification, they suggested that spirits consumption was positively related to advertising expenditures, whereas beer and wine consumption were negatively related to advertising expenditures. Larivière et al. concluded that advertising effects were subtle, may vary by beverage, and probably affect brand or product allocation, rather than overall consumption. On the basis of similar data for the United Kingdom and United States, respectively, Duffy (2001) and Nelson (1999) conclude that a 100 percent increase in alcohol advertising would result in a 1 percent increase in total consumption.

Advertising Restrictions

In addition to considering alcohol advertising expenditures, some ecological studies have attempted to ascertain if restrictions on alcohol advertising have a discernible effect on drinking and drinking problems. Early studies in this area concluded that advertising restrictions have little, if any, overall effect on increasing consumption. Thus, for example, a study of state-level alcohol control laws in the United States ( Ornstein and Hanssens, 1985 ) indicated that allowing outdoor (billboard) advertising was actually related to decreased spirits consumption and had no effect on beer consumption. However, allowing price advertising, especially on billboards, significantly increased both spirits and beer consumption. This effect was interpreted as indicating that price advertising leads to greater competition, lower prices, and therefore greater consumption. The analyses also suggested that allowing retailers and distributors to give away alcohol-related novelties (a form of promotion) increased consumption of both spirits and beer. Even so, the effects of price advertising and novelties were relatively small compared with those of other regulatory policies (e.g., drinking age) and economic factors (e.g., price). In another study ( Makowsky and Whitehead, 1991 ), the effects of removing a total ban on alcohol advertising in Saskatchewan, Canada, were investigated for beer, spirits, wine, and total alcohol sales. The analyses indicated that lifting the ban increased beer sales, decreased spirits sales, and had no effect on wine or total sales. That is, lifting the ban may have resulted in a substitution effect of beer for spirits, but did not appear to increase overall consumption.

Some support for the effectiveness of restrictions on broadcast alcohol advertising in reducing alcohol consumption and alcohol problems (i.e., liver cirrhosis mortality, motor vehicle fatalities) is provided by a study of 17 European and North American countries ( Saffer, 1991 Saffer, 1993a ). In a series of analyses controlling for income, price, tourism, kilometers of roadway, and percentage of alcohol consumed in the form of beer and wine, it was found that restrictions on alcohol advertising were related to lower rates of consumption and reduced motor vehicle fatalities. Specifically, countries with partial restrictions had alcohol consumption rates that were about 16 percent lower than countries with no restrictions, and countries with complete restrictions had consumption rates that were 11 percent lower than countries with partial restrictions. The corresponding reduced rates for motor vehicle fatalities were 10 percent and 23 percent, respectively. No significant effects were observed for cirrhosis mortality rates.

This study, however, has been seriously criticized. A reanalysis of the data ( Young, 1993 ) suggested there was evidence of model misspecification and reverse causation, with those countries experiencing low rates of alcohol problems being more likely to adopt alcohol advertising bans than countries with high rates of alcohol problems. That is, it appears that both low problem rates and advertising restrictions may be a result of preexisting conservative drinking styles. Moreover, the reanalysis also suggested that partial alcohol advertising bans might actually increase alcohol consumption through substitution. For example, bans on spirits advertising were associated with increases in beer consumption. Other studies ( Nelson and Young, 2001 ; Nelson, 2001 ) using more recent data and a somewhat longer time series have investigated the effects of bans on broadcast alcohol advertising in the same 17 countries on per capita alcohol consumption, cirrhosis deaths, and traffic fatalities. These studies concluded that a total ban on broadcast alcohol advertising had no measurable effects on alcohol consumption, cirrhosis deaths, or traffic fatalities, although the number of countries with such bans was quite small ( N = 4). Bans on broadcast spirits advertising were related to increases in consumption and road fatalities and were not significantly related to cirrhosis rates. The authors also note that such bans may be relatively ineffective because they are often circumvented through substitution of nonbanned media and the use of new technologies and marketing strategies. Contamination from neighboring areas where no bans are in effect is also problematic.

