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Cigarette and alcohol advertising in the media

Received 2008 Jan 9; Accepted 2009 Feb 6. This article has been cited by other articles in PMC. Abstract Background The effect of alcohol portrayals and advertising on the drinking behaviour of young people is a matter of much debate. We evaluated the relationship between exposure to alcohol advertising, marketing and portrayal on subsequent drinking behaviour in young people by systematic review of cohort longitudinal studies. Methods studies were identified in October 2006 by searches of electronic databases, with no date restriction, supplemented with hand searches of reference lists of retrieved articles.

Cohort studies that evaluated exposure to advertising or marketing or alcohol portrayals and drinking at baseline and assessed drinking behaviour at follow-up in young people were selected and reviewed.

Results seven cohort studies that followed up more than 13,000 young people aged 10 to 26 years old were reviewed. The studies evaluated a range of different alcohol advertisement and marketing exposures including print and broadcast media.

Two studies measured the hours of TV and music video viewing. All measured drinking behaviour using a variety of outcome measures. Two studies evaluated drinkers and non-drinkers separately. Baseline non-drinkers were significantly more likely to have become a drinker at follow-up with greater exposure to alcohol advertisements.

There was little difference in drinking frequency at follow-up in baseline drinkers. In studies that included drinkers and non-drinkers, increased exposure at baseline led to significant increased risk of drinking at follow-up.

The strength of the relationship varied between studies but effect sizes were generally modest.

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  • Previous work has shown that number of self-conflicts moderated young adolescents' responses to cigarette advertisements Shadel et al;
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  • However, these campaigns are often unclear.

All studies controlled for age and gender, however potential confounding factors adjusted for in analyses varied from study to study. Important risk factors such as peer drinking and parental attitudes and behaviour were not adequately accounted for in some studies. Conclusion data from prospective cohort studies suggest there is an association between exposure to alcohol advertising or promotional activity and subsequent alcohol consumption in young people.

Inferences about the modest effect sizes found are limited by the potential influence of residual or unmeasured confounding. Background The influence of alcohol marketing and advertising on the drinking behaviour of young people is a matter of much debate, mostly focused on the question of whether advertising increases consumption and risky drinking by young people.

Yet it should be acknowledged that young people are inevitably exposed to beverage alcohol advertising, as they are to advertising for any other consumer product. They are aware of it, and are able to identify and distinguish between alcohol brands, just as they are able to discern brands of other consumer goods.

However, the evidence does not support the notion that such awareness increases consumption by young people. Alongside this, macro-level analyses comparing advertising coverage with drinking consumption has been used to provide a rationale for imposing limits on alcohol advertising. One study, drawing on data from Organisation for Economic Co-operation and Development OECD countries, reported that total expenditure on alcohol advertising is linked to higher consumption and argued that advertising bans could result in significant reductions in consumption [ 7 ].

Similarly, an economic analysis in the Cigarette and alcohol advertising in the media States assessed the effects of alcohol advertising on youth drinking behaviours by comparing federally reported levels of youth drinking with detailed cigarette and alcohol advertising in the media on alcohol advertising in local markets during the same years. Correspondingly, in the United States the Institute of Medicine has called for stronger regulation of alcohol marketing [ 9 ].

However, causal relationships cannot be directly inferred from these studies and this limits the conclusions that can be drawn about the potential impact of advertising bans. Moreover, the alcohol and advertising industry have used data from econometric studies to argue that advertising bans have little impact on overall alcohol consumption [ 10 - 13 ].

Whether young people are directly targeted by alcohol advertisers or not, they are exposed to alcohol advertising on television, in print media, and on radio. A first question to be answered through rigorous research, therefore, is whether alcohol advertising does have an impact on alcohol consumption amongst young people.

This question is best addressed through large prospective cohort studies that examine the relationship between baseline early exposure to alcohol advertising and subsequent consumption and misuse. Helpfully, several such studies have recently been published [ 14 - 22 ].

The aim of our systematic review was to evaluate the likelihood that exposure to alcohol advertising, marketing and portrayal of alcohol increases self-reported alcohol use in young people. We have specifically focused on substantive behavioural outcomes — alcohol use — rather than surrogate outcomes such as brand awareness, or attitudes or intentions towards drinking as the exact causal relationship between surrogate outcomes and subsequent drinking behaviour is unclear.

Substantive outcomes provide a more robust basis for evidence based decision making. Several reviews of the literature on the association of advertising exposure and drinking in young people or, more generally, the effects of media on the behaviour and lifestyles of young people have previously been published [ 23 - 31 ]. However, none use explicit, transparent methodology and they generally lack critical appraisal of individual study weaknesses in relation to any likelihood of bias.

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  • These position statements include;
  • Drinking Habits, Access, Attitudes and Knowledge;
  • The key to understanding the empirical problems lies in the advertising response function and the type of data used to measure advertising;
  • Two studies measured the hours of TV and music video viewing;
  • The key to understanding the empirical problems lies in the advertising response function and the type of data used to measure advertising.

Our review differs in aim from previous reviews which focused on evaluating the association between media effects and expectancies of drinking or drinking behaviour.

Another important difference in our review is the detailed description of our systematic and rigorous approach to the topic, consistent with best methodological practice in systematic reviews of prospective cohort studies, in particular an assessment of the likelihood of bias of reviewed studies [ 33 ]. Furthermore, although previous reviews have referenced some of the studies we have included in our review, none have covered all the studies that we have included.

