Agn 115

Alcohol & Alcoholism Vol. 44, No. 3, pp. 229–243, 2009 doi: 10.
1093/alcalc/agn115
Advance Access publication 14 January 2009
SPECIAL ISSUE: THE MESSAGE AND THE MEDIA

Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use:
A Systematic Review of Longitudinal Studies
Peter Anderson1,∗ , Avalon de Bruijn2 , Kathryn Angus3 , Ross Gordon3 and Gerard Hastings3
1 Universityof Maastricht, Maastricht, The Netherlands, 2 National Foundation for Alcohol Prevention, Utrecht, The Netherlands and 3 Institute for Social
Marketing, University of Stirling and The Open University, Stirling, UK
∗ Corresponding author: Apartat de Correus 352, 17230 Palamos, Girona, Spain. Tel: +34-972-662480; E-mail: peteranderson.mail@gmail.com
(Received 14 July 2008; first review notified 16 October 2008; in revised form 16 December 2008; accepted 17 December 2008;
advance access publication 14 January 2009)
Abstract — Aims: To assess the impact of alcohol advertising and media exposure on future adolescent alcohol use. Methods: We
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searched MEDLINE, the Cochrane Library, Sociological Abstracts, and PsycLIT, from 1990 to September 2008, supplemented with
searches of Google scholar, hand searches of key journals and reference lists of identified papers and key publications for more recent
publications. We selected longitudinal studies that assessed individuals’ exposure to commercial communications and media and alcohol
drinking behaviour at baseline, and assessed alcohol drinking behaviour at follow-up. Participants were adolescents aged 18 years or
younger or below the legal drinking age of the country of origin of the study, whichever was the higher. Results: Thirteen longitudinal
studies that followed up a total of over 38,000 young people met inclusion criteria. The studies measured exposure to advertising and
promotion in a variety of ways, including estimates of the volume of media and advertising exposure, ownership of branded merchandise,
recall and receptivity, and one study on expenditure on advertisements. Follow-up ranged from 8 to 96 months. One study reported
outcomes at multiple time-points, 3, 5, and 8 years. Seven studies provided data on initiation of alcohol use amongst non-drinkers,
three studies on maintenance and frequency of drinking amongst baseline drinkers, and seven studies on alcohol use of the total sample
of non-drinkers and drinkers at baseline. Twelve of the thirteen studies concluded an impact of exposure on subsequent alcohol use,
including initiation of drinking and heavier drinking amongst existing drinkers, with a dose response relationship in all studies that
reported such exposure and analysis. There was variation in the strength of association, and the degree to which potential confounders
were controlled for. The thirteenth study, which tested the impact of outdoor advertising placed near schools failed to detect an impact on
alcohol use, but found an impact on intentions to use. Conclusions: Longitudinal studies consistently suggest that exposure to media and
commercial communications on alcohol is associated with the likelihood that adolescents will start to drink alcohol, and with increased
drinking amongst baseline drinkers. Based on the strength of this association, the consistency of findings across numerous observational
studies, temporality of exposure and drinking behaviours observed, dose-response relationships, as well as the theoretical plausibility
regarding the impact of media exposure and commercial communications, we conclude that alcohol advertising and promotion increases
the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol.