In contrast, a more recent analysis of longer time series of data (1970-1995) from 20 countries indicated that both partial bans and complete bans on alcohol advertising may reduce consumption ( Saffer and Dave, 2002 ). It was estimated that each added restriction on alcohol advertising (e.g., disallowing spirits advertising on television) reduced consumption by 5 to 8 percent. These effects were found even after controls for price, income, alcohol culture (percentage of alcohol consumed as beer and wine), cigarette advertising bans, and government activism in the economy. Importantly, this study addressed criticisms raised concerning previous studies (e.g., Young, 1993 ). In particular, it took into account reciprocal effects between consumption and alcohol advertising bans. In this regard, it was found that not only did advertising bans decrease consumption, but consumption also affected advertising bans. Specifically, countries with higher alcohol consumption were more likely to institute total bans on alcohol advertising compared with lower consumption countries.

In general, the findings from the ecological studies provide little consistent support for a relationship between aggregate alcohol advertising expenditures or advertising restrictions and aggregate alcohol sales, consumption, or problems. They do provide stronger evidence that alcohol advertising may lead to changes in brand or beverage preferences without increasing total consumption. The ecological research on alcohol advertising, however, has been criticized on a number of grounds (cf. Calfee and Scheraga, 1994 ; Fisher, 1993 ; Saffer, 1993b Saffer, 1995 , 2002 ). Aggregation of advertising data across media types is one recurrent problem; it is interesting to note that one study that took differential media impact into account found significant advertising effects ( Saffer, 1997 ). It is worth noting, however, that other studies investigating the independent contributions of separate media types have found no such effects (e.g., Nelson, 1999 ). In a related aggregation issue, it has been argued ( Saffer, 1993b ) that ecological studies have not considered the possible cumulative effects of advertising over many years. As a result, they may underestimate advertising effects. Studies investigating lagged effects of advertising over relatively lengthy time series, however, have found no advertising effects (e.g., Fisher and Cook, 1995 ; Coulson et al., 2001 ), although time series analysis, even with lags, may not be an appropriate method for detecting cumulative effects. Although the effects of advertising on brand or product preferences may decay rapidly, this may not be the case for any effects of advertising on overall drinking predispositions. Conversely, because advertising is pulsed or concentrated in relatively short intervals, using data that are aggregated at the yearly level may mask or hide short-term advertising effects ( Saffer, 1993b , Saffer and Dave, 2002 ). Again, however, ecological studies considering quarterly data have not found advertising effects (e.g., Nelson, 1999 ; Coulson et al., 2001 ). Aggregating advertising expenditures and sales data over large geographical areas (e.g., nationally) may mask potential advertising effects because of the relative lack of variability in such data. In this regard, it is important to note that the one study that considered variations in alcohol advertising at the regional level ( Saffer, 1997 ) found significant effects on vehicle fatalities. In a related issue with studies using aggregated data, it has been suggested that studying alcohol advertising cross-nationally is potentially important because variations in such advertising are usually at the margin, and quite small in relation to the total amount of alcohol advertising in the environment within any one country. As a result, normally occurring changes in levels of alcohol advertising can be expected to have only minimal effects, if any, in single-country studies ( Saffer, 1995 , 1996 , 1998 ).

An additional cautionary note regarding ecological analyses of alcohol advertising is that they may misspecify the underlying models by ignoring mediated effects. For example, one effect of advertising may be to increase competition among brands, thereby reducing price and, as a result, increasing consumption ( Nelson, 2001 ; Nelson and Young, 2001 ; Tremblay and Okuyama, 2001 ). If such a model holds, then one would not expect a significant direct effect from advertising to consumption if price is also included in a simple series analysis. This would be the case even if advertising were, in fact, an important indirect determinant of alcohol consumption and problems through its effects on price. Although some researchers have dismissed the significance of such indirect effects ( Nelson, 2001 ), they may be practically important. In the present example, if advertising does indeed lead to reductions in prices, then restricting advertising might increase price and reduce consumption. Thus, for example, a case study ( Tremblay and Okuyama, 2001 ) tentatively suggests that lifting the ban on broadcast spirits advertising may have led to price reductions and consequently to increased consumption of spirits. Unfortunately, appropriate analytic procedures that allow for assessing indirect effects, as well as direct effects, for the most part have been lacking in the ecological literature on alcohol advertising.

