Evaluation of monitoring youth exposure to alcohol advertising on cable television, United States 2016-19.

BACKGROUND AND AIMS: Exposure to alcohol advertising is associated with underage drinking, which contributes to adolescent morbidity and mortality. Alcohol advertisements are regulated by the alcohol industry. Our research team has published reports monitoring alcohol advertisers' compliance with industry guidelines. In this study, we estimated: (1) changes in youth and adult exposure to alcohol advertisements on cable television from 2016-19 and (2) changes in youth exposure to types of non-compliant advertising highlighted in monitoring reports over the same period. DESIGN: Interrupted time-series analysis using data from Nielsen US national television audience estimates, 2012-19. MEASURES AND METHODS: Outcome was advertising impressions (the total number of times an alcohol advertisement was viewed by youth or adults) by month. Non-compliant exposure was impressions from advertisements that did not meet guidelines. Covariates were advertising spending in multiple media categories. Seasonal autoregressive integrated moving average models estimated trends in exposure before the publication of monitoring reports (2012-15 reference period) and during the monitoring period (2016-19). We compared the modeled exposure trend during the monitoring period to the reference period projected trend. SETTING: United States. PARTICIPANTS: A total of 57 000 Nielsen panel households FINDINGS: Non-compliant exposure declined 6158 [95% confidence interval (CI) = -11 406 to -911] million impressions, or -77.3% during the monitoring period compared with the reference period trend. Total youth exposure declined by 20 995 (CI = -34 701 to -7288) million impressions (27.0%). Non-compliant exposure on programs, network dayparts and brands highlighted in monitoring reports declined by -82.4, -79.0 and -82.2%-more than other programs (-52.7%), network dayparts (-71.0%) or brands (143%). Adult exposure declined by 9.3%. CONCLUSIONS: Publication of alcohol advertising monitoring reports appears to have been associated with a 27.0% decline in US youth exposure to alcohol advertising on cable television and a 77.3% decline in US youth exposure to non-compliant alcohol advertising.

Trends in Youth Exposure to Alcohol Advertising on Cable Television, United States, 2013-2018.

OBJECTIVE: A growing body of research suggests that exposure to alcohol advertising increases the risk of alcohol-related adverse health consequences among underage populations. The alcohol industry has voluntary advertising guidelines to restrict the placement of alcohol advertisements only to media in which youth younger than age 21 comprise no more than 28.4% of the audience. However, the current guidelines do not account for variations in exposure among subpopulations of underage television viewers. Most youth exposure to alcohol advertising in traditional media in the United States comes from advertisements placed on cable television. Therefore, this study assessed trends among underage populations in per capita alcohol advertising exposure on cable television programs. METHOD: Advertising placement and audience data on cable television were licensed from Nielsen (New York, NY). Per capita alcohol advertising exposure (gross rating points, or GRPs) was calculated for youth ages 2-11, 12-17, and 18-20 years from 2013 to 2018. We compared relative trends in exposure between age groups. RESULTS: Alcohol advertising exposure among youth ages 2-11 grew from 13,011 to 15,470 GRPs from 2013 to 2018, whereas exposure declined among youth ages 12-17 (24,663 to 17,780), and 18-20 (35,022 to 25,700). From 2016 to 2018, youth exposure to noncompliant advertising declined for all three underage groups assessed in this study. CONCLUSIONS: Alcohol advertising exposure among younger children grew faster than in other age groups assessed in this study. This was also the case for advertisements that complied with the alcohol industry's placement guidelines. Continued monitoring of alcohol advertising exposure among underage populations can help detect emerging trends.

Youth Cognitive Responses to Alcohol Promotional Messaging: A Systematic Review.

OBJECTIVE: This review examines the research of the effects of alcohol advertising on the cognitive mechanisms that precede underage alcohol use. METHOD: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed 22 studies (1988-2016) selected from 22,040 articles. The final sample assessed cognitive responses of youth younger than the legal purchase age who were exposed to alcohol advertisements from television or magazines. RESULTS: The studies were predominantly cross-sectional (59.1%), used convenience sampling (63.6%), had 74 to 3,521 participants, and were from six countries. The most common methods and applied theories for assessing advertising effects on cognitions were linear methods based on priming and modeling theories, and structural equation modeling based on information-processing models. Overall, advertising content appealed to youth, particularly advertisements that emphasized lifestyles of drinkers rather than the product quality. Youth exposed to alcohol advertisements were more likely to associate positive and arousing effects with alcohol, and in some studies effects were modified by sex, alcohol use, and age. Residual confounding and selection bias were a concern in the majority of studies. CONCLUSIONS: Exposure to alcohol advertising may affect underage perceptions of risks and rewards of alcohol use. Nevertheless, the ability to draw causal conclusions is limited because of study designs. Future studies should use nonlinear methods to assess the association between advertising and cognitions and avoid measuring alcohol advertising as a uniform and dose-response exposure among diverse populations. Future research would be strengthened by applying consistent theoretical frameworks, improving control for confounding bias, and using validated cognitive outcome measures.

