Removing alcohol adverts from streets and public transport, and phasing out alcohol sponsorship in sport are among the steps that should be taken to prevent alcohol companies grooming children.

In a report published today by Alcohol Focus Scotland, leading academics and health experts outline how the Scottish Government can reduce the unacceptably high levels of alcohol marketing that children and young people are exposed to.

Children are very familiar with and influenced by alcohol brands and advertising campaigns, despite codes of practice which are supposed to protect them. There is clear evidence that exposure to alcohol marketing leads children to start drinking at a younger age and to drink more if they are already drinking.

Alcohol Focus Scotland was asked by Ministers to facilitate an international expert group on alcohol marketing to advise on the most effective policy options available and how they might be implemented in Scotland.

The group’s recommendations include:

  • removing alcohol marketing from public spaces such as streets, parks, sports grounds and on public transport
  • ending alcohol sponsorship of sports, music and cultural events
  • pressing the UK Government to introduce restrictions on TV alcohol advertising between 6am and 11pm, and to restrict cinema alcohol advertising to 18-certificate films
  • limiting alcohol advertising in newspapers and magazines to publications aimed at adults
  • restricting alcohol marketing on social networking sites

The report also recommends setting up an independent task force on alcohol marketing to remove the regulatory role of the alcohol industry.

More than 30 organisations, including Children 1st, the Scottish Cancer Prevention Network and the medical Royal Colleges, as well as the majority of MSPs (72), have pledged their support to end alcohol marketing in childhood. This report now outlines specific actions which could be taken to achieve that.

Professor Gerard Hastings, one of the group members and internationally renowned expert on social marketing, said:

“Self-regulation does not work; it will not control dishonest banks, over-claiming MPs or profit-driven multinational drinks companies. And yet we continue to rely on it to protect our children from alcohol marketing.  It is no surprise that study after study has shown that, as a result, children are being put in harm’s way – and that parents want policy makers to be more courageous.  Scotland now has a chance to grasp this nettle and show how independent statutory regulation of marketing can provide our young people the protection they deserve. The international community is trusting us to take the same public health lead we took on smoke-free public places and minimum unit pricing; let us show them that we will.”

Alison Douglas, Chief Executive of Alcohol Focus Scotland, said:

“An alcohol-free childhood is the healthiest and best option, yet we allow alcohol companies to groom our children from a young age. They are seeing and hearing positive messages about alcohol when waiting for the school bus, watching the football, at the cinema or using social media. We need to create environments that foster positive choices and support children’s healthy development. We hope Ministers will respond to this report and the groundswell of support for effective alcohol marketing restrictions in Scotland.”

Tam Baillie, Children and Young People’s Commissioner Scotland said:

“I strongly support this report which provides clear evidence on the nature and reach of alcohol marketing and makes welcome and sensible proposals to safeguard our children. All children and young people have the right to good health and that must include the right to grow up free from commercial pressures to drink alcohol. The extent of the actions we take now are a good measure of the value we place on our children for the future.”

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For more information or to arrange an interview with Professor Hastings or Alison Douglas, please contact Gillian Bell on 0141 572 6293 or email: gillianbell@alcohol-focus-scotland.org.uk

