Brands matter: Major findings from the Alcohol Brand Research Among Underage Drinkers (ABRAND) project.

BACKGROUND: Alcohol research focused on underage drinkers has not comprehensively assessed the landscape of brand-level drinking behaviors among youth. This information is needed to profile youth alcohol use accurately, explore its antecedents, and develop appropriate interventions. METHODS: We collected national data on the alcohol brand-level consumption of underage drinkers in the United States and then examined the association between those preferences and several factors including youth exposure to brand-specific alcohol advertising, corporate sponsorships, popular music lyrics, and social networking sites, and alcohol pricing. This paper summarizes our findings, plus the results of other published studies on alcohol branding and youth drinking. RESULTS: Our findings revealed several interesting facts regarding youth drinking. For example, we found that: 1) youth are not drinking the cheapest alcohol brands; 2) youth brand preferences differ from those of adult drinkers; 3) underage drinkers are not opportunistic in their alcohol consumption, but instead consume a very specific set of brands; 4) the brands that youth are heavily exposed to in magazines and television advertising correspond to the brands they most often report consuming; and 5) youth consume more of the alcohol brands to whose advertising they are most heavily exposed. CONCLUSION: The findings presented here suggests that brand-level alcohol research will provide important insight into youth drinking behaviors, the factors that contribute to youth alcohol consumption, and potential avenues for effective public health surveillance and programming.

The relationship between exposure to brand-specific alcohol advertising and brand-specific consumption among underage drinkers--United States, 2011-2012.

BACKGROUND: Marketing is increasingly recognized as a potentially important contributor to youth drinking, yet few studies have examined the relationship between advertising exposure and alcohol consumption among underage youth at the brand level. OBJECTIVES: To examine the relationship between brand-specific exposure to alcohol advertising among underage youth and the consumption prevalence of each brand in a national sample of underage drinkers. METHODS: We analyzed the relationship between population-level exposure of underage youth ages 12-20 to brand-specific alcohol advertising in national magazines and television programs and the 30-day consumption prevalence--by brand--among a national sample of underage drinkers ages 13-20. Underage youth exposure to alcohol advertising by brand for each month in 2011, measured in gross rating points (GRPs, a standard measure of advertising exposure), was obtained from GfK MRI (a media consumer research company) and Nielsen for all measured national issues of magazines and all national television programs, respectively. The 30-day consumption prevalence for each brand was obtained from a national survey of 1031 underage drinkers conducted between December 2011 and May 2012. RESULTS: Underage youth were more than five times more likely to consume brands that advertise on national television and 36% more likely to consume brands that advertise in national magazines. The consumption prevalence of a brand increased by 36% for each 1.5 standard deviation (50 GRPs) increase in television adstock among underage youth and by 23% for each 1.5 standard deviation (10 GRPs) increase in magazine adstock. CONCLUSION: These findings suggest that alcohol advertising influences an important aspect of drinking behavior--brand choice--among youth who consume alcohol.

Flavored alcoholic beverage use, risky drinking behaviors, and adverse outcomes among underage drinkers: results from the ABRAND Study.

OBJECTIVES: We examined associations between consumption of different types of flavored alcoholic beverages (FABs) and risky drinking and drinking-related harms among underage drinkers. METHODS: For the Alcohol Brand Research among Underage Youth study, we applied multivariable logistic regression analyses to data from underage drinkers (n = 1031, aged 13-20 years), recruited from a national Internet panel in 2011 to 2012, to estimate associations between consumption of malt-based drinks; spirits-based, premixed- or ready-to-drink cocktails; and supersized alcopops, alone or in combination, and alcohol-related outcomes. RESULTS: After adjustment for confounding variables, the exclusive consumption of alcopops was associated with episodic heavy drinking (odds ratio [OR] = 4.35; 95% confidence interval [CI] = 1.24, 15.31; P < .05) and alcohol-related injuries (OR = 6.25; 95% CI = 1.34, 29.10; P < .05). Exclusive consumption of cocktails was associated with episodic heavy drinking (odds ratio [OR] = 2.61; 95% CI = 1.26, 5.41; P < .05) and injuries requiring medical attention (OR = 6.50; 95% CI = 2.09, 20.17; P < .001. Exclusive consumption of 2 or more FABs was associated with episodic heavy drinking (OR = 2.78; 95% CI = 1.25, 6.16; P < .05), fighting (OR = 3.30; 95% CI = 1.46, 7.47; P < .001), and alcohol-related injuries (OR = 2.83; 95% CI = 1.43, 5.58; P < .001). CONCLUSIONS: FABs present an emerging public health problem among youths.

