The pilot study by Jernigan and others (2017), focused on digital and social media and compared young people with adults on the amount of alcohol marketing they recalled seeing. Youth reported greater exposure to alcohol marketing  and promotional content than adults in most media, including on the Internet. Furthermore, youth reported greater engagement with alcohol marketing online. This stresses the need to assure compliance with voluntary industry standards and to improve monitoring of alcohol marketing, especially regarding youth and the new media online.

A sample of 1,192 underaged youths and 1,124 adults completed an online survey, with questions about alcohol marketing in online as well as traditional media. A distinction in the questions was made between exposure (how often) and content (type) of alcohol marketing, and engagement with alcohol marketing.

Youth reported exposure to alcohol marketing in the last month was almost twice as much as exposure of adults on the Internet (29.7% versus 16.8%, p < 0.001). Youth interacted with alcohol-related online content in greater proportions than adults, such as celebrities using alcohol, celebrities wearing alcohol-branded items, pictures of celebrities showing the negative effect(s) of using alcohol, pictures of friends/peer using alcohol and pictures of friends/peers showing the negative effect(s) of using alcohol. Regarding the content of alcohol marketing, the difference between youth and adults was the most significant with content related to celebrities and alcohol.

The results show that youth were significantly, and twice as likely than adults to see or hear alcohol marketing on the TV, radio, billboards and especially the Internet. They also show that youth were more likely than adults to interact with online content of alcohol marketing.

These results are concerning, since youth in particular are vulnerable and susceptible to alcohol marketing, and age-gating on digital media are not that effective.

The article can be downloaded via the Online Wiley Library or have a look at our database of scientific publications.