Youth Exposure to Alcohol Advertising in the United States: Assessment of Two Types of Television Ratings and Implications for Voluntary Advertising Guidelines.

OBJECTIVE: Do youth switch channels during alcohol advertisements at different rates than adults? This question has implications for the alcohol industry's self-regulation of its advertising placements. People may avoid television advertisements by switching channels, which can be measured by comparing two television audience metrics: commercial ratings (which measure the audience during the advertisement) and program ratings (which measure the audience during the television program). We assessed changes in youth and adult audiences during alcohol advertisements with implications for alcohol industry self-regulatory compliance. METHOD: A census of alcohol advertisements for 2010-2014 was licensed from Nielsen (New York, NY). We compared noncompliant advertisements (with youth making up >28.4% of the audience) and the percentage decline in per capita advertising exposure for youth and adult age groups using both commercial and program ratings. RESULTS: The audience during the alcohol advertisement declined by 8.48% among underage viewers ages 12-17 years and by 7.04% for viewers ages 18-20 years, compared with 8.20% for adults ages 21-24, 10.43% for ages 25-34, and 9.74% for ages 35 and older. These declines exceeded the margin of error (±2.6%), indicating a decline in viewership across all age groups, but we could not draw conclusions about differences between age groups. Compared with audience estimates using commercial ratings, program ratings underestimated the number of noncompliant advertisements by 8,800, leading to an underestimate of noncompliant exposure by 140 million impressions. CONCLUSIONS: Both underage viewers and young adults switched channels during alcohol advertisements. Using commercial ratings rather than program ratings may more accurately measure compliance with alcohol industry advertising guidelines.

Alcohol policies and alcohol-attributable cancer mortality in U.S. States.

BACKGROUND: Although more restrictive alcohol control policies (e.g., higher alcohol taxes) are related to lower levels of alcohol consumption, little is known about the relationship between alcohol policies and rates of alcohol-attributable cancer. METHODS: State alcohol policy restrictiveness, as measured by a validated policy scale, were related to state rates of six alcohol attributable cancers in the U.S. from 2006 to 2010 in a lagged, cross-sectional linear regression that controlled for a variety of state-level factors. Cancer mortality rates were from the Center for Disease Control and Prevention's Alcohol-Related Disease Impact application, which uses population-attributable fraction methodology to calculate mortality from cancers of the esophagus, larynx, liver, oropharynx, prostate (male only) and breast (female only). RESULTS: More restrictive state alcohol policies were associated with lower cancer mortality rates for the six cancer types overall (beta [ß] -0.33; 95% confidence interval [CI] -0.59, -0.07), and among men (ß -0.45; 95% CI -0.81, -0.10) and women (ß -0.21; 95% CI -0.40, -0.02). A 10% increase in the restrictiveness of alcohol policies (based on the mean APS among states) was associated with an 8.5% decrease in rates of combined alcohol-attributable cancers. In all analyses stratified by cancer subtype and sex, the associations were in the hypothesized direction (i.e., more restrictive state policy environments were associated with lower rates of alcohol-attributable cancers), with the exception of laryngeal cancer among women. CONCLUSION: Strengthening alcohol policies is a promising prevention strategy for alcohol-related cancer.

Youth Exposure to Alcohol Advertising in National Magazines in the United States, 2001-2011.

OBJECTIVES: To update public health surveillance of alcohol advertising to underage populations by assessing alcohol industry compliance with their voluntary guidelines for US magazine advertisements from 2001 to 2011. METHODS: Using advertising industry standard sources The Nielsen Company and MediaMark, we evaluated youth exposure to alcohol advertising, and relative advertising exposure of youths versus adults, in 168 national magazines. RESULTS: From 2001 to 2011, magazine alcohol advertising seen by youths declined by 62.9%, from 5.4 billion impressions (single person seeing a single advertisement) to 2.0 billion impressions. Most alcohol advertising (65.1% of ads) was for spirits (e.g., vodka, whiskey). Since 2008, alcohol companies achieved 100% compliance with their limited guidelines. However, youths were overexposed to magazine advertising relative to adults on average 73% of the time. CONCLUSIONS: Despite improving compliance with placement guidelines in national editions of the 168 measured magazines, most youth exposure to magazine alcohol advertising exceeded adult exposure, per capita. If alcohol companies adopted stricter guidelines based on public health risk assessments, youths would not be overexposed to alcohol advertising in magazines.