The relationship between alcohol price and brand choice among underage drinkers: are the most popular alcoholic brands consumed by youth the cheapest?

We examined the influence of price on alcohol brand choice among underage youth. Using a national sample of 1,032 youth, ages 13-20, recruited from a national Internet panel in 2011-2012, we compared differences in mean prices between popular and unpopular brands, examined the association of price and brand popularity using logistic regression, and rank ordered the average price of top brands. Lower brand-specific prices were significantly associated with higher levels of past 30-day consumption prevalence. However, youth did not preferentially consume the cheapest brands. These findings indicate that youth have preferences for certain brands, even if those brands cost more than competing brands. Our study highlights the need for research on the impact of brand-specific alcohol marketing on underage drinking.

Brand-specific consumption of flavored alcoholic beverages among underage youth in the United States.

BACKGROUND: Although several studies have identified flavored alcoholic beverages (FABs) as being popular among underage drinkers, no previous study has ascertained the prevalence of brand-specific FAB consumption among a national sample of underage youth. OBJECTIVES: To ascertain the brand-specific consumption prevalence and consumption share of FABs among a national sample of underage drinkers in the United States. METHODS: In 2012, we conducted an online, self-administered survey of a national sample of 1031 underage drinkers, ages 13-20 years, to determine the prevalence of past 30-day consumption for each of 898 alcoholic beverage brands, including 62 FABs, and each brand's youth consumption share, based on the estimated total number of standard drinks consumed. There were three brand-specific outcome measures: prevalence of consumption, prevalence of consumption during heavy episodic drinking, and consumption share, defined as the percentage of the total drinks consumed by all respondents combined that was attributable to a particular brand. RESULTS: The FAB brands with the highest prevalence of past 30-day consumption were Smirnoff malt beverages, 17.7%; Mike's, 10.8%; Bacardi malt beverages, 8.0%; and Four Loko/Four MaXed, 6.1%. Just five brands accounted for almost half (49.1%) of the total consumption share by volume within the FAB category. CONCLUSION: Flavored alcoholic beverages are highly popular among underage drinkers, and the FAB brand preferences of this group are highly concentrated among a small number of brands. To decrease the consumption of FABs by underage youth, all states should reclassify these beverages as distilled spirits rather than beer.

State-specific liquor excise taxes and retail prices in 8 US states, 2012.

The authors investigated the relationship between state excise taxes and liquor prices in 8 states, using 2012 data for 45 brands. The authors made 6042 price observations among 177 liquor stores with online prices. Using a hierarchical model, the authors examined the relationship between excise taxes and product prices. State excise taxes were significantly related to liquor prices, with an estimated pass-through rate of 0.93. The proportion of price accounted for by excise taxes averaged 7.0%. The authors find that excise taxes do increase the price of alcohol, but states are not taking advantage of this opportunity to reduce alcohol-related morbidity and mortality.

Brand-specific consumption of alcohol among underage youth in the United States.

