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.

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.

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