D. Wilmsen, Dr. H. Hendriks., Ir. W.E. van Dalen. (2020). Examining the relationship between exposure to alcohol marketing through traditional media channels and drinking behavior. EUCAM.
Consumers are exposed to approximately 4000 advertisements per day (Sanders, 2017), mostly through social media and traditional media channels, including television, radio, outdoor campaigns, sport events, popular music concerts, product placement in movies and TV shows and in supermarkets. Only in the United States, leading alcohol companies spend around 2 billion dollars per year on their advertisements, exposing young people to 30 billion alcohol commercials through TV in 2018 (Henehan, Joannes, Hines & Ross, 2019), and on other channels? In fact, studies have found that youth between 10 and 19 years old are significantly more exposed to alcohol advertising than adults (Winpenny et al., 2012). These findings are problematic since most studies have demonstrated a positive association between exposure to alcohol advertisements and increased alcohol consumption among youth (e.g. Anderson, 2009; Jernigan, 2008, Babor et al, 2017. Considering that in most countries alcohol companies currently self-regulate in regard to the content, the volume of advertisements, and the channels of distribution, this results in an overexposure of potentially harmful content to adolescents (Noel, Babor & Robaina, 2016).
Why is alcohol advertising so harmful? One has to consider that adolescents and young adults often watch TV, attend sport and music events and go outside where they can be exposed to outdoor and indoor alcohol advertisements, thereby potentially increasing their alcohol use. As Jernigan and others state: ‘Youth alcohol consumption is a major global public health concern’. And furthermore, when these young people are encouraged to drink, they are more likely to be involved in automobile crash injuries and death, unprotected sexual intercourse, and suicide (WHO 2018). The aim of the review is to provide an overview of all studies related to alcohol advertisements through traditional media and alcohol consumption, thereby, it aims at demonstrating the urgency for effective policy measures.
TYPES OF STUDIES
Mainly studies that investigated the relationship between exposure to alcohol marketing through traditional media channels and drinking behaviour were included. More specifically, the channels valid for inclusion were television, magazines, sponsoring and in-store promotions. Cross-sectional, longitudinal, experimental and qualitative studies were included, whilst grey literature, reviews and meta-analytic studies were not taken into account. Only studies from 2000 were retained eligible for inclusion. Initially, 66.555 articles were found in the search, but not all were eligible for selection. Finally, only 68 articles were valid after selecting based on publication date (2000-2019), media type (traditional media only), and type of variable. Only 39 articles were finally retained for the study after eliminating duplicates. Type of variable means that the independent variable had to be either alcohol marketing, alcohol commercial, alcohol advertising or alcohol sponsoring, whilst the dependent variable has to be drinking behaviour or alcohol use.
TYPES OF PARTICIPANTS
The sample size ranged from 31 participants in a focus group, to 70.922 in a longitudinal study, with a total of 156.939 respondents among both males and females. One study looked at male university only (Engels et al., 2009). The age of participants varied between 10 and 51 years old, with the majority being between 12 and 25 years old. Most studies included school going children and university students that ranged from never drinking to binge drinking.
VARIABLES AND MEDIA TYPES
As mentioned above the independent variable is exposure to alcohol advertisement, including alcohol portrayal, and alcohol sponsorship; the dependent variable is participant’s drinking behaviour, also described as alcohol use or consumption.
Impact of traditional alcohol advertising on the drinking behavior of young people.
After analysing the 39 articles, the main result is that being exposed to alcohol advertising leads to higher alcohol consumption among youth worldwide. A positive and significant association was found, mainly among 26 studies, whilst among the other 13 researches this association only stands in certain cases.
To begin with, participants that already drink seem to be more likely to drink more alcohol. White et al. (2017) found that drinking in the past month increased by 10% for every increase of exposure to alcohol commercials and increased 16% for past-week risky drinkers. White et al. (2017) found that being exposed to alcohol advertisements increased the likelihood of drinking in the past month by 10% and to engage in risky drinking in the past week by 16%.