BACKGROUND: Little is known about brand-specific alcohol consumption among underage youth, as existing information is collected at the level of alcoholic beverage type. This study identifies the alcohol brands consumed by a nationally representative sample of underage youth in the United States. METHODS: We obtained a national sample of 1,032 underage youth, aged 13 to 20, using a pre-recruited Internet panel maintained by Knowledge Networks. Youth aged 18 to 20 were recruited directly from the panel via email invitation. Teens aged 13 to 17 were identified by asking adult panelists to identify a member of their household. The survey assessed the past 30-day consumption of 898 brands of alcohol among 16 alcoholic beverage types, including the frequency and amount of each brand consumed in the past 30 days. Market share for a given brand was calculated by dividing the total number of drinks for that brand in the past 30 days across the entire sample by the total number of drinks for all identified brands. RESULTS: The alcohol brands with highest prevalence of past 30-day consumption were Bud Light (27.9%, 95% confidence interval [CI] 23.3 to 32.4%), Smirnoff malt beverages (17.0%, 95% CI 12.9 to 21.1%), and Budweiser (14.6%, 95% CI 11.0 to 18.3%). Brand market share was concentrated in a relatively small number of brands, with the top 25 brands accounting for nearly half of all market shares. CONCLUSIONS: Underage youth alcohol consumption, although spread out over several alcoholic beverage types, is concentrated among a relatively small number of alcohol brands. This finding has important implications for alcohol research, practice, and policy.

Differences in liquor prices between control state-operated and license-state retail outlets in the United States.

AIMS: This study aims to compare the average price of liquor in the United States between retail alcohol outlets in states that have a monopoly ('control' states) with those that do not ('licence' states). DESIGN: A cross-sectional study of brand-specific alcohol prices in the United States. SETTING: We determined the average prices in February 2012 of 74 brands of liquor among the 13 control states that maintain a monopoly on liquor sales at the retail level and among a sample of 50 license-state liquor stores, using their online-available prices. MEASUREMENTS: We calculated average prices for 74 brands of liquor by control versus license state. We used a random-effects regression model to estimate differences between control and license state prices-overall and by alcoholic beverage type. We also compared prices between the 13 control states. FINDINGS: The overall mean price for the 74 brands was $27.79 in the license states [95% confidence interval (CI): $25.26-30.32] and $29.82 in the control states (95% CI: $26.98-32.66). Based on the random-effects linear regression model, the average liquor price was approximately $2 lower (6.9% lower) in license states. CONCLUSIONS: In the United States monopoly of alcohol retail outlets appears to be associated with slightly higher liquor prices.

Minimum financial outlays for purchasing alcohol brands in the U.S.

BACKGROUND: Low alcohol prices are a potent risk factor for excessive drinking, underage drinking, and adverse alcohol-attributable outcomes. Presently, there is little reported information on alcohol prices in the U.S., in particular as it relates to the costs of potentially beneficial amounts of alcohol. PURPOSE: To determine the minimum financial outlay necessary to purchase individual brands of alcohol using online alcohol price data from January through March 2012. METHODS: The smallest container size and the minimum price at which that size beverage could be purchased in the U.S. in 2012 were determined for 898 brands of alcohol, across 17 different alcoholic beverage types. The analyses were conducted in March 2012. RESULTS: The majority of alcoholic beverage categories contain brands that can be purchased in the U.S. for very low minimum financial outlays. CONCLUSIONS: In the U.S., a wide variety of alcohol brands, across many types of alcohol, are available at very low prices. Given that both alcohol use and abuse are responsive to price, particularly among adolescents, the prevalence of low alcohol prices is concerning. Surveillance of alcohol prices and minimum pricing policies should be considered in the U.S. as part of a public health strategy to reduce excessive alcohol consumption and related harms.

Household smoking bans and adolescent antismoking attitudes and smoking initiation: findings from a longitudinal study of a Massachusetts youth cohort.