Authors: Jonathan K. Noel & Thomas F. Babor Title: Does industry self-regulation protect young people from exposure to alcohol marketing? A review of compliance and complaint studies Journal: Addiction, 2016, 10.1111/add.13432OLYMPUS DIGITAL CAMERA Abstract: Background and aims: Exposure to alcohol marketing is considered to be potentially harmful to adolescents. In addition to statutory regulation, industry self-regulation is a common way to protect adolescents from alcohol marketing exposures. This paper critically reviews research designed to evaluate the effectiveness of the alcohol industry's compliance procedures to manage complaints when alcohol marketing is considered to have violated a self-regulatory code. Methods: Peer-reviewed papers were identified through four literature search engines: PubMed, SCOPUS, PsychINFO and CINAHL. Non-peer-reviewed reports produced by public health agencies, alcohol research centers, non-governmental organizations, government research centers and national industry advertising associations were also included. Results: The search process yielded three peer-reviewed papers, seven non-peer reviewed reports published by academic institutes and non-profit organizations and 20 industry reports. The evidence indicates that the complaint process lacks standardization across countries, industry adjudicators may be trained inadequately or biased and few complaints are upheld against advertisements pre-determined to contain violations of a self-regulatory code. Conclusion: The current alcohol industry marketing complaint process used in a wide variety of countries may be ineffective at removing potentially harmful content from the market-place. The process of determining the validity of complaints employed by most industry groups appears to suffer from serious conflict of interest and procedural weaknesses that could compromise objective adjudication of even well-documented complaints. In our opinion the current system of self-regulation needs major modifications if it is to serve public health objectives, and more systematic evaluations of the complaint process are needed. The article can be downloaded via this link in the Wiley Online Library.
Authors: Jernigan, Noel, Landon, Thornton & Lobstein Title: Alcohol marketing and youth alcohol consumption: a systematic review of longitudinal studies published since 2008 Journal: Addiction, 2016, 10.1111/add.13591OLYMPUS DIGITAL CAMERA Abstract: Background and aims: Youth alcohol consumption is a major global public health concern. Previous reviews have concluded that exposure to alcohol marketing was associated with earlier drinking initiation and higher alcohol consumption among youth. This review examined longitudinal studies published since those earlier reviews. Methods: Peer-reviewed articles were identified in medical, scientific and social science databases, supplemented by examination of reference lists. Non-peer-reviewed papers were included if they were published by organisations deemed to be authoritative, were fully referenced and contained primary data not available elsewhere. Papers were restricted to those that included measures of marketing exposure and alcohol consumption for at least 500 underage persons. Multiple authors reviewed studies for inclusion and assessed their quality using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observation Cohort and Cross-Sectional Studies. Results: Twelve studies (ranging in duration from nine months to eight years), following nine unique cohorts not previously reported on involving 35,129 participants from Europe, Asia and North America, met inclusion criteria. All 12 found evidence of a positive association between level of marketing exposure and level of youth alcohol consumption. Some found significant associations between youth exposure to alcohol marketing and initiation of alcohol use (odds ratios ranging from 1.00 to 1.69), there were clear associations between exposure and subsequent binge or hazardous drinking (odds ratios ranging from 1.38 to 2.15). Mediators included marketing receptivity, brand recognition, and alcohol expectancies. Levels of marketing exposure among younger adolescents were similar to those found among older adolescents and young adults. Conclusions: Young people who have greater exposure to alcohol marketing appear to be more likely subsequently to initiate alcohol use and engage in binge and hazardous drinking. This article is protected by copyright. All rights reserved. The article can be downloaded via this link in the Wiley Online Library.
Author: Auden C. McClure, Susanne E. Tanski, Zhigang Li, Kristina Jackson, Matthis Morgenstern, Zhongze Li, James D. Sargent Title: Internet Alcohol Marketing and Underage Alcohol Use Journal: Pediatrics, 2016, peds. 2015-2149. AbstractOLYMPUS DIGITAL CAMERA Background and objective: Internet alcohol marketing is not well studied despite its prevalence and potential accessibility and attractiveness to youth. The objective was to examine longitudinal associations between self-reported engagement with Internet alcohol marketing and alcohol use transitions in youth. Methods: A US sample of 2012 youths aged 15 to 20 was surveyed in 2011. An Internet alcohol marketing receptivity score was developed, based on number of positive responses to seeing alcohol advertising on the Internet, visiting alcohol brand Web sites, being an online alcohol brand fan, and cued recall of alcohol brand home page images. We assessed the association between baseline marketing receptivity and both ever drinking and binge drinking (≥6 drinks per occasion) at 1-year follow-up with multiple logistic regression, controlling for baseline drinking status, Internet use, sociodemographics, personality characteristics, and peer or parent drinking. Results: At baseline, ever-drinking and binge-drinking prevalence was 55% and 27%, respectively. Many (59%) reported seeing Internet alcohol advertising, but few reported going to an alcohol Web site (6%) or being an online fan (3%). Higher Internet use, sensation seeking, having family or peers who drank, and past alcohol use were associated with Internet alcohol marketing receptivity, and a score of 1 or 2 was independently associated with greater adjusted odds of initiating binge drinking (odds ratio 1.77; 95% confidence interval, 1.13–2.78 and odds ratio 2.15; 95% confidence interval, 1.06–4.37 respectively) but not with initiation of ever drinking. Conclusions: Although high levels of engagement with Internet alcohol marketing were uncommon, most underage youths reported seeing it, and we found a prospective association between receptivity to this type of alcohol marketing and future problem drinking, making additional research and ongoing surveillance important.
Authors: Rebecca L. Collins, Phyllis L. Ellickson, Daniel McCaffrey, Katrin Hambarsoomians 
Title: Early Adolescent Exposure to Alcohol Advertising and its Relationship to Underage Drinking
Journal: Journal of Adolescent Health, 2007, 40, 527-534. AbstractOLYMPUS DIGITAL CAMERA Objective: The study examines whether the exposure to alcohol marketing affects adolescents' beer use. 
Design: Prospective study (longitudinal study) 
Setting: 39 schools in South Dakota, US 
Participants: Sixth grade students between 11 and 12 years old (N=1786). One of the youngest groups sampled (grade 6). A majority of these early adolescents have not started drinking yet (respectively 15 and 17 percent).
Methods: It is examined whether the level of exposure to television beer advertisements, alcohol ads in magazines, in-store beer displays, beer concessions, radio listening time, ownership of beer promotional items in grade 6 affect beer drinking in grade 7 and drinking intentions in grade 7. Logistic regression analysis is performed to calculate odds ratios adjusted for covariates (parental monitoring, adult drinking, peer drinking, parent approval, friend approval, school grades, low religiosity, depressed mood, deviance, impulsivity, sports participation, parent education, gender, ethnicity, frequency of beer drinking in grade 6). 
Findings: 17% reported past year beer drinking at grade 7. The odd ratios (95%CI) for drinking beer of the complete model in which all the ad variables are included together with the joint effects for beer drinking were: ESPN cable network 1.08 (0.83-1.42); other sports beer ads 1.19 (1.01-1.40); other TV beer ads 1.13 (0.95-1.34); magazine reading 0.96 (0.87-1.06); radio listening 1.17 (1.00-1.37); beer concessions 1.01 (0.91-1.13); in-store beer displays 1.03 (0.92-1.14); beer promotional items 1.76 (1.23-2.52). Joint effect of exposure to ads from all sources: F(8,28)=8.36, p<0.0001, and from 3 TV sources: F(3,33)+3.35, p<0.05. 20% of youth in 75th percentile of alcohol marketing exposure at grade 6 reported past year beer drinking at grade 7, compared with 13% in 25th percentile. 
Conclusions Authors: Children at extremely high levels of overall advertising exposure were subsequently 50% more likely to drink and 36% more likely to intend to drink as those at low levels. These results are in line with Stacy et al (2004) but contradict the findings of Ellikson et al (2005)

