Alcohol Marketing and Underage Drinking: Time to Get Real

COnsumer products—tobacco, alcohol, energy dense foods, guns, and cars—have been the primary cause of chronic diseases in middle- and high-income countries for decades (Mokdad et al., 2004; Murray and Lopez, 2013). In 2010, they became the leading cause of death among people in low-income nations as well (Alwan and Maclean, 2009; Robinson and Hort, 2012), and alcohol contributes substantially to this burden (Rehm et al., 2009). Alcohol products are developed, branded, and sold as part of billion dollar marketing campaigns by multinational corporations. In the words of the alcohol beverage industry, “The various aspects of product marketing—including advertising, labeling, consumer promotion, packaging, and merchandising—are an integral part of promoting different brands of virtually every consumer good” (International Center for Alcohol Policies, 2014b). Marketing is particularly important for some types of alcohol, because it is the only way of distinguishing company products within certain types of beverages, for example, vodka.

Alcohol companies go to great lengths to develop brand identities—linking their products with sports, music, and media celebrities (Primack et al., 2012, 2014); developing and distributing fashionable branded clothing (McClure et al., 2006, 2009); making sure their products are prominently placed in television shows and movies (Bergamini et al., 2013; Dal Cin et al., 2008); and implementing massive advertising campaigns on traditional media like television and, increasingly, in social media (Federal Trade Commission, 2014). Companies differ in some aspects of their marketing strategies—the themes, media venue emphasis, and the amount spent on advertising. For example, Coors spends lavishly on advertising, having overtaken Budweiser with its Coors Light brand in 2012 (Peterson, 2012). In contrast, Pabst, which overtook regular Coors in sales in 2006, did so in some respects because it was not aggressively marketing the product (Ferdman, 2014).

Although not all alcohol marketing is aimed at young people, much of it is. This is because companies want to capture new users before they become loyal to another brand. Regardless of the drinking age in a country, it is impossible to create a marketing campaign aimed at legal young adults and not have those advertising messages appeal to the underage segment, who watch many of the same media venues as their older peers and respond alike to the messaging themes. Thus, on the face of it, given the similarity between 21- and 25-year-olds and their underage peers, it is absurd to propose that an effective advertising campaign aimed at 21- to 25-year-olds would not also drive consumption among the underage. Most of the scientific reviews to date agree that there is moderately strong evidence that we should be concerned about the possibility that alcohol marketing contributes to underage problem drinking (Anderson et al., 2009; Hastings et al., 2005; Smith and Foxcroft, 2009).

The August issue of Alcohol Clinical and Experimental Research contains another important contribution to the literature on alcohol marketing and underage drinking by linking exposure to alcohol marketing to the brands consumed by underage drinkers. Ross and colleagues (2014) assessed alcohol marketing exposure in an underage drinker sample by ascertaining in the past month how much they watched each of 20 popular television programs that carry alcohol advertising. Based on the shows they watched and the ads shown in each one (obtained from Nielsen), they could determine exposure to television alcohol advertising by brand. They assessed brand-specific consumption using pull-down menus that listed all brands by beverage category on the web-based survey. People who watch TV will not be surprised that the top 10 brands delivering alcohol messaging to underage drinkers included Sam Adams, Absolute, Bud Light, Stella Artois, Dos Equis, and Heineken.

The adjusted odds ratio for the association between any exposure to a brand advertisement and consumption of that brand was 3, even after controlling for a range of potentially confounding variables. This could have been largely due to the comparison between advertised and nonadvertised brands. After excluding many brands not advertised during the time period, viewing a specific television advertisement was still associated with higher risk of consuming that brand in the past 30 days. The authors performed other tests of the robustness of their findings, showing that the association persisted regardless of how brand ad exposure was assessed, whether drinking was assessed as any use or as a continuous variable, or when the analysis was stratified by brand market share. The study adds another piece of evidence to the causal argument by verifying that the often found association between alcohol marketing exposure has specificity at the level of the brand—the key level with respect to how alcohol companies try to distinguish their products.