Anschutz and Engels (2013) came to a similar conclusion and found that exposure to alcohol tv-commercials lead to more alcohol consumption in high weekly drinkers. Moreover, two studies found that sports clubs receiving sponsorship, such as event naming, product marketing, payment of club fees, providing uniforms and travel costs among other things were associated with increased odds of being classified as a hazardous drinker (O’Brien et al., 2014) and scored higher on the Alcohol Use Disorders Identification Test (AUDIT) than those who do not receive sponsorship (O’Brien & Kypri, 2008).
Furthermore, a number of studies found that liking or having a favourite alcohol advertisement was associated with higher alcohol consumption. Unger et al. (2003) found that liking an alcohol commercial was associated with a greater risk of 30-day alcohol use, regular drunkenness and lifetime alcohol use. Morgenstern et al. (2014) concluded that having a favourite alcohol advertisement was significantly associated with binge drinking. They also found that having a favourite alcohol advertisement was associated with the country of origin of the participant, with 24.6% in Germany, 35.3% in Italy,36.5% in Poland and 30.0% in Scotland. According to Morojele et al. (2018), a participant who was exposed to alcohol advertisements they liked through various media channels was 2.08 times more likely to have used alcohol in the past half year than if they were only exposed to an alcohol advertisement via one media channel. Gordon et al (2010) found similar results, arguing that when participants liked alcohol advertisements, the odds of drinking in the next year increased with 31%. The study of Grenard et al. (2013) further confirms these findings. In addition to liking an ad, awareness of the number of marketing channels was found to increase the odds of being a drinker by 12% (Gordon et al., 2010).
Also, recalling exposure to advertising in magazines, bottle shops and bars or pubs among 16-17 years old females was associated with alcohol initiation (Jones & Magee, 2011). Finally, Henriksen et al (2008) found that students who could recall or recognize alcohol brands increased the odds of current drinking with 22%.
EFFECTS OF ALCOHOL ADS RELATED TO CHARACTERISTICS OF THE VIEWER
Five studies found significant gender and age differences. Firstly, it was found that in New Zealand males have higher AUDIT score compared to females, whilst age was negatively correlated with AUDIT score, when considering the whole sample affected by alcohol sponsorship (O’Brien & Kypri, 2008). Still, another study (Jones & Magee, 2001) also found age to be relevant when encountering differences in gender associated with alcohol consumption; respectively, when 16-17 years old females initiated drinking, that was associated with recalling exposure to advertising in bottle shops, magazines, bars and pubs. Moreover, alcohol consumption of 12-15 years old females was predicted to be greater after being exposed to alcohol advertisements in bars and pubs. Similarly, exposure to alcohol advertisements in bars and pubs and bottle shops was associated with higher alcohol consumption among males aged 16-17, but not for women. On top of this, a qualitative study (Jones & Smith, 2011) suggests that perceived ownership of alcohol branded merchandise, is seen as desirable and worn as to convey social status among females aged 16-17. On the other hand, older females aged 18-25, seen the product as “uncool”.
When analysing children, specifically 3415 German kids (M = 12.5), significant differences in age and sex emerge for all drinking outcomes (Morgensten et al., 2011). First of all, boys scored higher on ever, current and binge drinking frequency than girls; also, younger adolescents had lower prevalence on all outcomes than older adolescents. Apart from these differences, most importantly, the likelihood of ever drinking, currently drinking and even binge drinking were 4-5 times higher for those exposed to alcohol advertisements than for the reference group. In a later study, Morgenstern et al. (2014) found that students who could name a favorite alcohol advertisement reported poorer school performance,watching more hours of TV per day and having higher scores in sensation-seeking and rebelliousness. Furthermore, they were also likely to be exposed to alcohol consumption among friends, siblings and parents. Among this sample, when asking to name a favourite alcohol brand the majority of Polish and German participants could name a beer brand, while Italian and Scottish respondents named a spirit brand.
Chen et al. (2016) were the only ones able to demonstrate that social economic status is significantly associated with increased alcohol consumption, but only among participants who reported parental drinking. They also found that adolescents in Taiwanese districts with a lower level of economic disadvantage were more likely to initiate alcohol use.
DO THE EFFECTS OF ALCOHOL ADS DEPEND ON THE MEDIUM?