Notes to editors

  • Alcohol Focus Scotland is the national charity working to prevent and reduce alcohol harm. The report and summary Promoting good health from childhood, Reducing the impact of alcohol marketing on children in Scotland can be downloaded at: alcohol-focus-scotland.org.uk/news/scottish-government-urged-to-curb-alcohol-marketing-to-protect-children
  • Or click here to download the report and summary via the EUCAM site. 
  • Members of the international virtual expert group have expertise in alcohol marketing research, policy and legislation, as it relates to the protection of public health, and the reduction of health and social harm caused by alcohol. A full list of members can be found in appendix 2 of the report.
  • Marketing pledge wording: “I believe that alcohol marketing has no place in childhood. All children should play, learn and socialise in places that are healthy and safe, protected from exposure to alcohol advertising and sponsorship.” Full list of supportive organisations: http://www.alcohol-focus-scotland.org.uk/campaigns-policy/alcohol-marketing/
  • While some marketing restrictions require action at UK or European level, the Scottish Government has substantial powers over key areas of regulation. The report’s recommendations make reference to competence.
  • Last month a series of reports were published in a supplement to the scientific journal Addiction that presents the latest evidence on alcohol marketing and its impact on children. The Addiction supplement, Alcohol marketing regulation: From research to public policy, is free to download from the Wiley Online Library: http://onlinelibrary.wiley.com/doi/10.1111/add.v112.S1/issuetoc
The Monitoring Alcohol Marketing Practices in Africa (MAMPA) Project was a public health surveillance program devoted to monitoring alcohol marketing activities in the African region as well as youth exposure to these marketing activities. Data on alcohol marketing was collected in Ghana, Nigeria, Uganda, the Gambia, Kenya, Malawi and Namibia. The main conclusions of this independent analysis of this MAMPA data are:
  • The findings of the report provide evidence of violations of industry self-regulation codes in the seven countries studied
  • The findings points to the need for systematic surveillance of alcoholic beverage marketing to protect vulnerable populations, such as youth, who may already be experiencing problems related to their alcohol use.
  • The report underscores the need for policy strategies to more effectively monitor and regulate alcohol advertising across all media outlets.
  • The report points out that a variety of options exist, including complete bans on alcohol advertising.
  This secondary analysis of the original MAMPA marketing data confirms the conclusions of the original MAMPA report, in that it provides strong evidence of code violations in all media evaluated, and suggests that exposure to potentially harmful alcohol marketing content is widespread in six of the seven countries studied. These reports also raise questions about the effectiveness of current industry efforts to regulate alcohol marketing. The report (full text, including an executive summary) can be downloaded via this link. 

Authors: Kate Robaina, MPH, Thomas Babor, PhD, MPH & Jonathan Noel, MPH (2016).

Title: Evaluating compliance with alcohol industry self-regulation in seven countries in Africa. An external evaluation of the MAMPA (Monitoring Alcohol Marketing Practices in Africa) project. OLYMPUS DIGITAL CAMERA

Executive summary

Introduction
The Monitoring Alcohol Marketing Practices in Africa (MAMPA) Project was a public health surveillance program devoted to monitoring alcohol marketing activities in the African region as well as youth exposure to these marketing activities. The first project report was the subject of a World Health Organization (WHO) technical meeting in Brazzaville in 2012, where it was recognized that MAMPA had methodological limitations that precluded definitive conclusions about the extent to which alcohol marketing in four countries within Africa violated international guidelines regarding the exposure of young persons to potentially harmful advertising content. It was recommended that content of advertisements should be analyzed using a coding scheme developed by a panel of experts.

Following the meeting, the WHO Regional Office for Africa asked researchers from the University of Connecticut School of Medicine to systematically evaluate the marketing materials collected as part of the MAMPA project, and to expand the study to include the second wave of data collected from three other sub-Saharan African countries: Kenya, Malawi, and Namibia.

The purpose of this report is to describe the results of an independent analysis of the MAMPA data. The specific aims of the re-analysis of the MAMPA marketing data were: 1) to provide estimates of the prevalence of code violations in alcohol advertisements within and across these seven African nations, 2) to determine which sections of the Code were violated most often; 3) to determine if different producers and media had more violations than others; and 4) to test the feasibility of a new standardized rating procedure to evaluate code violations in alcohol marketing materials (Babor, Xuan & Damon, 2013a). Developed initially for television and print media, the procedure is applied for the first time in this study to radio ads and outdoor advertisements.

Methods
Ethnographic field methods were used to collect marketing materials from rural and urban areas of seven countries: Ghana, Nigeria, Uganda, the Gambia, Kenya, Malawi and Namibia. These countries were selected to provide a range of social availability climates (according to religion and culture) and regulatory environments (ranging from a ban on alcohol advertising to only partial restriction).