INTRODUCTION mid-teens tend to be the ones with heavier consumption, alcohol

dependence and alcohol-related harm, including poorer mental
Adolescents are frequent users of alcohol and increasingly con- health, poorer education outcome and increased risk of crime
sume it in a risky fashion. For example, in Europe, nearly all in early adulthood (Jefferis et al., 2005, Englund et al., 2008;
(over 9 in 10) 15- to 16-year-old students have drunk alco- Pitkänen et al., 2008). During adolescence, alcohol can lead
hol at some point in their life (Currie et al., 2004), starting to structural changes in the hippocampus (a part of the brain
on average just after 121/2 years of age. Data from the 2003 involved in the learning process) (De Bellis et al., 2000) and at
European School Survey Project on Alcohol and Other Drugs high levels can permanently impair brain development (Spear,
(ESPAD) found that the average amount of alcohol drunk by 2002). Drinking by adolescents and young adults is associated
15- to 16-year olds on the last drinking occasion was 60 g (six with automobile crash injury and death, suicide and depres-
drinks) (Hibell et al., 2004). Over one in eight (13%) of 15- to sion, missed classes and decreased academic performance, loss
16-year-old students reported being drunk more than 20 times of memory, blackouts, fighting, property damage, peer criti-
in their life, and over one in six (18%) reported binge drinking cism and broken friendships, date rape, and unprotected sexual
(5+ drinks on a single occasion) three times or more in the last intercourse that places people at risk for sexually transmitted
month. Binge drinking in young people has increased across diseases, HIV infection and unplanned pregnancy (Bonomo
much of Europe in the last 10 years, although more so in the et al., 2001). Adolescents aged 14–17 years with alcohol use
early part of this period (Anderson and Baumberg, 2006). disorders show substantially greater brain activation to alco-
Children and adolescents have greater vulnerability to alcoholic beverage pictures than control youths, predominantly in
hol than adults. As well as usually being physically smaller, brain areas linked to reward, desire and positive affect (Tapert
they lack experience of drinking and its effects. They have et al., 2003). The degree of brain response to the alcohol pic-
no context or reference point for assessing or regulating their tures is highest in youths who consume more drinks per month
drinking, and, furthermore, they have built up no tolerance to and report greater desires to drink.
alcohol. From mid-adolescence to early adulthood, there are Alcohol advertising is one of the many factors that have the
major increases in the amount and frequency of alcohol con- potential to encourage youth drinking. For young people who
sumption and alcohol-related problems (Bonomo et al., 2004; have not started to drink, expectancies are influenced by nor-
Wells et al., 2004). Those with heavier consumption in their mative assumptions about teenage drinking as well as through

C The Author 2009. Published by Oxford University Press on behalf of the Medical Council on Alcohol. All rights reserved
230 Anderson et al.
the observation of drinking by parents, peers and models in take a snapshot of advertising exposure (awareness and/or ap-
the mass media. Research has linked exposure to portrayals of preciation) and levels of drinking, and look for correlations be-
alcohol use in the mass media with the development of positive tween the two. However, because they cannot show whether ex-
drinking expectancies by children and adolescents (Austin and posure preceded drinking uptake, they leave open the possibility
Knaus, 2000; Austin et al., 2000). Young people with more that any correlation is as likely to reflect drinking encouraging
positive affective responses to alcohol advertising hold more young people to take an interest in advertising, as vice versa.
favourable drinking expectancies, perceive greater social ap- As Aitken et al. (1988) point out, however, paying atten-
proval for drinking, believe drinking is more common among tion to advertising presupposes that the viewer is getting some
peers and adults, and intend to drink more as adults (Chen and benefit or reward from it—most fundamentally that they are
Grube, 2002). Fourteen-year olds with greater exposure to ad- doing the right thing by consuming the advertised product—
vertisements in magazines, at sporting and music events and on and advertisers deliberately design their work to provide such
television are more advertisement-aware than those with less rewards (Aitken, 1988). Thus, cross-sectional data can shed a
exposure, as are teens who watch more TV, pay attention to useful light on the role of alcohol advertising in young people’s
beer advertisements and know adults who drink (Collins et al., drinking.
2003). Amongst 10- to 17-year olds, the perceived likeabil- Longitudinal studies take the debate a step further by mea-
ity of beer advertisements is a function of the positive affec- suring exposure at time A, and how this relates to drinking

tive responses evoked by the specific elements featured in the at time B. Provided potential confounders (such as peer and
advertisements. Liking of specific elements featured in beer parental drinking) are controlled for, any correlation indicates
advertisements, such as humour, animation and popular mu- a causative relationship. This review therefore focuses on lon-
sic, significantly contribute to the overall likeability of these gitudinal studies with young people. It builds on and extends re-
advertisements and subsequently to advertising effectiveness views conducted by Jernigan (2006), Smith and Foxcroft (2007)
indicated by an intent to purchase the product and brand pro- and Booth et al. (2008).
moted by the advertisements (Chen et al., 2005).
