Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use: A Systematic Review of Longitudinal Studies
To assess the impact of alcohol advertising and media exposure on future adolescent alcohol use.
The researchers searched MEDLINE, the Cochrane Library, Sociological Abstracts, and PsycLIT, from 1990 to September 2008, supplemented with searches of Google scholar, hand searches of key journals and reference lists of identified papers and key publications for more recent publications.
They selected longitudinal studies that assessed individuals’ exposure to commercial communications and media and alcohol consumption behaviour at baseline, and assessed alcohol use behaviour at follow-up. Participants were adolescents aged 18 years or younger or below the legal alcohol consumption age of the country of origin of the study, whichever was the higher.
Thirteen longitudinal studies that followed up a total of over 38,000 young people met inclusion criteria. The studies measured exposure to advertising and promotion in a variety of ways, including estimates of the volume of media and advertising exposure, ownership of branded merchandise, recall and receptivity, and one study on expenditure on advertisements.
Follow-up ranged from 8 to 96 months. One study reported outcomes at multiple time-points, 3, 5, and 8 years. Seven studies provided data on initiation of alcohol use amongst non-alcohol users, three studies on maintenance and frequency of alcohol consumption amongst baseline alcohol users, and seven studies on alcohol use of the total sample of non-alcohol users and alcohol consumers at baseline.
Twelve of the thirteen studies concluded an impact of exposure on subsequent alcohol use, including initiation of alcohol use and heavier alcohol consumption amongst existing alcohol users, with a dose response relationship in all studies that reported such exposure and analysis.
There was variation in the strength of association, and the degree to which potential confounders were controlled for. The thirteenth study, which tested the impact of outdoor advertising placed near schools failed to detect an impact on alcohol use, but found an impact on intentions to use.
Longitudinal studies consistently suggest that exposure to media and commercial communications on alcohol is associated with the likelihood that adolescents will start to consume alcohol, and with increased alcohol use amongst baseline alcohol consumers.
Based on the strength of this association, the consistency of findings across numerous observational studies, temporality of exposure and alcohol use behaviours observed, dose-response relationships, as well as the theoretical plausibility regarding the impact of media exposure and commercial communications, the researchers conclude that alcohol advertising and promotion increases the likelihood that adolescents will start to use alcohol, and to consume more if they are already using alcohol.
This review found consistent evidence to link alcohol advertising with the uptake of alcohol use among non-alcohol using young people, and increased consumption among their alcohol consuming peers. This evidence comes from high quality longitudinal studies and is corroborated by weaker cross-sectional ones. Because it focuses on mass media advertising, it almost certainly underestimates the impact of wider alcohol promotion and marketing. These findings are not surprising: exactly the same conclusions have emerged from reviews of the impact of tobacco and food marketing on young people,” write the study authors.