04 December 2014 In Social and Cultural Aspects

AIMS: To investigate the association between having a favourite alcohol advertisement and binge drinking among European adolescents.

DESIGN: Data were obtained from a longitudinal observational study on relationships between smoking and drinking and film tobacco and alcohol exposures.

SETTING: State-funded schools.

PARTICIPANTS: Baseline survey of 12 464 German, Italian, Polish and Scottish adolescents (mean age 13.5 years), of whom 10 259 (82%) were followed-up 12 months later.

MEASUREMENTS: Pupils were asked the brand of their favourite alcohol advertisement at baseline. Multi-level mixed-effects logistic regressions assessed relationships between having a favourite alcohol advertisement ('alcohol marketing receptivity') and (i) binge drinking at baseline; and (ii) initiating binge drinking during follow-up among a subsample of 7438 baseline never binge drinkers.

FINDINGS: Life-time binge drinking prevalence at baseline was 29.9% and 25.9% initiated binge drinking during follow-up. Almost one-third of the baseline sample (32.1%) and 22.6% of the follow-up sample of never-bingers named a branded favourite alcohol advertisement, with high between-country variation in brand named. After controlling for age, gender, family affluence, school performance, TV screen time, personality characteristics and drinking behaviour of peers, parents and siblings, alcohol marketing receptivity was related significantly to both binge drinking at baseline [adjusted odds ratio (AOR) = 2.13, 95% confidence interval (CI) = 1.92, 2.36] and binge drinking initiation in longitudinal analysis (AOR = 1.45, 95% CI = 1.26, 1.66). There was no evidence for effect heterogeneity across countries.

CONCLUSIONS: Among European adolescents naming a favourite alcohol advertisement was associated with increased likelihood of initiating binge drinking during 1-year follow-up, suggesting a relationship between alcohol marketing receptivity and adolescent binge drinking.

04 December 2014 In Social and Cultural Aspects

Background: Neither federal regulations nor industry voluntary codes require 'responsibility' statements in alcohol advertising. Stand alone 'public service' responsibility campaigns have been found to convey pro-drinking themes. We analyzed responsibility statements placed in conventional alcohol advertising to consider how responsible drinking is presented, and potential communicative goals for responsibility messages.

Methods: We conducted a descriptive textual analysis of 'drink responsibly' messages appearing in all advertisements pertaining to beer, spirits and alcopop products placed in U.S. national, newsstand magazines from 2008 to 2010 ( = 1795). We coded advertisements for presence, prominence and content of responsibility messages. Using a qualitative approach, we created a taxonomy of product promotional elements within the responsibility messages.

Results: Analysis revealed that 87% of the advertisements included a responsibility message ( = 1555); responsibility messages were less prominent than any included tagline (product slogan). Messages never defined responsible drinking or promoted abstinence. No link was made between warnings and activities conveyed in the advertisements. There were 197 unique responsibility messages, 88% of which ( = 174) were promotional of the advertised product. Responsibility promotional content was categorized into 5 strategies: Product name, Consumption information, Product qualities, Product promise, Qualities of the drinker.

Conclusions: Responsibility messages were overwhelmingly used to promote product rather than convey relevant public health information. Based on this analysis, existing responsibility messages are largely ineffective at conveying relevant public health information, and should be supplemented by or replaced with prominently placed, externally developed, cognitively tested warnings that do not reinforce marketing messages.

04 December 2014 In Social and Cultural Aspects

BACKGROUND: Alcohol is estimated to be the fifth leading risk factor for global disability-adjusted life years. Restricting or banning alcohol advertising may reduce exposure to the risk posed by alcohol at the individual and general population level. To date, no systematic review has evaluated the effectiveness, possible harms and cost-effectiveness of this intervention.