Among all 39 studies, several types of traditional media were encountered, respectively: television, movies (including brand placements and alcohol portrayal), in-store promotions (including price reductions), (sports)-sponsorship, magazines, newspapers, outdoor campaigns (including posters and billboards) and lastly promotions in bars and pubs.
Alcohol advertising through television was studied the most (17 studies), followed by movies which was studied in five researches. Conversely, four studies examined in-store promotions and two articles focused solely on sports sponsorship. Morgenstern et al. (2014) asked participants to report their favourite alcohol commercial, regardless of its media type, thus media types were not specified in this article.
Among the seventeen articles that studied exposure to alcohol advertising on TV, ten also included other media. Still, four of them found that alcohol marketed through television was the most effective on alcohol consumption (Chen et al., 2016; Chen et al., 2017; Gordon et al., 2010; Morojele et al., 2018). One remarkable result was found in the research by Jones and Magee (2011), where it was found that alcohol advertisements on TV was associated with reduced odds of regular alcohol consumption. Alcohol advertisements in magazines, bottle shops, pubs or bars and on promotional materials or billboards were however significantly associated with alcohol initiation.
Faulkner et al. (2016) found that although exposure to alcohol advertisements through television was most common among Australian youth, this was not associated with consuming alcohol in past months or at a risky level. Weekly exposure to alcohol advertising through billboards, newspapers, magazines and owning alcohol branded items however did have a significant association with previously mentioned alcohol outcomes.
Dal Cin et al. (2009) found that more exposure to alcohol depictions in movies was the only medium associated with higher alcohol consumption. De facto, this was not found when watching general media, that is “the number of movies, participants watched per week and daily hours of TV”. Similar to this last discovery, it was found from another study (Unger Schuster et al.2003) that watching general television or sports events was not associated with any alcohol use outcome variables including lifetime alcohol use and lifetime drunkenness. Another article suggested that there were no significant differences between exposure to alcohol marketing through various channels, including movies (in theaters and on DVD) and television programs depicting drunk people, alcohol advertisements in magazines among online channels (Tucker et al., 2013). Another example of this comes from the study of Hurtz et al.(2007) where they found clear evidence of an association between weekly exposure to alcohol marketing and drinking alcohol, but not for all media types. Peer alcohol use, risk taking and ownership of promotional alcohol items such as branded clothing had the strongest relationship with ever drinking (Hurtz et al., 2007).
Although some converse results, it always emerges a link between alcohol consumption and alcohol content’s exposure on traditional media; anew, mostly through television, considered as the most powerful medium to influence drinking habits.
RECCOMENDATIONS FOR NEW RESEARCH
A crucial aspect to focus on in future studies is the effect of marketing’s content on drinking behaviour. This is outlined because heretofore the majority of researches rather aim their attention at types of media, the volume of such marketing, or only the outcome deriving from exposure to alcohol marketing; still, it should become pivotal to also ascertain what type of imagery is particularly effective on individuals (Collins, 2007; Morgenstern, 2011b).
To continue, another suggestion is to research through longitudinal studies. The root cause for this, is that longitudinal studies can examine a causality effect, therefore how exposure to alcohol advertisement is a prediction of consumption among individuals over time (Morojele, 2018). The abovementioned would be a concrete proof of the danger provoked from alcohol marketing, and consequently be an incentive to act on policies and regulations as to avoid harm, mainly to youth.
Additionally, it would be relevant to focus on alcohol use among athletes who received free promotional items or sponsorship from alcohol brands (O’Brien & Kypri, 2008; O’Brien et al., 2014) and specifically examine the effects it has on women. This is valuable and essential because the industry uses promotions as a way to advertise “below the line” (Faulkner & White, 2016; Hurtz et al., 2007), probably informed about the fact that usually people, amongst which youth, is aware, therefore noticed promotional materials in regard to alcohol (Faulkner & White, 2016). On top of this, Chen et al. (2017) suggests that future research could delve into variables such as exposure timing, brands and advertising content to set out the non-linear relationship between alcohol marketing and drinking behaviour.
Lastly, as White et al. (2017) also suggested, it should become a priority to focus on determining the influence of policy changes and the effects of secular trends, such as ‘FebFast’ and ‘Dry July’ from Australia, and the ‘IkPas’ movement from the Netherlands. These trends are ‘alcohol-free’ initiatives to incentive people into quit or diminish drinking alcohol.