Another limitation of the existing ecological studies is that they have not considered special populations that may be more susceptible to or exposed to advertising. In particular, it has been argued that young people, or certain groups of young people, may be especially influenced by alcohol advertisements (e.g., Atkin, 1993 ) and that minority populations have been specially targeted by alcohol advertising (e.g., Scott et al., 1992 ; Abramson, 1992 ). It is possible that advertising may be more important at some stages of the drinking process (e.g., initiation) than others (continuation of established drinking patterns). Although aggregate consumption rates for youth are highly correlated with those for adults ( Nelson, 2001 ), they are not identical. The effects of alcohol advertising on aggregated youth drinking thus remains an empirical question.

Survey and Other Correlational Studies

For the most part, survey studies of alcohol advertising have focused on children and adolescents. In general, the survey studies have addressed a fundamentally different question from those addressed in the ecological studies. Rather than asking if alcohol advertising affects overall consumption among young people, these studies ask who might be affected and by what processes. These are questions that cannot be addressed with aggregated data and the types of analyses typically used in ecological studies. In addition, rather than relying on measures of potential exposure at the population level (e.g., advertising expenditures), survey studies have focused at the individual level and specifically on young people known to be more or less exposed to, attentive to, or attracted to alcohol advertising. Early survey studies found small, but significant, positive relationships between reported exposure to alcohol advertising and drinking beliefs and behaviors among young people ( Aitken, Eadie, Leather, McNeill, and Scott, 1988 ; Atkin and Block, 1981 ; Atkin, Hocking, and Block, 1984 ; Atkin, Neuendorf, and McDermott, 1983 ). These effects were small, however, and some studies failed to find substantively meaningful relationships between alcohol advertising and drinking beliefs and behaviors among young people (e.g., Adlaf and Kohn, 1989 ; Strickland, 1982 Strickland, 1983 ).

More recently, research has focused more on attentional and affective processes that may mediate between exposure to alcohol advertising and drinking beliefs and behaviors. Specifically, it has been proposed that attention to and positive affect toward alcohol advertising and the characters and images it contains may be factors that are important in determining whether alcohol advertising influences drinking beliefs and behavior (e.g., Austin and Nach-Ferguson, 1995 ; Grube, 1995 ; Grube and Wallack, 1994 ; Thorson, 1995 ). In one study a small sample of high school students were exposed to videotaped television beer advertising with and without sports content ( Slater et al., 1997 ). The advertisements were embedded in either a sports program or an entertainment program. It was found that girls responded more negatively to beer advertisements and counter-argued them more than boys did, particularly when they had sports content. Of most relevance here, non-Hispanic white adolescents who were more favorable toward the beer advertisements were also more likely to report current drinking and future intentions to drink. The effects, however, were small and were not replicated among Latino adolescents. Moreover, because of the cross-sectional nature of the study, it is not clear what the causal relationship is. In particular, it cannot be determined if a favorable orientation to alcohol advertisements predisposes young people to drinking or if being predisposed to drinking makes young people more favorable toward alcohol advertisements.

The relationship between evaluation of alcohol advertising and drinking was also investigated in a study of 7- to 12-year-old children ( Austin and Nach-Ferguson, 1995 ). It was found that liking alcohol advertisements was positively related to experimentation with alcohol. This effect was relatively robust, accounting for about 11 percent of the variance in the drinking measure. In a similar study with at-risk preadolescents, it was found that identification with the characters in alcohol commercials predicted expectancies regarding the positive effects of drinking ( Austin and Meili, 1994 ). In a similar study, with third, sixth, and ninth graders, both rated desirability of characters in alcohol advertisements and identification with those characters predicted positive alcohol expectancies and, indirectly, a risky behavior index that included drinking ( Austin and Knaus, 2001 ). These patterns of results were replicated and extended using a sample of ninth and twelfth graders from central California ( Pinkleton, Austin, and Fujioka, 2001 ). A “predrinking behavior” index was also constructed by having the respondents rate the extent to which they would like to have each of a series of clothing and toy items with alcohol-related logos. Perceived desirability, identification, and ratings of advertisement production and content quality were found to be related to alcohol expectancies, the predrinking index, and an alcohol-behavior index. Again, however, all of these studies were cross-sectional and rely on simple correlational and regression techniques, thus precluding causal interpretations of these relationships.