OBJECTIVES: To evaluate the benefits, harms and costs of restricting or banning the advertising of alcohol, via any format, compared with no restrictions or counter-advertising, on alcohol consumption in adults and adolescents. SEARCH METHODS: We searched the Cochrane Drugs and Alcohol Group Specialised Register (May 2014); CENTRAL (Issue 5, 2014); MEDLINE (1966 to 28 May 2014); EMBASE (1974 to 28 May 2014); PsychINFO (June 2013); and five alcohol and marketing databases in October 2013. We also searched seven conference databases and www.clinicaltrials.gov and http://apps.who.int/trialsearch/ in October 2013. We checked the reference lists of all studies identified and those of relevant systematic reviews or guidelines, and contacted researchers, policymakers and other experts in the field for published or unpublished data, regardless of language.

SELECTION CRITERIA: We included randomised controlled trials (RCTs), controlled clinical trials, prospective and retrospective cohort studies, controlled before-and-after studies and interrupted time series (ITS) studies that evaluated the restriction or banning of alcohol advertising via any format including advertising in the press, on the television, radio, or internet, via billboards, social media or product placement in films. The data could be at the individual (adults or adolescent) or population level.

DATA COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration.

MAIN RESULTS: We included one small RCT (80 male student participants conducted in the Netherlands and published in 2009) and three ITS studies (general population studies in Canadian provinces conducted in the 1970s and 80s).The RCT found that young men exposed to movies with a low-alcohol content drank less than men exposed to movies with a high-alcohol content (mean difference (MD) -0.65 drinks; 95% CI -1.2, -0.07; p value = 0.03, very-low-quality evidence). Young men exposed to commercials with a low-alcohol content compared with those exposed to neutral commercials drank less (MD -0.73 drinks; 95% CI -1.30, -0.16; p value = 0.01, very-low-quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow-up data were available. Using the Grading of Recommendations Assessment, Development and Evaluation approach, the quality of the evidence was rated as very low due to a serious risk of bias, serious indirectness of the included population and serious level of imprecision.Two of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban. Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta-analysis of the two studies that evaluated the implementation of a ban showed an overall mean non-significant increase in beer consumption in the general population of 1.10% following the ban (95% CI -5.26, 7.47; p value = 0.43; I2 = 83%, very-low-quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto-regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95% CI -27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95% CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95% CI -0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95% CI -36.83, -8.15; p value = 0.002). Using the GRADE approach, the evidence from the ITS studies was rated as very low due to a high risk of bias arising from a lack of randomisation and imprecision in the results.No other prespecified outcomes (including economic loss or hardship due to decreased alcohol sales) were addressed in the included studies and no adverse effects were reported in any of the studies. None of the studies were funded by the alcohol or advertising industries.

AUTHORS' CONCLUSIONS: There is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high-quality, well-monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base.

04 December 2014 In Social and Cultural Aspects

BACKGROUND AND AIMS: There has been insufficient research attention to the alcohol industry's use of corporate sponsorship as a marketing tool. This paper provides a systematic investigation of the nature and extent of alcohol sponsorship-at the brand level-in the United States.

METHODS: The study examined sponsorship of organizations and events in the United States by alcohol brands from 2010 to 2013. The top 75 brands of alcohol consumed by underage drinkers were identified based on a previously conducted national internet-based survey. For each of these brands, a systematic search for sponsorships was conducted using Google. The sponsorships were coded by category and type of sponsorship.

RESULTS: We identified 945 sponsorships during the study period for the top 75 brands consumed by underage drinkers. The most popular youth brands were far more likely to engage in sponsorship and to have a higher number of sponsorships. The identified sponsorships overwhelmingly associated alcohol brands with integral aspects of American culture, including sports, music, the arts and entertainment, and drinking itself. The most popular brands among underage drinkers were much more likely to associate their brands with these aspects of American culture than brands that were less popular among underage drinkers.

CONCLUSIONS: Alcohol brand sponsorship must be viewed as a major alcohol marketing strategy that generates brand capital through positive associations with integral aspects of culture, creation of attractive brand personalities, and identification with specific market segments. Alcohol research, practice and policy should address this highly prevalent form of alcohol marketing.

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