The alcohol industry goes to great lengths to defend its ability to engage in marketing to young people; part of that defense is to deny that its marketing affects harmful drinking patterns in anyone, much less underage drinkers. The industry promotes this point of view in its corporate propaganda, claiming that “the balance of the evidence does not support a direct causal relationship between overall alcohol marketing, and drinking levels or harmful drinking patterns (chronic or episodic)” and “studies have shown that the principal influences on youth drinking are parents and peers” (International Center for Alcohol Policies, 2014a). The industry supports its view that marketing does not promote underage drinking by paying scientists (Nelson, 2012) who cast doubt on the already sizable literature that links alcohol marketing with underage problem drinking (Nelson, 2010). That viewpoint is used to argue in favor of self-regulation of marketing as a substitute for effective government oversight of these activities.

It’s time to move beyond questioning whether alcohol marketing influences underage youth and get serious about rolling back alcohol advertising worldwide. Below is a framework for systematic changes that could be undertaken by scientific journals, alcohol research societies, and government funding agencies to seriously address industry’s role in alcohol use.

Scientific journals could make it easier to keep industry-sponsored scientists from undermining alcohol marketing research by requiring full disclosure of monetary or in-kind compensation obtained from any alcohol company for all submissions, including letters to the editor. Alcohol journals could call for manuscripts that study the alcohol industry. They could promote these submissions in other ways as well. For example, I had difficulty finding a word describing the topic for this editorial in the menu of attributes in the second stage of the submission process. The menu included “genomics,” “GWAS,” and “candidate genes” but did not include “marketing” as a topic. Journals like ACER should offer keywords that include advertising and promotion, alcohol industry, bar and retail environments, litigation, media, packaging and labeling, price, public policy, surveillance and monitoring, and taxation. That would make it clear that the journal welcomes those research topics as important contributions to the scientific literature.

Similarly, the Research Society on Alcoholism, which sponsors ACER, has an annual meeting devoted to alcohol research. My review of the RSA/ISBRA Program Outline for the July 21 meeting in Bellevue, Washington, finds it replete with important scientific topics that included neuroscience, epigenetics, and molecular biology, as well as new clinical interventions and epidemiologic studies that focused on early childhood experiences, parental influence, and other individual and family risk factors. However, there was not one symposium, plenary session, or workshop addressing corporate practices, bar influences, taxation, or government regulation of the alcoholic beverage industry. The Society could make an effort to promote this kind of research, and do a better job of melding research with activism, the way the annual National Conferences on Tobacco or Health do.

Funding agencies, like NIAAA, could allocate more of their research dollars toward better understanding how corporate and government practices (e.g., marketing, pricing, self-regulation, bar environments, and taxation) affect drinking. Such funding is needed to provide evidence free from the biases that industry funding brings to research in this area. The NIAAA program announcement calling for studies of alcohol marketing (see http://grants.nih.gov/grants/guide/pa-files/PA-11-015.html) was well received by scientists who understand the importance of marketing, but it has expired and needs to be renewed and extended. Government funding agencies could support studies that model disease and costs attributable to marketing influence. They could empanel international scientists whose charge is to summarize the extant literature on marketing and drinking in a definitive NIAAA monograph that gets updated periodically. The National Cancer Institute’s Smoking and Tobacco Control Monograph series provides many examples of how NIAAA alcohol monographs could promote alcohol control (e.g., see NCI Monograph 19, The Role of the Media in Promoting and Reducing Tobacco Use; National Cancer Institute, 2008).

Finally, and most importantly, we all need to realize that when it comes to corporations, self-regulation is little better than no regulation at all. In the words of Willem Buiter¹ (who was commenting on the woefully inadequate regulatory response to the world financial crisis of 2008), “self-regulation stands in relation to regulation the way self-importance stands in relation to importance and self-righteousness to righteousness.” It’s time to get real about corporate influences on underage drinking and hazardous alcohol use at any age and get serious about constraining corporate practices like marketing through better government oversight and regulation of the alcoholic beverage industry.