Another study used survey data obtained from fifth- and sixth-grade school children ( Grube and Wallack, 1994 ; Grube, 1995 ). Awareness of alcohol advertising was ascertained by presenting them with a series of still photographs taken from television commercials for beer. In each case, all references to product or brand were blacked out. They were asked whether they had seen each advertisement and, if so, to identify the product being advertised, and, if they knew that, the brand of the product. The most important findings from this survey were that awareness of advertising was related to increased knowledge of beer brands and slogans and to more positive beliefs about drinking. Awareness of alcohol advertising also had a significant indirect effect on intention to drink as an adult that was mediated through positive beliefs. Importantly, these effects were maintained even though the reciprocal effects of beliefs and knowledge on awareness of advertising were controlled through the nonrecursive modeling. The findings were interpreted as suggesting that awareness of alcohol advertising may predispose young people to drink rather than the other way around.

A series of recent studies from New Zealand have reached similar conclusions. In one study of 10- to 17-year-olds ( Wyllie, Zhang, and Casswell, 1998b ), respondents were given a written description of and shown a still photograph taken from three television beer advertisements. They were then asked how often they had seen each advertisement and how much they liked each of them. Liking was significantly related to intention to drink as an adult. This effect accounted for a substantial proportion of the variance in these drinking intentions. The effect of liking on current drinking behaviors was more modest and nonsignificant ( p < 0.06). Importantly, the reciprocal effects of drinking and drinking intentions on liking were not significant. Stronger results were reported in a recent study of 18- to 29- year-olds ( Wyllie, Zhang, and Casswell, 1998a ) using similar procedures. In this case, liking of alcohol advertisements was positively related to endorsement of positive statements about drinking and to current alcohol consumption. Most importantly, liking of the advertisements was related to increased numbers of self-reported drinking problems. The reciprocal effects of drinking and drinking beliefs on liking of alcohol advertisements were not significant in the model.

Another recent survey study ( Connolly, Casswell, Zhang, and Silva, 1994 ) represents an advance over previous studies because it used a longitudinal design. Recall of alcohol advertisements at age 15 was positively related to beer drinking 3 years later at age 18 among young men. Unexpectedly, among young women, those who recalled more alcohol advertising at age 15 reported drinking less beer at age 18 than did those recalling fewer advertisements. Although this study is important because it reports the first published longitudinal data showing a significant relationship between alcohol advertising and later drinking, it is problematic for a number of reasons. Most importantly, the analyses did not control for drinking or predisposition to drink at the earlier waves of the study. It is possible that those young men who recalled more advertisements at age 15 were already drinkers at that time and that the differences observed 3 years later were simply a continuance of this pattern. The fact that recall of alcohol advertising was related to decreased drinking among the young women further obscures the interpretation of this study.

A final survey study ( Casswell and Zhang, 1998 ) investigated the relations among liking of alcohol advertising at age 18 and beer drinking and drinking-related aggression at age 21. The study used data from later waves of the previously described study ( Connolly et al., 1994 ). The results indicated that liking alcohol advertising at age 18 was related to higher levels of beer consumption at age 21 and to alcohol-related aggression at that same age. The effects of liking of advertising on aggression were mediated through effects on drinking. Importantly, these effects were obtained even though drinking at age 18 was included as a predictor in the analyses. These findings are thus most consistent with the interpretation that alcohol advertising predisposes young people to drink, rather than drinking predispositions influencing attention to and affect toward alcohol advertising.

Preliminary analyses from other more recent studies (summarized in Martin et al., 2002 ) have replicated and extended these findings. Thus, one of these studies found that young people with more positive affective responses to alcohol advertising held more favorable drinking expectancies, perceived greater social approval for drinking, believed drinking was more common among peers and adults, intended to drink more as adults, and drank with higher frequency and in greater quantities. Interestingly, the effects of affective response to alcohol advertising on drinking behavior and intentions appear to be largely mediated through expectancies and normative beliefs. That is, a major consequence of alcohol advertising may be to increase young people's beliefs about the likelihood of positive consequences of drinking and the normativeness of drinking. In a second of these recent studies, exposure to alcohol advertising was found to be related to increases in drinking over time. The converse, that drinking would affect exposure to alcohol advertising, was not supported.

In sum, survey studies generally find significant associations between reported exposure to, attention to, and recall of alcohol advertising, on the one hand, and drinking beliefs and behaviors, on the other. These relationships, however, tend to be modest for the most part. Moreover, a number of these studies have used small and nonrepresentative samples, raising questions about generalizability. In addition, because of the cross-sectional designs of most of these studies and the failure to control for previous drinking in one of the longitudinal studies, it is difficult to make statements about causality. The emerging studies ( Martin et al., 2002 ) are suggestive of advertising effects and may provide a more definitive answer once more complete analyses become available.