These studies, however, do not establish whether alcohol
advertising actually influences young people’s drinking be- METHODS OF THE REVIEW
haviour. Answering this question requires either experimental
studies, which are not possible for ethical reasons, or systematic Types of studies
observation of real world effects. We considered studies that examined the association between
One approach to observation is to look for correlations be- alcohol advertising and promotion, the portrayal of alcohol
tween the amount of alcohol advertising and the amount of in mass media, and adolescent drinking. We included only
drinking taking place in a particular jurisdiction using econo- longitudinal studies in which individuals’ drinking behaviour
metric methods. It is hypothesized that, if advertising has an and exposure to advertising, receptivity or attitudes to alcohol
effect, drinking rates should shadow temporal variations in the advertising, or brand awareness were measured at baseline and
amount of advertising. Establishing such a link, however, is individuals’ drinking behaviours were then measured in one or
problematic for a number of reasons. First, measures of the more follow-ups. Experimental, cross-sectional and time-series
amount of advertising, which typically use expenditure on or econometric studies were excluded from this review.
advertising, vary in the accuracy and inclusiveness. For ex-
ample, in the UK, whilst mass media advertising expenditure Types of participants
has been estimated to be £202.2 million (UK Cabinet Office, Studies that included adolescents 18 years of age or younger
2003), expenditure on promotion more generally (taking in were reviewed with the exception of US-based studies, where
point of sale promotion, electronic communications and other the legal drinking age of 21 years was taken as the cut-off.
‘below the line’ activity) is thought to approach £800 million
(Drink Pocket Book, 2006). Second, the analysis depends on Types of intervention
the construction of a complex model that ascribes values for all The ‘intervention’ is alcohol mass media advertising by the
the different variables—including price, drinking restrictions industry, including portrayal of alcohol in the mass media,
and disposable income—as well as advertising (Harrison and alcohol promotion and media exposure that contained alco-
Godfrey, 1989; Casswell, 1995; Saffer, 1996) that might be hol advertisements. Mass media channels of communication
implicated. Third, the duration of advertising effects need to include advertising delivered through television, radio, news-
be taken into account: a powerful campaign may continue to papers, outdoor advertising, posters, etc. Alcohol promotion
have an effect years after it was first deployed. Indeed, ad- includes give-aways and items bearing alcohol industry logos.
vertisers deliberately try to enhance these long-term effects as In practice, the measure of exposure to the intervention may
part of their effort to build brands. Fourth, variations in the not discriminate between specific types of advertising, since
amount of advertising tend to be minor (few comprehensive adolescents are exposed to many sources.
bans have been introduced) so researchers are looking for po-
tentially very small changes in drinking patterns. Finally, and Types of outcome measures
most importantly given our focus on adolescents, measures of Self-reported drinking status.
the overall amount of advertising do not necessarily give an
accurate picture of youth exposure. Search strategy
To obtain this focus on young people, it is necessary to do We searched MEDLINE, the Cochrane Library, Sociological
research directly with them. Such investigations come in two Abstracts, and PsycLIT, from 1990 to September 2008, sup-
forms: cross-sectional and longitudinal. Cross-sectional studies plemented with searches of Google scholar, hand searches of
Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use 231
key journals and reference lists of identified papers and key one in Germany and one in New Zealand. The years during
publications for more recent publications. The search strategy which data were collected ranged between 1985 and 2005.
combined the following four sets of terms. Child Search Strat- Baseline sample sizes ranged from 630 to 6522, with a total of
egy: Child(MeSH) OR Child∗ OR Schoolchild∗ OR School over 38,000 at follow-up across the 13 studies.