OBJECTIVES: We sought to determine whether adolescents living in households in which smoking was banned were more likely to develop antismoking attitudes and less likely to progress to smoking compared with those living in households in which smoking was not banned. METHODS: We completed a longitudinal 4-year, 3-wave study of a representative sample of 3834 Massachusetts youths aged 12 to 17 years at baseline; 2791 (72.8%) were reinterviewed after 2 years, and 2217 (57.8%) were reinterviewed after 4 years. We used a 3-level hierarchical linear model to analyze the effect of a household ban on antismoking attitudes and smoking behaviors. RESULTS: The absence of a household smoking ban increased the odds that youths perceived a high prevalence of adult smoking, among both youths living with a smoker (odds ratio [OR] = 1.56; 95% confidence interval [CI] = 1.15, 2.13) and those living with nonsmokers (OR = 1.75; 95% CI = 1.29, 2.37). Among youths who lived with nonsmokers, those with no home ban were more likely to transition from nonsmoking to early experimentation (OR = 1.89; 95% CI = 1.30, 2.74) than were those with a ban. CONCLUSIONS: Home smoking bans may promote antismoking attitudes among youths and reduce progression to smoking experimentation among youths who live with nonsmokers.

Local restaurant smoking regulations and the adolescent smoking initiation process: results of a multilevel contextual analysis among Massachusetts youth.

OBJECTIVE: To assess whether smoke-free restaurant laws influence the progression from (1) never smoking to early experimentation and (2) early experimentation to established smoking. DESIGN: A longitudinal, 4-year, 3-wave study of a representative sample of Massachusetts youth. SETTING: A total of 301 Massachusetts communities. PARTICIPANTS: Study participants were 3834 Massachusetts youths aged 12 to 17 years at baseline, from January 2, 2001, to June 18, 2002, of whom 2791 (72.8%) were reinterviewed after 2 years (from January 30, 2003, to July 31, 2004) and 2217 (57.8%) were reinterviewed after 4 years (from February 16, 2005, to March 26, 2006). Wave 3 respondents were recruited from both those who responded at wave 2 and those who did not. MAIN EXPOSURE: The primary predictor of interest is the strength of the local restaurant smoking regulation in the respondents' town of residence at the baseline of each transition period. MAIN OUTCOME MEASURES: (1) Overall progression to established smoking (having smoked > or =100 cigarettes in one's lifetime), (2) transition from nonsmoking (never having puffed a cigarette) to experimentation, and (3) transition from experimentation to established smoking. RESULTS: Youths living in towns with a strong restaurant smoking regulation at baseline had significantly lower odds of progressing to established smoking (odds ratio, 0.60; 95% confidence interval, 0.42-0.85) compared with those living in towns with weak regulations. The observed association between strong restaurant smoking regulations and impeded progression to established smoking was entirely due to an effect on the transition from experimentation to established smoking (odds ratio, 0.53; 95% confidence interval, 0.33-0.86). CONCLUSION: Local smoke-free restaurant laws may significantly lower youth smoking initiation by impeding the progression from cigarette experimentation to established smoking.

Effect of smoking regulations in local restaurants on smokers' anti-smoking attitudes and quitting behaviours.

OBJECTIVE: To examine the effect of smoking regulations in local restaurants on anti-smoking attitudes and quitting behaviours among adult smokers. DESIGN: Hierarchical linear modelling (HLM) was used to assess the relationship between baseline strength of town-level restaurant smoking regulation and follow-up (1) perceptions of the social acceptability of smoking and (2) quitting behaviours. SETTING: Each of the 351 Massachusetts towns was classified as having strong (complete smoking ban) or weak (all other and no smoking restrictions) restaurant smoking regulations. SUBJECTS: 1712 adult smokers of Massachusetts aged > or = 18 years at baseline who were interviewed via random-digit-dial telephone survey in 2001-2 and followed up 2 years later. MAIN OUTCOME MEASURES: Perceived social acceptability of smoking in restaurants and bars, and making a quit attempt and quitting smoking. RESULTS: Among adult smokers who had made a quit attempt at baseline, living in a town with a strong regulation was associated with a threefold increase in the odds of making a quit attempt at follow-up (OR = 3.12; 95% CI 1.51 to 6.44). Regulation was found to have no effect on cessation at follow-up. A notable, although marginal, effect of regulation was observed for perceiving smoking in bars as socially unacceptable only among smokers who reported at baseline that smoking in bars was socially unacceptable. CONCLUSIONS: Although local restaurant smoking regulations did not increase smoking cessation rates, they did increase the likelihood of making a quit attempt among smokers who had previously tried to quit, and seem to reinforce anti-social smoking norms among smokers who already viewed smoking in bars as socially unacceptable.

