Alcohol marketing and underage drinking: time to get real.

ONSUMER PRODUCTS—tobacco, alcohol, energydense foods, guns, and cars—have been the primarycause of chronic diseases in middle- and high-incomecountries for decades (Mokdad et al., 2004; Murray andLopez, 2013). In 2010, they became the leading cause ofdeath among people in low-income nations as well (Alwanand Maclean, 2009; Robinson and Hort, 2012), and alcoholcontributes substantially to this burden (Rehm et al., 2009).Alcohol products are developed, branded, and sold as partof billion dollar marketing campaigns by multinational cor-porations. In the words of the alcohol beverage industry,“The various aspects of product marketing—includingadvertising, labeling, consumer promotion, packaging, andmerchandising—are an integral part of promoting diﬀerentbrands of virtually every consumer good” (InternationalCenter for Alcohol Policies, 2014b). Marketing is particu-larly important for some types of alcohol, because it is theonly way of distinguishing company products within certaintypesofbeverages,forexample, vodka.Alcohol companies go to great lengths to develop brandidentities—linking their products with sports, music, andmedia celebrities (Primack et al., 2012, 2014); developingand distributing fashionable branded clothing (McClureet al., 2006, 2009); making sure their products are promi-nently placed in television shows and movies (Bergaminiet al., 2013; Dal Cin et al., 2008); and implementing massiveadvertising campaigns on traditional media like televisionand, increasingly, in social media (Federal Trade Commis-sion, 2014). Companies diﬀer in some aspects of their mar-keting strategies—the themes, media venue emphasis, andthe amount spent on advertising. For example, Coors spendslavishly on advertising, having overtaken Budweiser with itsCoors Light brand in 2012 (Peterson, 2012). In contrast,Pabst, which overtook regular Coors in sales in 2006, did soin some respects because it was not aggressively marketingtheproduct(Ferdman,2014).Althoughnotall alcohol marketingisaimedatyoungpeo-ple, much of it is. This is because companies want to capturenew users before they become loyal to another brand.Regardless of the drinking age in a country, it is impossibleto create a marketing campaign aimed at legal young adultsandnothavethoseadvertisingmessagesappeal totheunder-age segment, who watch many of the same media venues astheir older peers and respond alike to the messaging themes.Thus, on the face of it, given the similarity between 21- and25-year-oldsandtheirunderagepeers, itisabsurdtoproposethat an eﬀective advertising campaign aimed at 21- to 25-year-olds would not also drive consumption among theunderage. Most of the scientiﬁc reviews to date agree thatthere is moderately strong evidence that we should be con-cerned about the possibility that alcohol marketing contrib-utes to underage problem drinking (Anderson et al., 2009;Hastingset al.,2005;SmithandFoxcroft, 2009).The August issue of Alcohol Clinical and ExperimentalResearch contains another important contribution to the lit-erature on alcohol marketing and underage drinking by link-ing exposure to alcohol marketing to the brands consumedby underage drinkers. Ross and colleagues (2014) assessedalcohol marketing exposure in an underage drinker sampleby ascertaining in the past month how much they watchedeach of 20 popular television programs that carry alcoholadvertising. Based on the shows they watched and the adsshownineachone(obtainedfromNielsen), theycoulddeter-mine exposure to television alcohol advertising by brand.They assessed brand-speciﬁc consumption using pull-downmenus that listed all brands by beverage category on theweb-based survey. People who watch TV will not be sur-prised that the top 10 brands delivering alcohol messaging tounderage drinkers included Sam Adams, Absolute, BudLight,StellaArtois, DosEquis, andHeineken.The adjusted odds ratio for the association between anyexposure to a brand advertisement and consumption of thatbrand was 3, even after controlling for a range of potentiallyconfounding variables. This could have been largely due tothe comparison between advertised and nonadvertisedbrands. After excluding many brands not advertised duringthe time period, viewing a speciﬁc television advertisementwas still associated with higher risk of consuming that brandin the past 30 days. The authors performed other tests of therobustnessoftheirﬁndings,showingthattheassociationper-sisted regardless of how brand ad exposure was assessed,whether drinking was assessed as any use or as a continuousvariable, or when the analysis was stratiﬁed by brand marketshare. The study adds another piece of evidence to the causalargument by verifying that the often found associationbetween alcohol marketing exposure has speciﬁcity at the