Remarks of EUCAM: 
This seems a thoroughly conducted study which is focused on more types of alcohol marketing than only televised alcohol advertisement. It is interesting to see the large effect of ownership of promotional items and drinking beer at a later age. The study finds a small but significant effect for the joint effect of exposure to televised beer ads in all models. As the authors already conclude, this is in line with the findings of Stacy et al (2004), but not with the findings of Ellikson et al (2005). The design of measurement of the main variables was similar to the other studies, but small differences in the specific questionnaires could explain these varying results. Alternatively, the older sample of Ellickson could explain the differences in results. It is important to test in further research what could explain these differences in findings. 
Author: Alan W. Stacy, Jennifer B. Zogg, Jennifer B. Unger, Clyde W. Dent
Title: Exposure to Televised Alcohol Ads and Subsequent Adolescent Alcohol Use
Journal: American Journal Health Behaviour, 2004, 28 (6), 498-509. AbstractOLYMPUS DIGITAL CAMERA Objective: The study examines whether the exposure to television alcohol advertisements affects adolescents' alcohol use. The study differs from most other studies by measuring the exposure to television alcohol advertisement in different ways.

Design: Prospective study (longitudinal study) which differs from other studies by taking into account many confounders and multiple measurements of exposure to televised alcohol ads. Respondents are asked to indicate how often they have watched specific television series. This data is multiplied by the number of alcohol commercials broadcasted during these series. Because the broadcasting of alcohol advertisements occurs much more frequently during televised sporting events, the amount of televised sporting events viewed is reported separately by the respondents. In addition, respondents are asked to self-report the frequency of alcohol advertisements they are exposed to. The memorability of alcohol advertisements by the respondents is measured by a cued-recall memory test in which respondents are asked whether they recognized specific commercials and a draw-an-event memory test in which respondents are asked to draw a sketch of the first commercial that come to their mind.
Setting: 20 middle in Los Angeles, California, US. 
Participants: Seventh grade students between 12 and 13 years old (N=2250)
Methods: It is examined whether the level of exposure to alcohol advertisement on television affect drinking behaviour at the 12-month follow-up. Logistic regression analysis is performed to calculate odds ratios adjusted for covariates (general television viewing, participation in team sports, perception of friends' alcohol use, perceived peer approval alcohol use, intentions to use alcohol, perceptions of adults' alcohol use, gender, ethnicity, school). 
Findings: The watched TV shows exposure index shows that each 1 standard deviation increase in alcohol advertising exposure is associated with 44% increase in odds of beer drinking (95% CI=27%, 61%), 34% increase in odds of wine/liquor drinking (95% CI=17% , 52%), and 26% increase in odds of consuming 3 or more drinks on one occasion (95% CI=8% , 48%) during previous 30 days. However, the amount of viewed TV sport events and the self-reported frequency only have a significant effect on the beer consumption and do not affect the consumption of wine/liquor or the risk of binge drinking. The Memory tests showed no effect on the drinking behaviour with the exception of the score on the draw-an-event memory test. Each 1 standard deviation increase in the draw-an-event memory test is associated with 14% decrease in odds of beer drinking (95% CI=-25%, -1%). 
Conclusions Authors: The strength of the associations between exposure of alcohol ads on television and alcohol use varied across exposure measures and was most consistent for beer. 

Remarks of EUCAM: 
The effects of the watched TV shows exposure index on adolescents' alcohol use seems strong even if we control for main confounders. However, other measurements of exposure in the study show more mixed results, which make the interpretation of the findings more difficult. This study suggest an effect of televised alcohol advertisement exposure on especially using beer, but makes clear that is very important how we measure televised alcohol ad exposure. The authors are very precise in addressing limitations in their study. The limitations they address can be found in most other longitudinal studies on the effects of alcohol marketing. This study is innovative in the assessment of confounders, however, it is impossible to include every possible confounder in an observational study. Another limitation is the geographical limitation of the study. The study is conducted in only one region in the US. Like most other observational studies, alcohol use is only measured by self-report and is not biochemically validated.