RECCOMENDATIONS DO FOR POLICY MEASURES?
Currently, the alcohol industry has a dominate role in regulating alcohol marketing; however, that is defined as “entirely inadequate” from the British Medical Association (2009) and in comparable words by Babor et al (2017). In fact, out of the 39 articles revised for this study, there are four main recurring suggestions. Respectively, it should become a priority to minimise exposure to alcohol marketing through every media channel (Bigman et al., 2019; Chang et al., 2014; Collins et al., 2007 ; De Bruijn et al., 2016 ; Faulkner et al., 2016; Grenard et al., 2013; Henriksen et al., 2008; Jones & Magee, 2011; Redondo, Russel & Bernal, 2018; White et al., 2017), and specifically through ownership of alcohol branded products (Jones & Smith, 2011), and television & radio (Chen et al., 2017). Another option is to ban alcohol marketing altogether (Jones & Magee, 2011), since when restrictions are applied to channels such as television, the industry finds subtle ways to promote their products (Chang et al., 2014; Morgenstern et al., 2014).
Clear evidence shows that in Poland, there is a ban applied on all wine and spirits advertising, but not for beer. As a consequence, when tested marketing receptivity, that is “naming the brand in a favourite alcohol advertisement, if there is”, and to name a favourite alcohol advertising, respondents can easily and exclusively name beer brands (Morgenstern et al., 2014). Accordingly, marketing receptivity, is recorded as the highest among youth. As a consequence, a ban for all forms of alcohol promotion should be adopted, like in Norway and recently in Lithuania (www.eucam.info).
Moreover, another policy that should be embraced regards the monitoring of alcohol advertisements and impose to large alcohol brands to report their annual expenditures on all forms of alcohol promotion (Dumbili & Williams, 2016; Hurtz, 2007; Henriksen et al., 2008).
An additional suggestion is to monitor the way alcohol is currently portrayed in promotional materials, including movies, analysing its content and the effects that specific content and transformational appeals, for instance, have on individuals; these appeals are evoked when the transformational advertisement ‘awakes’ moods, emotions, feelings that “transform the experience of using the brand” (Puto & Wells, 1984). The recommendation is important considering that the majority of alcohol marketing was found to picture positive portrayal of alcohol use (Engels et al., 2009; Redondo et al., 2018; Tucker, et al. 2013; Unger, 2003), and suggest to also investigate on the relationship between negative alcohol portrayal on audience’s beliefs and drinking behaviour (e.g. associating alcohol use with revolting characters) (Redondo et al., 2018).
Lastly, a number of scholars call for interventions for alcohol prevention through media literacy programs (Chen et al., 2015; Dumbili, 2017; Grenard et al., 2013; Tucker et al., 2013), since such measures are supposed to raise awareness on the effect that alcohol marketing has on people, therefore it could be designed to target adults and parents, and schools to implement its curricula.
To conclude, it is safe to deduce that more exposure to alcohol marketing lead to an increase in alcohol use. This is based on research including 156.939 male and female participants, from different parts of the world, with different backgrounds; in accordance, the results can be generalised to the wider population and it therefore show the urgent need for improved policy measures .
Three main limitations apply to the current review. First of all, because of the research method’s diversity used among the 29 studies (experimental research, surveys and qualitative methods, cross-sectional studies and follow-up/longitudinal studies), it becomes hard to compare the results, that if studies of only one research method were included.
Another aspect is, anew, the differences in how exposure to alcohol marketing was operationalized among the studies. Consequently, these dissimilarities created a difficulty in distinguishing outcomes measures.
Lastly, another limitation is that this review focuses solely on alcohol marketing through traditional media channels, thereby not considering digital marketing. Although there is enough evidence that traditional marketing is truly influential, there is a need to research the effects of newer forms of media. Also, because according to Pew Research Centre, 92% of teens between the ages of 13 and 17 are online on a daily basis, using mostly social networking sites including Facebook and Instagram (Lenhart, 2015). Since this age group is extensively researched and found to be susceptible to alcohol marketing through traditional media, there is an urgency to research the effectiveness of online media including websites, social networking sites and the effectiveness of social media influencers.
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