Alcohol advertising pre-disposes young people to have favorable attitudes toward drinking

The alcohol industry has developed and regulates its own guidelines regarding advertising.

A new study has investigated the ability of panels to find consensus around code violations.

Results indicate that a modified Delphi Technique may enhance the ability of regulatory agencies to monitor the content of alcohol-beverage advertising.

In order to avoid exposing vulnerable groups such as children and young adults to alcohol advertising, industry groups have developed their own self-regulation guidelines. However, these guidelines have been criticized for possible conflict of interest, lack of objectivity, and unresponsiveness to complaints about violations. A study of violations of the U.S. Beer Institute code has identified a relatively inexpensive method of assessing whether alcohol-advertising content is in compliance with the industry's voluntary standards.

Results will be published in the October 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Research suggests that alcohol advertising pre-disposes young people to have favorable attitudes toward drinking, and to prefer certain brands, particularly those marketed to young adults, and to promote an earlier onset of drinking," said Thomas F. Babor, professor of public health and community medicine at The University of Connecticut School of Medicine as well as first author of the study. "The strength of the association, the consistency of the findings, the dose-response relationship, and the theoretical plausibility of the effect strongly suggest that alcohol advertising increases the likelihood that young people will start to use alcohol and will drink more if they are already using alcohol."

"Given that alcohol use is the leading drug problem among young people, and responsible for approximately 4700 deaths per year among persons under 21, and since the earlier young people start drinking, the more likely they are to experience alcohol problems later in life, there is a strong public health interest in reducing youth exposure to alcohol advertising," added David H. Jernigan, associate professor in the Department of Health, Behavior and Society at Johns Hopkins Bloomberg School of Public Health.

"Advertising codes of practice have been developed by the advertising industry, and more recently by the alcohol industry, including trade associations representing the beer, wine and spirits producers," explained Babor. "Over the years, the alcohol industry has taken increasing responsibility for specifying the exposure and content limits of their marketing, primarily to avoid government regulation. Although they have created a structure that is purportedly 'independent,' it is actually controlled entirely by industry personnel. As currently organized, the voluntary self-regulation programs set up by the alcohol industry provide a convenient way to claim they are being responsible without having to modify their advertising campaigns, which are often directed at young people."

"This is a case where the fox is not only minding the chicken house, but has actually built it," said Jernigan. "The codes are created and enforced by the industry. They are vague and may be changed with impunity. There are no penalties for violations, and according to reviewers engaged by the industry, violations are few - indeed, the Beer Institute's Code Compliance Review Board has never found an ad in violation of the beer industry's code."

Babor and his colleagues selected six alcohol advertisements based on their likelihood of having violated the "Beer Code," and then had two panels of raters - a community panel of college students, and an expert panel of health professionalss voluntary standards. The ratings addressed issues such as whether the actors depicted in the ads appeared younger than age 21, the amount of drinking suggested in the ad story situation, and the association of the beer product with social success. The alcohol advertisements were rated on two occasions, separated by one month.

"Our study shows that it is feasible to obtain consistent evaluations of marketing code violations from both health professionals and members of vulnerable groups, and that such information could be rapidly translated into decisions about whether an alcohol ad should be broadcast," said Babor. "Results indicate that the modified Delphi Technique can facilitate consensus development around code violations, which may enhance the ability of regulatory agencies to monitor the content of alcohol-beverage advertising."

"While both groups found violations in the ads, the expert raters were more conservative and less likely to be influenced by feedback, either from their own ratings as a group or from the ratings of the other group," added Jernigan. "The authors found that as few as 15 raters could produce consistent estimates of code violations, suggesting that it is possible, and relatively inexpensive, to put together an independent panel of raters to assess whether the content of alcohol ads is in compliance with the industry's voluntary standards."

While Babor was somewhat surprised that college students identified more violations than experts/health professionals, Jernigan was not; both noting that older health experts were less adept at seeing content designed to appeal to young persons through humor, sexually suggestive material, and associations between drinking and social success. "Much of the content of alcohol ads flies under the comprehension radar of adults," said Jernigan. "This underscores why it is important to include young people and young adults in rating panels assessing industry compliance with its standards."

"The procedure we've developed at the very least can be used to rapidly detect code violations and report them to industry sources so that they can remove ads with objectionable content," said Babor. "More importantly, it may be used to document the extent of code violations so that policymakers can consider whether stronger measures are needed, such as a total ban on alcohol marketing, as is done for tobacco products."

Jernigan would like to go even further. "Unless a panel of raters is permitted to 'pre-vet' the advertising, that is, to judge the ads before they are released to the public, even scientifically sound content assessments will always occur after the damage of youth exposure to them has already been done," he said. "Realistically, there are two ways of addressing the influence of alcohol advertising on young people: changing the content of the ads so they are less likely to influence kids, or changing where and when the ads are shown - in other words, placement - to reduce the likelihood that kids will see the ads. This study shows that the content of the advertising can be assessed and judged reliably by 'civilian' rating panels. But because of the difficulty of assessing and blocking ads before they are released to the public, addressing placement of the advertising - that is, reducing the likelihood that kids will see the ads in the first place - is critical if we are to give parents, teachers and law enforcement the support they need to safeguard our youth from the harmful effects of alcohol use."

"Parents may be interested in knowing this procedure could be used to protect young persons from ad content designed to make alcohol more appealing to them," added Babor. "For example, most people would be surprised to learn that each year, several of the beer ads broadcast to millions of young persons on Superbowl Sunday contain serious code violations that may contribute to binge drinking by American youth."