Examples of unique marketing materials (N=282) used by both domestic and foreign alcohol producers were obtained by trained observers recruited from public health NGOs and research NGOs working on alcohol prevention and operating at the national level within each country. Observers were trained to collect digital recordings of visual stimuli across four types of media: TV, radio, print and outdoor advertising. In order to conduct this secondary analysis of the data collected in the original four MAMPA countries and in the three additional countries, all unique alcohol ads from each country were identified from the available recordings and abstracted into individual video, audio, or image files.

Because of between-country variation in alcohol marketing regulations, a set of guidelines developed by the alcohol industry (ICAP’s Guiding Principles: Self-Regulation of Marketing Communications for Beverage Alcohol) were chosen as the standard code to compare all advertisements. Using an objective Delphi rating procedure developed and validated in prior alcohol marketing research (Babor, Xuan & Proctor,
2008; Babor et al., 2013a), the ads were subjected to an evaluation by 9 trained raters across two rounds, the second of which allowed the raters to see the average ratings of the group. Each rater had experience in public health, substance use, or public health, and was considered to have the necessary expertise to protect vulnerable populations. Raters were from Kenya, Malawi, Nigeria and the US. Interrater reliability between the raters was assessed using violation level and item-level data and was found to be high.

Results
In total, 282 unique examples of alcohol advertising were analyzed. Observers collected the largest number of marketing examples in Uganda (25.2% of all examples) and Nigeria (24.8%). The Gambia, where there is a ban on alcohol advertising, contributed only 1.4% of the total ads collected. Over seventy percent (70.6%) of ads collected from all countries were obtained from outdoor media (billboards, posters, signage, etc.).

Overall, 78 advertisements (27.7%) were found to contain at least one violation, representing an industry compliance rate of 72.3%. Advertisements collected from Kenya were the most likely to contain a violation. Guiding Principle 5, which refers to “the effects of alcohol,” accounted for the largest number of violations (77 ads). This guideline was most often scored as a violation because of the suggestion that alcoholic beverages can enhance attractiveness and/ or remove social or sexual inhibitions (n=51) and/ or presenting alcohol as necessary for social success or acceptance (n=63). The second most frequently violated guideline was Guiding Principle 3 (69 ads), which speaks to health and safety aspects in marketing communications. This principle was most often violated for presenting alcohol as a stimulant, sedative or tranquilizer (50 ads), and suggesting that alcohol can “prevent, treat or cure illness or resolve personal problems” (29 ads).

Violation rates significantly differed between media (p = <.001), with television ads having the highest proportion of violations (72.2%) and outdoor ads having the lowest (21.6%). Certain types of outdoor ads, however (e.g. billboards and posters), contained higher violation rates (37.3% and 30.8%, respectively).

Conclusion
The findings suggest that code violations of the ICAP Guiding Principles were prevalent in the four types of media sampled during the MAMPA project in the seven countries. It is interesting to note that the country with the fewest marketing materials recorded (n = 4) was The Gambia, which is a Muslim country with a ban on most forms of advertising. Despite the limitations of the prior MAMPA project and the current re-analysis, this research establishes a basis for a monitoring and regulating alcohol advertising in African countries. The methodology offers a systematic way to evaluate media advertisements of alcoholic beverages to determine whether their contents comply with generally accepted guidelines for responsible advertising practices.

Based on the evidence described above, governments and policymakers should give serious consideration to the key messages emerging from the Consultative meeting on addressing alcohol marketing in the African Region (WHO, 2012) and from the PAHO Expert Meeting on Alcohol Marketing Regulation (PAHO,
2016), which are consistent with the well-documented premise that alcohol is not an ordinary commodity (Babor et al., 2010) and should not be marketed as such.

These findings provide evidence of violations in the seven countries studied and the need for systematic surveillance of alcoholic beverage marketing to protect vulnerable populations such as youth, who may already be experiencing problems related to their alcohol use.

Our secondary analysis of the original MAMPA marketing data confirms the conclusions of the original MAMPA report, in that it provides strong evidence of code violations in all media evaluated, and suggests that exposure to potentially harmful alcohol marketing content is widespread in six of the seven countries studied. These reports also raise questions about the effectiveness of current industry efforts to regulate alcohol marketing.

The report (full text) can be downloaded via this link. 