age∗ OR Kid OR Kids OR Adolescent(MeSH) OR Adoles∗ OR Two studies investigated the impact of media exposure (tele-
Teen∗ OR Boy∗ OR Girl∗ OR Minors(MeSH) OR Minors OR vision and music videos) on the use of alcohol; three studies,
Schools(MeSH) OR Primary school∗ OR Secondary school∗ alcohol use in motion pictures; two studies, a range of market-
OR Elementary school∗ OR High school∗ OR Highschool∗ ing exposure (including TV, magazines, concession stands at
Or College∗ OR Universit∗ OR Young OR Youth∗ . Alcohol sports or music events, and in store advertisements); two stud-
Search Strategy: Alcohol drinking(MeSH) OR Alcohol∗ drink∗ ies, ownership of alcohol branded merchandise; one study, TV
OR Alcoholic beverages(MeSH) OR Alcohol∗ beverage∗ OR alcohol commercials alone; one study, recall and liking of ad-
Beer(MeSH) OR Beer∗ OR Wine(MeSH) OR Wine∗ OR vertisements; one study, outdoor advertising; one study, brand
Liquor∗ OR Spirits OR Alcohol∗ . Marketing Search Strat- recognition, recall and receptivity to alcohol marketing; and
egy: Marketing(MeSH:NoExp) OR Marketing OR Advertising one study, volume of and expenditure on advertisements.
as Topic(MeSH) OR Advert∗ OR Promot∗ OR Sponsor∗ OR In 10 studies, participants were followed up once after base-
Television(MeSH) OR Televis∗ OR TV∗ OR Radio(MeSH) line. The duration of the follow-up was 12 months, 18 months,

OR Radio OR Radios OR Motion picture∗ OR Movie∗ OR 24 months, 30 months and 12–26 months. One study followed
Film∗ OR Display∗ OR Billboard∗ OR Poster OR Posters up participants at 8, 16 and 24 months. The New Zealand study
OR Newspapers(MeSH) OR Newspaper∗ OR Magazine∗ OR reported outcomes at multiple time points, 3 years, 5 years and
Mass media(MeSH) OR Internet(MeSH) OR Internet. Longi- 8 years. One study evaluated participants at four time points
tudinal Studies Search Strategy: Longitudinal Studies(MeSH) and presents results for follow-up after 21 months taking the
OR Longitud∗ OR Cohort∗ OR Follow-up∗ OR Prospectiv∗ OR multiple time points into account in the analysis (Snyder et al.,
Subsequ∗ OR Wave∗ . 2006). Attrition rates varied from 31% to 100% (the sample
There were four stages in the review process: with 100% follow-up included and analysed all students with
alcohol consumption measurements at baseline and follow-up
1. Studies identified in the electronic search were pre- (Casswell and Zhang, 1998). Three studies used imputation
screened for relevance by a reviewer. Articles were re- for missing data (Ellickson et al., 2005; Collins et al., 2007;
jected if the title and abstract did not focus on the impact Wills et al., 2008); all other studies excluded participants with
of alcohol advertising or promotion on adolescent drink- missing data from the analyses.
ing behaviour. If the article could not be rejected with All studies measured alcohol use at follow-up. Eight studies
certainty, the full text was obtained and screened by two provided data on initiation of alcohol use amongst non-drinkers
reviewers. (Robinson et al., 1998; Ellickson et al., 2005; Sargent et al.,
2. Two reviewers independently assessed relevant studies for 2006; Fisher et al., 2007; Henriksen et al., 2008; Hanewinkel
inclusion. and Sargent, 2008; McClure et al., 2008; Wills et al., 2008),
3. One reviewer extracted data from included studies using a three studies on maintenance and frequency of drinking
form and a second reviewer checked these data. amongst baseline drinkers (Robinson et al., 1998; Casswell and
4. Studies were combined using qualitative narrative synthe- Zhang, 1998; Casswell et al., 2002; Ellickson et al., 2005) and
sis because there was heterogeneity among study designs, six studies on alcohol use of the total sample of non-drinkers
type of ‘intervention’ and outcomes measured. and drinkers at baseline (Connolly et al., 1994; Stacy et al.,
2004; Van den Bulck and Beullens, 2005; Snyder et al., 2006;
Collins et al., 2007; Pasch et al., 2007).
