Author: Lesley A. Smith, David R. Foxcroft
Title: The effect of alcohol advertising and marketing in drinking behaviour in young people: A systematic review.

Objective: To evaluate the effect of exposure to alcohol marketing on alcohol consumption in youngsters by reviewing recent longitudinal studies.
Design: Literature study
Participants: Cohort studies that included at least 75% youngsters of the overall sample or were results for young people were reported separately. Finally, 9 publications met the eligibility criteria which reported on 7 studies. 5 of these studies were conducted in the US [1,2,3,4,5] one in Belgium [6], and one in New Zealand [7,8,9].
Methods: A literature study is performed on longitudinal studies which examine the impact of exposure to advertising or marketing on drinking behaviour. Searches were performed by using electronic databases Medline and Embase and using a systematic search strategy.
Findings: The data in the studies showed to some extend evidence for an effect of alcohol advertising and marketing on drinking behaviour of youngsters. The effect was consistent across the studies, all seven cohort studies found significant effects of different exposure variables and self report of alcohol consumption. According to this review article, it is certainly plausible that advertising would have an effect on youth consumer behaviour.
Conclusions Authors: The authors mention several limitations when interpreting the results. Although longitudinal/cohort studies are less susceptible to bias than cross-sectional studies, the results are less robust if the design and execution is less adequate. The authors mention several methodological limitations:

(1) The validity of the studies is largely dependent of the number of confounders included in the study. Unmeasured confounders cannot be adjusted for and can result in biased findings. According to the authors, the effect sizes of the exposure variables can be due to unmeasured confounders.
(2)The cohort studies in the sample do not account for psychological characteristics which can explain the mechanisms of alcohol advertising exposure. Cohort studies should provide better understanding of the mediators in the relationship between advertising exposure and alcohol consumption.
(3) The results of the loss of respondents during the different measurement time is inevitable, but should be minimized. Reasons for missing data should be examined. Attrition could effect the generalisability of findings and a loss of power.

Another limitation of the study is inherent to all review articles, they can not rule out a publication bias. For example, studies which do not find significant results can be excluded from publication.

Remarks of EUCAM:
This study provides a very clear overview of recent longitudinal studies and shows strong evidence of a consistent effect of alcohol marketing on drinking behaviour. The study gives a summary of the main findings in the study, but does not critically evaluate separate studies. For a more elaborate summary of the separate articles you can click on the references within the website of EUCAM.

[1] Ellickson, P.L., Collins R. L, Hambarsoomians K, and McCaffrey D. F, Does alcohol advertising promote adolescent drinking? Results from a longitudinal assessment. Addiction, 2005; 100(2):235-246.

[2] Snyder, L.B., S.M. Milici F. F, Sun H, and Strizhakova Y, Effects of alcohol advertising exposure on drinking among youth. Archives of Pediatrics & Adolescent Medicine, 2006; 160(1):18-24.

[3] Stacy, A.W., Zogg J. B, Unger J. B, and Dent C. W, Exposure to televised alcohol ads and subsequent adolescent alcohol use. American Journal of Health Behaviour, 2004; 28(6):498-509.

[4] Robinson, T.N., H.L. Chen, and J.D. Killen, Television and music video exposure and risk of adolescent alcohol use. Pediatrics, 1998; 102(5):E54.

[5] Sargent, J.D., T.A. Wills, Stoolmiller M, Gibson J, and X. Gibbons F, Alcohol use in motion pictures and its relation with early-onset teen drinking. J Stud Alcohol, 2006; 67:54-65.

[6] van den Bulck, J. and K. Beullens, Television and music video exposure and adolescent alcohol use while going out. Alcohol Alcohol, 2005; 40(3):249-53.

[7] Casswell, S., Pledger M, and Pratap S, Trajectories of drinking from 18 to 26 years: Identification and prediction. Addiction, 1427; 97(11):1427-1437.

[8] Casswell, S. and Zhang J. F, Impact of liking for advertising and brand allegiance on drinking and alcohol-related aggression: a longitudinal study. Addiction, 1998; 93(8):1209-17.

[9] Connolly, G.M., Casswell S, Zhang J. F, and Silva P. A, Alcohol in the mass media and drinking by adolescents: a longitudinal study. Addiction, 1994; 89(10):1255-63.

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