Authors: Thomas F. Babor, Katherine Robaina, Jonathan K. Noel, E. Bruce Ritson Title: Vulnerability to alcohol-related problems: a policy brief with implications for the regulation of alcohol marketing Journal: Addiction, 2016, 10.1111/add.13626OLYMPUS DIGITAL CAMERA Abstract: Background and aims: The concern that alcohol advertising can have detrimental effects on vulnerable viewers has prompted the development of codes of responsible advertising practices. This paper evaluates critically the concept of vulnerability as it applies to (1) susceptibility to alcohol-related harm and (2) susceptibility to the effects of marketing, and describes its implications for the regulation of alcohol marketing. Methods: We describe the findings of key published studies, review papers and expert reports to determine whether these two types of vulnerability apply to population groups defined by (1) age and developmental history; (2) personality characteristics; (3) family history of alcoholism; (4) female sex and pregnancy risk; and (5) history of alcohol dependence and recovery status. Results: Developmental theory and research suggest that groups defined by younger age, incomplete neurocognitive development and a history of alcohol dependence may be particularly vulnerable because of the disproportionate harm they experience from alcohol and their increased susceptibility to alcohol marketing. Children may be more susceptible to media imagery because they do not have the ability to compensate for biases in advertising portrayals and glamorized media imagery. Conclusion: Young people and people with a history of alcohol dependence appear to be especially vulnerable to alcohol marketing, warranting the development of new content and exposure guidelines focused on protecting those groups to improve current self-regulation codes promoted by the alcohol industry. If adequate protections cannot be implemented through this mechanism, statutory regulations should be considered. The article (full text) can be downloaded via this link in the Wiley Online Library.
Leading public health experts warn that youth around the world are exposed to extensive alcohol marketing, and that current controls on that marketing appear ineffective in blocking the association between youth exposure and subsequent drinking. Alcohol is the leading cause of death and disability for young males aged 15-24 in nearly every region of the world, and young females of the same age in the wealthy countries and the Americas. The experts call for governments around the world to renew their efforts to address the problem by strengthening the rules governing alcohol marketing with more effective independent statutory regulations. Their call coincides with the publication of a series of reports in a supplement to the scientific journal Addiction that presents the latest evidence on alcohol marketing and its impact on children. Key findings from the collection of peer-reviewed manuscripts include:
  • Exposure to alcohol marketing is associated with youth alcohol consumption
  • Analysis of alcohol promotion during the 2014 FIFA World Cup indicates alcohol marketing practices frequently appeared to breach industry voluntary codes of practice
  • Alcohol industry self-regulatory codes do not sufficiently protect children and adolescents from exposure to alcohol promotions, especially through social media
The Addiction supplement comprises 14 papers, with research presented from around the world. Lead editor Professor Thomas Babor, of the University of Connecticut, says: “Governments are responsible for the health of their citizens.  No other legal product with such potential for harm is as widely promoted and advertised in the world as alcohol. These papers provide a wealth of information to support governments in their efforts to protect children and other vulnerable populations from exposure to alcohol marketing.” As an example, the marketing activities of Heineken can be described. International experts consider it a catastrophe that Heineken goes further and further in terms of marketing, in particular at Formula 1 sports. Every year, Heineken reaches around 400 million TV viewers worldwide. Wim van Dalen, President of EUCAM and Director of the Dutch Institute for Alcohol Policy STAP says: “This form of sponsoring reaches millions of minors worldwide. Furthermore, alcohol is associated in a positive way with driving – this is totally unacceptable.” Chris Brookes of the UK Health Forum noted that “Governments have previously approved self-regulatory measures on alcohol advertising; however, we can no longer say that they might work to protect our young people – they don’t. In a literature review of more than 100 studies, none was identified that supported the effectiveness of industry self-regulation programmes.” The papers offer guidelines to developing more effective alcohol marketing regulations:
  • The most effective response to alcohol marketing is likely to be a comprehensive ban on alcohol advertising, promotion and sponsorship, in accordance with each country’s constitution or constitutional principles.