Therefore, we provide an update to previous reviews focusing on findings from longitudinal study designs. Methods Eligibility criteria We considered studies that evaluated the relationship between alcohol advertising or marketing and alcohol use in young people. We included prospective cohort longitudinal studies where young people's exposure to alcohol advertising or attitudes to alcohol advertising and alcohol drinking behaviour were evaluated at baseline and alcohol drinking outcomes were again evaluated after a given period of time.

The rationale for restricting the review to prospective cohort studies is that they provide the highest level of evidence that is available for evaluation of advertising and marketing exposure and subsequent drinking behaviour. If such studies are well designed, conducted and analysed they can provide supportive evidence for a causal association between a particular exposure and an outcome.

We excluded experimental studies which evaluated a single exposure to advertising of one form or another and examined cigarette and alcohol advertising in the media effects on either attitude or liking for the advertisements or drinking behaviour. Whilst experimental studies have advantages in that they offer better control over the intervention that participants are exposed to so that the intervention can be more accurately described and causality more confidently inferred; they do not reflect the complexity of the advertising and commercial milieu that people are exposed to in their daily lives, and only evaluate effects post-exposure at a single time-point, so results are not applicable to a broader context.

We have also excluded cross-sectional, time-series and econometric studies. Cross-sectional surveys measure the association between a particular exposure such as alcohol advertising and drinking behaviour, but do not show whether the exposure preceded the outcome.

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  • As such, level of identification with cigarette advertising models may be a key moderating variable when considered in combination with self-conflict;
  • This distinction is important because if adolescents who exhibit maladaptive levels of self-conflict look to outside sources for help with resolving these conflicts, it is likely that they look to other people and social resources Harter, 1999a;
  • Alcohol and Tobacco Advertising on Billboards.

Reverse causality cannot be ruled out, whereby young people who drink or misuse alcohol are more receptive to alcohol advertising. Time-series studies are also not ideal for showing temporal relationships due to a greater risk of confounding.

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  2. Public health implications of beverage marketing alcohol as an ordinary consumer product.
  3. Quality components assessed were.

One other weakness of the time-series studies is that they measure exposure and outcomes at a population level, rather than in individuals, and therefore include all age groups and are not exclusively focused on young people. Variation in effects in different age groups may be obscured when looking at aggregate population data. Econometric or ecological studies, which may also use time-series data, use data from different sources and statistical modelling to examine relationships between exposure advertising expenditure and outcome alcohol sales.

Again these studies are not ideal for this review as they do not specifically look at drinking behaviour in young people but report aggregate alcohol consumption across the population. The observed effect is also highly dependent on the choice and source of factors that are used for the statistical model. To be included in our review, cohort studies were required: This includes advertising appearing on television, radio, newspapers, billboards, posters, or depiction of alcohol use in movies, TV programmes, music videos and song lyrics, promotional activities including give-aways such as t-shirts and other items bearing alcohol brand logos.

Portrayals of alcohol use are particularly prevalent in prime-time programming [ 34 ], music videos [ 35 ], and during television coverage of sports events [ 36 ]; and iii to evaluate any alcohol consumption outcome which included: We excluded studies reporting only intention to drink as an outcome, or attitude to drinking. Studies only reporting awareness and that did not measure any effects on drinking were also excluded. Identification of studies Electronic databases searched were Medline and Embase from their inception to October 2006.

Search terms included free text and MESH terms for drinking behaviour and advertising and marketing. The exact search strategies are shown in Table 1 see Additional file 1 Reference lists of retrieved reviews and primary studies were also scanned for additional relevant studies. There was no restriction to language of publication. Study selection and synthesis Potentially relevant studies were identified by screening titles and abstracts of retrieved references from the cigarette and alcohol advertising in the media databases.

Articles were not selected unless the title or abstract focused on effects of alcohol advertising, marketing or portrayals and on drinking behaviour in young people.

Where this was not clear, the full text of the articles was retrieved for further screening.

  1. Results Table 1 presents zero order correlations among all covariates and individual independent variables i.
  2. Indeed, price competition may set off a price war in which all firms will lose revenue.
  3. Finally, I am involved currently in a project with Melanie Wakefield, Chaloupka, and others to examine the effect of tobacco counteradvertising on youth smoking.

Each retrieved article was screened for review inclusion according to the eligibility criteria described above. Data from included studies were extracted and summarised as a narrative synthesis. Threats to internal and external validity were appraised for each study using the Newcastle-Ottawa Quality Assessment Scale for cohort studies adapted for this review [ 37 ].

Quality components assessed were: Was the sample a consecutive sample or a random sample of the population? Performance bias — was ascertainment of exposure by structured interview?

Advertising and Promotion of Alcohol and Tobacco Products to Youth

Attrition bias — a were all participants followed up for the same length of time? Studies were awarded an asterix if the component was adequately addressed. Studies not eligible for inclusion were tabulated with reason for exclusion.

Screening, selection, data extraction and narrative synthesis were undertaken by one systematic reviewer. Results The electronic searches identified 915 potentially relevant articles. After screening the titles and abstracts, 115 potentially relevant articles were obtained as full text publications. An additional six articles were identified from screening the reference lists of retrieved articles.

Many studies were excluded mainly because they were secondary reports: We found five foreign language publications without English abstracts requiring translation to determine eligibility but this was beyond the scope of this systematic review. Other articles were excluded mainly due to ineligible study designs: We excluded three articles because although data were taken from a prospective cohort study, these data were from a cross-sectional analysis focusing on just one time point [ 4538 ].