Diffusion of local restaurant smoking regulations in Massachusetts: identifying disparities in health protection for population subgroups.

OBJECTIVES: The objectives of this study were to examine the diffusion of smoke-free restaurant regulations and identify socioeconomic and racial/ethnic disparities in health protection from secondhand smoke exposure in restaurants. METHODS: We examined the relationship between adoption of local smoking regulations by restaurants for each of the 351 cities and towns in Massachusetts and a number of individual variables over nine time points, starting when there were no 100% smoke-free restaurant regulations and ending with the eventual imposition of the statewide ban on smoking in restaurants and bars. RESULTS: We found that over the 10 years before the statewide ban went into effect, only 36 percent of the total population was covered by local regulations that protected them from secondhand smoke exposure in restaurants. We also observed a substantial disparity in protection based on educational status, with up to 7 percentage points fewer nongraduates protected by local smoke-free restaurant regulations.

Effects of restaurant and bar smoking regulations on exposure to environmental tobacco smoke among Massachusetts adults.

OBJECTIVES: We examined the association of local restaurant and bar regulations with self-reported exposure to environmental tobacco smoke among adults. METHODS: Data were derived from a telephone survey involving a random sample of Massachusetts households. RESULTS: Compared with adults from towns with no restaurant smoking restrictions, those from towns with strong regulations had more than twice the odds of reporting nonexposure to environmental tobacco smoke (odds ratio [OR]=2.74; 95% confidence interval [CI]=1.97, 3.80), and those from towns with some restrictions had 1.62 times the odds of reporting nonexposure (OR=1.62; 95% CI=1.29, 2.02). Bar smoking bans had even greater effects on exposure. CONCLUSIONS: Strong local clean indoor air regulations were associated with lower levels of reported exposure to environmental tobacco smoke in restaurants and bars.

The impact of emotional tone, message, and broadcast parameters in youth anti-smoking advertisements.

OBJECTIVES: In the context of controversy regarding the optimal characteristics of anti-smoking advertisements for youth, this study examines the impact on recall and perceived effectiveness of variations in the message, emotional tone, reach and frequency of broadcast, remoteness of broadcast, and characteristics of the adolescent audience such as changes in smoking behavior, ownership of cigarette promotional items, and demographic variables. METHOD: A two-wave longitudinal survey of a population-based sample of 618 Massachusetts youth 12 to 15 years old was carried out in 1993 and 1997. A Generalized Estimating Equation (GEE) approach was used to model the recall and perceived effectiveness of eight advertisements as a function of viewer and ad characteristics. RESULTS: Advertisements featuring messages about serious health consequences which had been independently rated as high in negative emotion were more likely to be recalled and were perceived as more effective by youth survey respondents than ads featuring messages about normative behavior for teens or ads relying on humor. Advertising intensity, while contributing to recall, was negatively related to perceived effectiveness. CONCLUSIONS: This study supports mounting evidence that negative emotion in anti-smoking advertisements is effective with youth audiences.

Effect of local restaurant smoking regulations on environmental tobacco smoke exposure among youths.