  • Regulations should be statutory, and enforced by an appropriate public health agency of the local or national government, not by the alcohol industry.
  • Regulations should be independent of the alcohol industry, whose primary interest lies in growing its markets and maximizing profits.
  • A global agreement on the marketing of alcoholic beverages would support country efforts to move towards a comprehensive ban on alcohol advertising, promotion and sponsorship.
  • Collaboration with other population-level efforts to restrict marketing of potentially harmful products, such as ultra-processed food, sugary beverages, tobacco, and breast-milk substitutes, should be encouraged and supported.
The journal supplement is funded by Alcohol Research UK and the Institute of Alcohol Studies, with the authors and editors of the supplement giving their time to produce these papers pro bono. The papers originated in work undertaken by the UK Health Forum to bring EU and US alcohol policy leads together, with funding from the EU. The specific papers were developed for a meeting on alcohol marketing convened by the Pan American Health Organization (PAHO).  This collection of papers represents the highest level of scholarly attention devoted to this issue that has been brought together in the pages of one scientific journal. -- Ends – This is a verbatim copy of the press release that has been published here: http://www.addictionjournal.org/press-releases/current-controls-on-alcohol-marketing-are-not-protecting-youth-warn-public-heal  For editors: The Addiction supplement, Alcohol marketing regulation: From research to public policy, is free to download from the Wiley Online Library: http://onlinelibrary.wiley.com/doi/10.1111/add.v112.S1/issuetoc Media seeking interviews with lead author Prof. Thomas Babor, Chair, Department of Community Medicine and Health Care, University of Connecticut, can contact him by telephone (+1 860 679 5459) or email (babor@nso.uchc.edu). The UK Health Forum is a registered charity whose mission is to operate as a centre of expertise, working with and through their members to contribute to the prevention of the avoidable non-communicable diseases - coronary heart disease, stroke, type 2 diabetes, obesity, cancer, respiratory diseases and vascular dementia. http://www.ukhealthforum.org.uk Alcohol Research UK is an independent charity that tackles alcohol-related harm by funding high quality, impartial research. http://alcoholresearchuk.org The Institute of Alcohol Studies is a registered charity (number 1112671) aiming to educate, preserve and protect the good health of the public by promoting the scientific understanding of beverage alcohol and the individual, societal and health consequences of its consumption and promoting measures for the prevention of alcohol-related problems and to promote, for the public benefit, research into beverage alcohol and to publish the useful results.  http://www.ias.org.uk/ Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.  www.addictionjournal.org
At December 1st, several European NGO's (including EUCAM) organised the event "What about our kids?", that will be hosted by MEP Daciana Octavia Sârbu. 
Reports about this events:
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The Audiovisual Media Services Directive offers a once in a decade opportunity to protect children from commercial communications on alcohol and unhealthy foods.
On 1 December, join experts from a wide range of backgrounds to discuss the effects of advertising on children’s behaviours, tools to reduce child exposure to commercial communications for unhealthy food and alcohol and the effectiveness of self-regulatory schemes. More information on the event, including the preliminary programme, will follow soon. Venue:
European Parliament, Brussels Room József Antall 4Q2
If you do not have a valid access pass to the European Parliament, please state your full name, date of birth, ID type and ID number with your registration.
General queries: Marleen Kestens | mkestens@ehnheart.org Communications: communications@epha.org AVMSD | What about our kids? Event supported by:
European Heart Network (EHN); British Medical Association (BMA); European Alcohol Policy Alliance (Eurocare); European Association for the study of the liver (EASL); European Centre for Monitoring Alcohol Marketing (EUCAM); European Public Health Alliance (EPHA); International Association of Mutual Benefit Societies (AIM); IOGT-NTO; Scottish Health Action on Alcohol Problems (SHAAP)