Alcohol portrayals are relatively common on television, in film, and in music and music videos. These portrayals are largely positive or neutral, often associating drinking with positive consequences or desirable attributes. Negative consequences of drinking are rarely portrayed. Only a few studies have investigated the effects of exposure to alcohol portrayals in popular media. Generally, the findings from these studies are mixed and inconclusive.

Overall, the research on the effects of alcohol advertising also presents mixed and inconclusive findings. With some notable exceptions (e.g., Saffer, 1997 ), experimental and ecological studies have produced little or no evidence that alcohol advertising affects drinking beliefs, behaviors, or problems among young people. In contrast to experimental and ecological studies, however, survey research studies on alcohol advertising and young people consistently indicate that there are small, but significant, correlations between awareness of and affect toward alcohol advertising and drinking beliefs and behaviors among young people. Children and adolescents who are more aware of and favorably disposed to alcohol advertisements hold more favorable beliefs about drinking, intend to drink more frequently as adults, and drink more frequently and in larger quantities than do other young people. Taken as a whole, the survey studies provide some evidence that alcohol advertising may influence drinking beliefs and behaviors among some children and adolescents.

A growing body of research is confirming and extending these findings (cf. Martin et al., 2002 ). This evidence, however, is far from conclusive. Because of the cross-sectional design of most of the published studies, causal inferences are difficult. Alcohol advertising may predispose young people to drink or the opposite may be true instead. That is, young people who are favorable toward drinking may seek out information about alcohol and thus be more attentive to alcohol advertisements.

Although studies using longitudinal data and nonrecursive modeling techniques suggest that responses to advertising affect many drinking behaviors, further research is needed. Longitudinal studies that follow the samples of young people from childhood to late adolescence and that adequately control for past drinking behaviors and predisposition would be particularly useful.

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Research for and preparation of this paper were supported by National Institute on Alcohol Abuse and Alcoholism (NIAAA) grant AA12136 to the Prevention Research Center, Pacific Institute for Research and Evaluation.

The author thanks Dr. Elizabeth D. Waiters for assisting in the review of alcohol portrayals in popular music.

• Cite this Page National Research Council (US) and Institute of Medicine (US) Committee on Developing a Strategy to Reduce and Prevent Underage Drinking; Bonnie RJ, O'Connell ME, editors. Reducing Underage Drinking: A Collective Responsibility. Washington (DC): National Academies Press (US); 2004. 11, Alcohol in the Media: Drinking Portrayals, Alcohol Advertising, and Alcohol Consumption Among Youth.
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OMAHA (DTN) -- Here are the Top 5 things the DTN Newsroom is tracking for the week of August 4. Watch for coverage of these and other topics through the week on our subscription platforms as well as on www.dtnpf.com . Note that all report release times are Central Daylight Time (CDT) unless otherwise noted.

1. Weather Models Shrug: Things look a bit uncertain for much of farm country next week. A front could bring scattered showers and a brief cool down to many areas, but where it stalls and for how long leads to an uncertain temperature forecast. Northern Plains should be warm to hotter than normal, the Delta region appears hot and drier. There's a chance of cooler, wet weather in the Canadian Prairies, which would benefit drought-stressed crops.

2. Stock Market Responses: We'll watch through the week on how markets respond to the Fed's decision to hold the ground, for the moment, on interest rates. As more indicators show improvement in inflation and some stability in the economy, as DTN Editor Emeritus Urban Lehner notes in his current An Urban's Rural View, it's getting tougher not to lower rates. Will the market begin to bake in a rate drop over the next few weeks? We'll be watching. To read Lehner's thoughts about September rate cuts, go here: https://www.dtnpf.com/… . DTN Lead Analyst Todd Hultman also weighs in on the Fed decision, and its influence on commodity prices and farm expenses, in the most recent Todd's Take column, found here: https://www.dtnpf.com/… .

3. Land Rate Numbers: It's time for USDA to update land and rental rate numbers, and we'll be digging into the trends.

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Biden campaign grapples with undecided voters who don’t yet believe trump could be the nominee.

Voting in the Republican primary can’t start soon enough in the minds of President Joe Biden’s campaign advisers.

