BACKGROUND: The Chief Medical Officer for England has developed the first guidance in England and some of the first internationally on alcohol consumption by children. Using the most recent iteration of a large biennial survey of schoolchildren we measure the extent to which young people's drinking fell within the guidelines just prior to their introduction and the characteristics of individuals whose drinking does not; how alcohol related harms relate to compliance; and risk factors associated with behaving outside of the guidance.

METHODS: A cross-sectional survey was conducted utilising a self-completed questionnaire with closed questions. A total of 11,879 schoolchildren, aged 15-16 years, from secondary schools in North West England participated in the study. Data were analysed using chi square and conditional logistic regression.

RESULTS: Alcohol consumption is an established norm by age 15 years (81.3%). Acute alcohol related violence, regretted sex and forgetfulness were experienced by significantly fewer children drinking within the guidance (than outside of it). Over half of drinkers (54.7%) reported routinely drinking more heavily than guidance suggests (here >/= 5 drinks/session >/= 1 month), or typically drinking unsupervised at home or at a friend's home when parents were absent (57.4%). Both behaviours were common across all deprivation strata. Children with greater expendable incomes were less likely to consume within guidance and reported higher measures for unsupervised, frequent and heavy drinking. Although drinking due to peer pressure was associated with some measures of unsupervised drinking, those reporting that they drank out of boredom were more likely to report risk-related drinking behaviours outside of the guidance.

CONCLUSIONS: Successful implementation of guidance on alcohol consumption for children could result in substantial reductions in existing levels of alcohol related harms to young people. However, prolonged social marketing, educational and parental interventions will be required to challenge established social norms in heavy and unsupervised child drinking across all social strata. Policy measures to establish a minimum price for alcohol and provide children with entertaining alternatives to alcohol should also increase compliance with guidance.

This paper presents a meta-analysis of prospective cohort (longitudinal) studies of alcohol marketing and adolescent drinking. The paper provides a narrative summary of 21 longitudinal studies, and 12 of these are selected for inclusion in the meta-analysis. Each study surveyed a sample of youth to determine baseline drinking status and marketing exposure, and re-surveyed the youth to determine subsequent drinking outcomes. Logistic analyses provide estimates of the log-odds ratio for effects of baseline marketing on drinking at follow-up. Two meta-samples are analyzed: 23 effect-size estimates for drinking onset (initiation); and 40 estimates for drinking behaviors (frequency, amount, binging). Marketing methods include ads in mass media (TV, magazines), promotion portrayals (branded merchandise, movie displays), and subjective evaluations (liking of ads). Publication bias is assessed using funnel plots that account for "missing" studies, bivariate regressions (Egger test), and multivariate regressions that account for study heterogeneity, publication bias, journal quality, and data dependencies. The empirical results are consistent with publication bias, misspecification in some studies, and lack of a genuine effect, especially for mass media. The paper also discusses the issue of "dissemination bias" in the use of research results by investigators and health policy interest groups.

The social norms marketing approach is one method used to reduce extreme alcohol consumption. The current study implemented a web-based survey (N = 891) to assess whether sensation-seeking, perceived moderate drinking norms, and social norm message believability impacted alcohol consumption on a college campus. Sensation seeking was not directly related to normative perceptions of others' moderate alcohol consumption. Sensation seeking, perceived norms, and message believability all had direct effects on alcohol consumption, and the interaction of sensation seeking and message believability impacted alcohol consumption, while the interaction of sensation seeking and perceived norms on alcohol consumption was marginally significant. Implications of these findings for the social norms marketing approach are discussed.

Self-regulation is a common strategy used by industries to avoid or supplement statutory health and safety regulation of their products and practices. The public health experience with self-regulation in the alcohol industry provides methods and lessons relevant to health educators and advocates working in other public health fields. Methods for and examples and limitations of monitoring content and placement of marketing messages are described. The alcohol experience shows that, although self-regulation has many drawbacks in terms of protecting the health of the public, there are tools available for valid monitoring of self-regulated activities that, when combined with aggressive dissemination of results to media and policy makers, can make self-regulation more accountable and build an evidence base for effective measures to be taken.

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