Authors: Jonathan K. Noel, Thomas F. Babor, Katherine Robaina, Melissa Feulner, Alan Vendrame, Maristela Monteiro Title: Alcohol marketing in the Americas and Spain during the 2014 FIFA World Cup Tournament Journal: Addiction, 2016, 10.1111/add.13487OLYMPUS DIGITAL CAMERA Abstract: Aims: To identify the nature of visual alcohol references in alcohol advertisements during televised broadcasts of the 2014 FIFA World Cup Tournament matches and to evaluate cross-national differences according to alcohol marketing policy restrictiveness. Design: A review was conducted of recent legal documents and court cases, as well as the activities of alcoholic beverage industries. Setting: Television broadcasts of the 2014 FIFA World Cup in Argentina, Brazil, Canada, Finland, France, Mexico, Spain and the United States. Cases: Eighty-seven alcohol advertisements; 20 matches. Measurements: Quantitative rating scales, combined with the Delphi rating technique, were used to determine compliance of the alcohol advertisements with the International Alliance for Responsible Drinking's (IARD) Guiding Principles. Recordings of five matches from four countries were also used to identify the number of in- and out-of-game alcohol brand appearances. Results: A total of 86.2% of all unique alcohol advertisements contained at least one violation of IARD's Guiding Principles, with violation rates ranging from 72.7% (Mexico) to 100% (Brazil). Countries with the least restrictive marketing policies had a higher prevalence of violations in guidelines designed to protect minors. There were 2.76 in-game alcohol brand appearances and 0.83 out-of-game alcohol brand appearances per minute. Brand appearances did not differ across countries or according to a country's marketing policy restrictiveness. Conclusion: Self-regulation and statutory policies were ineffective at limiting alcohol advertising during the 2014 FIFA World Cup Tournament television broadcasts. Most advertisements contained content that violated the self-regulation codes, and there were high levels of within-broadcast brand appearances. The article can be downloaded via this link in the Wiley Online Library.
Authors: Tim Lobstein, Jane Landon, Nicole Thornton & David Jernigan Title: The commercial use of digital media to market alcohol products: a narrative review Journal: Addiction, 2016, 10.1111/add.13493OLYMPUS DIGITAL CAMERA Abstract: Background and aims: The rising use of digital media in the last decade, including social networking media and downloadable applications, has created new opportunities for marketing a wide range of goods and services, including alcohol products. This paper aims to review the evidence in order to answer a series of policy-relevant questions: does alcohol marketing through digital media influence drinking behaviour or increases consumption; what methods of promotional marketing are used, and to what extent; and what is the evidence of marketing code violations and especially of marketing to children? Methods and findings: A search of scientific, medical and social journals and authoritative grey literature identified 47 relevant papers (including 14 grey literature documents). The evidence indicated (i) that exposure to marketing through digital media was associated with higher levels of drinking behaviour; (ii) that the marketing activities make use of materials and approaches that are attractive to young people and encourage interactive engagement with branded messaging; and (iii) there is evidence that current alcohol marketing codes are being undermined by alcohol producers using digital media. Conclusions: There is evidence to support public health interventions to restrict the commercial promotion of alcohol in digital media, especially measures to protect children and youth. The article can be downloaded via this link in the Wiley Online Library.
Authors: Audrey R. Chapman Title: Can human rights standards help protect children and youth from the detrimental impact of alcohol beverage marketing and promotional activities? Journal: Addiction, 2016, 10.1111/add.13484OLYMPUS DIGITAL CAMERA Abstract: Background and aims: The alcohol industry in the Latin American and Caribbean (LAC) region promotes demand for alcohol products actively through a number of channels, including advertising and sponsorship of sports and other events. This paper evaluates whether human rights instruments that Latin American countries have ratified can be used to limit children's exposure to alcohol advertising and promotion. Methods: A review was conducted of the text of, and interpretative documents related to, a series of international and regional human rights instruments ratified by most countries in the LAC region that enumerate the right to health. Results: The Convention on the Rights of the Child has the most relevant provisions to protect children and youth from alcohol promotion and advertising. Related interpretive documents by the United Nations Committee on the Rights of the Child affirm that corporations hold duties to respect and protect children's right to health. Conclusion: Human rights norms and law can be used to regulate or eliminate alcohol beverage marketing and promotional activities in the Latin American region. The paper recommends developing a human rights based Framework Convention on Alcohol Control to provide guidance. 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.