OBJECTIVES: We examined the effect of local restaurant smoking regulations on restaurant environmental tobacco smoke exposure among youths. METHODS: We interviewed 3863 Massachusetts youths aged 12-17 years and ascertained how often they saw smokers in restaurants in their town. We assessed the effect of local restaurant smoking regulation strength on nonexposure to environmental tobacco smoke (seeing smokers never or only rarely). RESULTS: Compared with youths from towns with weak regulations, youths from towns with medium-strength regulations had 1.4 times the odds (odds ratio = 1.36; 95% confidence interval = 1.12, 1.65) and youths from towns with strong regulations had twice the odds (odds ratio = 2.03; 95% confidence interval = 1.64, 2.52) of reporting nonexposure. CONCLUSIONS: Strong local restaurant smoking regulations are associated with reduced environmental tobacco smoke exposure among youths

Young adults: vulnerable new targets of tobacco marketing.

OBJECTIVES: We examined young adult smoking patterns and receptivity to cigarette advertising to assess vulnerability to tobacco marketing strategies. METHODS: We obtained data from a telephone survey of 12,072 Massachusetts adults. RESULTS: Smokers aged 18 to 30 years were more likely than older adults to smoke only occasionally and to consume fewer than 10 cigarettes per day. They also were more receptive to cigarette marketing and were more likely to be frequent patrons of bars and clubs. CONCLUSIONS: Many young adult smokers are in the initiation phase of smoking and are likely to undergo a transition to either nonsmoking or heavier smoking. If unimpeded by regulation, tobacco promotion in bars and clubs is likely to lead to increased adult smoking prevalence.

Adolescent participation in tobacco promotions: the role of psychosocial factors.

OBJECTIVES: To identify psychosocial factors that place adolescents at risk for participation in tobacco promotions, and to further investigate the hypothesis that psychosocial vulnerabilities have an indirect effect on smoking initiation among youth by way of involvement with tobacco promotions. METHODS: Data were from a follow-up telephone survey of youth in Massachusetts. A subset of adolescents who were not established smokers, had not smoked cigarettes in the past 30 days, and did not own a promotional item at baseline in 1993 was used for the analyses (n = 468). Bivariate analyses were used to evaluate the association between psychosocial vulnerabilities and subsequent acquisition of cigarette promotional items. Logistic regression was conducted to identify the set of factors that best predict attainment of tobacco promotional items, and to examine the mediating influence of item acquisition on the relation of between psychosocial vulnerabilities and smoking initiation. RESULTS: Adolescents who were academically disengaged at baseline were more likely to acquire a tobacco promotional item at follow-up. Academic disengagement was significantly associated with item acquisition, above and beyond the other psychosocial vulnerabilities. The direct effect of academic disengagement changed from marginally significant to nonsignificant when item acquisition was introduced. CONCLUSIONS: This study provides evidence that receptivity to tobacco promotional items is greatest among youth who are disengaged from school.

The role of smoking and rebelliousness in the development of depressive symptoms among a cohort of Massachusetts adolescents.

BACKGROUND: Recent studies have shown that smoking leads to depressive symptoms among adolescents, but the mechanisms underlying the relationship remain unclear. In this study, we focused on one possible mechanism, namely, the effect of rebelliousness. We examined the extent to which rebelliousness accounts for the relation between smoking and depression among adolescents in Massachusetts. METHODS: Data were from a follow-up telephone survey of youth in Massachusetts. A subset of adolescents who were classified as not highly depressed at baseline in 1993 was used for the analyses (n = 522). Logistic regression analyses were used to predict whether cigarette smoking increased the odds of developing high depressive symptoms 4 years later, while controlling for rebelliousness and other factors. RESULTS: Ever smoking a cigarette at baseline had a statistically significant impact on high depressive symptoms at follow-up. Once rebelliousness was considered, the relationship between ever smoking and follow-up depressive symptoms became nonsignificant. CONCLUSIONS: The findings indicate that rebelliousness accounted for the relation between adolescent smoking and the emergence of depressive symptoms. Rebelliousness may provide a modifiable variable to be targeted to interrupt the linkage between adolescent smoking and depression.