Even as the Biden reelection campaign forges ahead with preparations for another potential general election match-up between Biden and his predecessor, it is grappling with a stubborn reality: The majority of undecided voters simply do not seem to believe – at least not yet – that Donald Trump is likely to be the Republican presidential nominee.

According to the campaign’s internal research, this is the case for most of the undecided voters that the campaign is targeting – nearly three-in-four of them, senior Biden campaign officials told CNN. Those officials said one of the biggest reasons driving this is the simple fact that many voters are not paying close attention to the election, including the ins and outs of the GOP nomination process.

“You can’t conceive of how tuned out these folks are,” one senior campaign official said.

To that end, Biden campaign officials see the task of helping voters recognize that Trump is a strong frontrunner as one of their most important and urgent challenges, with the first GOP caucus in Iowa now just days away. A key part of that work is painting a vivid picture of what a second term of a Trump White House would look like.

At some point in the near future, Biden campaign officials say they expect that a switch will turn on for many of these voters who are not yet convinced that Trump is likely to be on the ballot in the fall. As one senior official put it, a realization will hit : “Oh s—, it is an election between that guy and that guy.”

But what’s impossible for the campaign to predict at this point in the election cycle is when exactly it will click for voters that “that guy” – Trump – is poised to be the GOP presidential nominee. Just 20% of the public has been paying a lot of attention to the 2024 presidential campaign, according to an AP-NORC poll from the end of last year; meanwhile, 47% said they have paid little or no attention.

For now, the most immediate task at hand for Biden’s team is to lay the groundwork for their anticipated fight against the former president. Biden opened the campaign year with his most forceful rebuke of Trump yet as his advisers look to steadily ramp up their attacks in the coming months.

“Donald Trump’s campaign is about him, not America, not you. Donald Trump’s campaign is obsessed with the past, not the future. He’s willing to sacrifice our democracy to put himself in power,” Biden said ahead of the third anniversary of the January 6, 2021, insurrection.

The campaign this week showed its laser focus on Trump around two high-profile events in Iowa.

The former president appeared in a Fox News town hall on Wednesday night at the same time Florida Gov. Ron DeSantis and former UN Ambassador Nikki Haley faced off in CNN’s Republican presidential primary debate. But the Biden campaign chose to only respond in real-time to Trump’s comments – and did not engage in the Haley-DeSantis fight – as they previewed their main political arguments for the coming year.

“The president looks forward to spending the next 10 months reminding the American people how dangerous Donald Trump and his MAGA agenda are for Americans’ pocketbooks, their freedoms, and their democracy,” said Biden communications director Michael Tyler.

One issue the Biden team was quick to seize on: Trump taking credit for overturning Roe v. Wade. The campaign’s press team sent a news release simply quoting the former president saying, “The following is a statement from Donald J. Trump: ‘For 54 years they were trying to get Roe v. Wade terminated, and I did it. And I’m proud to have done it.’’”

Biden’s advisers view those kinds of comments as fodder for their general election fight, especially as they believe abortion rights could serve as a major motivating factor at the ballot box.

Biden’s team also saw a recent opening for a fight with Trump over the economy. The campaign quickly sought to amplify the former president’s prediction the economy would crash with the hope it would happen under Biden’s watch, and they tapped the president himself to fire back on social media.

“[Trump]’s acknowledging that my economy is doing pretty darn well, because he doesn’t want that to continue,” Biden said in a video posted to social media platform X. “And by the way, the idea that he wants to see a crash in the next 12 months – he doesn’t want to be Herbert Hoover. He has to understand, he’s already Herbert Hoover. He’s the only other president who lost jobs during his term.”

The focus on Trump and particularly the argument around protecting democracy has outsized importance, as senior officials acknowledge that Biden’s economic message is still not breaking through. As the president continues to trail his predecessor in hypothetical head-to-head matchups, voters in particular hold a poor view of the US economy, despite economic bright spots and months of “Bidenomics” messaging.

Biden advisers and allies openly acknowledge that they expect a Biden-Trump match-up to be close. Until Trump clearly emerges as the next GOP nominee, they say, they plan to continue reminding voters what the former president did with his first term in office and warn of what another four years of a Trump presidency would look like.

“Once you get to that head-to-head, the dynamics change. The world is different,” one senior Biden campaign official said.

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