RESULTS Study samples included random samples of youth (Snyder
et al., 2006; McClure et al., 2008; Wills et al., 2008), ran-
The search strategy resulted in 810 titles, reduced to 729 fol- domly selected schools with all participants invited to partic-
lowing deletion of duplicates. Initial assessment of the titles ipate (Stacy et al., 2004; Van den Bulck and Beullens, 2005;
and abstracts reduced the number of papers to 131, further re- Sargent et al., 2006), all elementary schools in a State (Collins
duced to 29 on closer assessment of the abstract and full text. et al., 2007; Hanewinkel and Sargent, 2008), all middle and
Sixteen publications reporting on 13 studies met the inclusion high schools in a city (Henriksen et al., 2008), all participants
criteria. One longitudinal study was excluded, because the use at six schools, with no information given on how the schools
of alcohol at baseline was not accounted for (Wingood et al., were selected (Robinson et al., 1998), the original sample of
2003). No additional methodological quality criteria were used participants selected for participation in an RCT (Ellickson
in selecting papers for inclusion. Table 1 summarizes the stud- et al., 2005; Pasch et al., 2007), all participants of a longitu-
ies, describing the alcohol marketing and media exposures, the dinal cohort study (Fisher et al., 2007) and a sub-sample of
drinking behaviour outcome measures, the sample and study a longitudinal cohort study who had exposure and outcome
designs, the survey methods, the baseline sample sizes and data available at all follow-up periods (Connolly et al., 1994;
follow-up rates, the methods of analyses, the confounders anal- Casswell and Zhang, 1998; Casswell et al., 2002).
ysed and the outcome at follow-up. The individual studies were Measurement of exposure and alcohol use were by self-
not ranked for methodological quality. reported questionnaires in seven studies (Robinson et al., 1998;
The 13 studies included a variety of different age groupings Stacy et al., 2004; Ellickson et al., 2005; Collins et al., 2007;
that ranged between 10 and 21 years of age at baseline. Ten Henriksen et al., 2008; Hanewinkel and Sargent, 2008), by both
studies were conducted in the United States, one in Belgium, face-to-face interview and computer interview in one (Connolly
232
Table 1. Summary of included studies

Study [reference] Study objective Sample/study Survey method Baseline sample Follow-up Analysis Covariates/ Outcome at follow-up
Country Alcohol marketing and design size (months) confounders analysed
Baseline survey date media exposure
Follow-up
Age group (years) Drinking behaviour
rate
outcome measurea
Connolly et al. (1994) New Impact of recall of Participants in a Face-to-face 667 who 60 and 36 Multiple Gender Impact of number of commercial
Zealand alcohol-related mass multi-disciplinary interview at 13 were present for regression Socio-economic status advertisements recalled at ages 13
435/667
1985 media material on longitudinal study of and 15 years; alcohol analyses; only P Living situation and 15 on average and maximum
(65%)
13 and again at 15 subsequent alcohol growth computer survey interviews at values reported Occupation amounts of alcohol consumed on an
(analysed
consumption and development at 18 years ages 13, 15 and Peer approval of people who occasion and on frequency of
sample)
Alcohol portrayals in mass 18 years drink drinking. There was no significant
media (e.g. TV, radio) Number of moderation relationship with wine and spirit
including commercial messages recalled consumption. For males, number of
advertising (product Number of hours of TV watched commercial advertisements recalled
advertising, sponsorship) at age 15, but not 13, predicted
and entertainment media average (P = 0.047) and maximum
amounts of beer (P = 0.008)
Average amount of alcohol consumed on an occasion. For
Anderson et al.
consumed on an occasion females, the number of commercial
during a year; maximum advertisements recalled at age 13,
of typical amounts but not 15, predicted frequency of
consumed across all beer consumption (P = 0.029)
drinking locations; total
frequencies of beer and
other drinks (wine and
spirits) consumed
Robinson et al. (1998) USA Impact of media exposure on Non-randomized Paper survey 2609 18 1583/2609 Analysis Age During the 18-month follow-up, 325
(California) initiation of alcohol use prospective survey included Gender (36%) non-drinkers began drinking.
(61%)
1994 and maintenance of across six public high 1533 Controlling for the effects of age,
Mean age (SD) 14.6 (0.5) drinking among existing schools students Ethnicity gender, ethnicity and the exposure
drinkers with Hours of other media watched to other media, each 1-h increase
Exposure to TV, music videos complete per day in TV viewing associated
(on music channels and data on with a 9% increased risk for
rental videotapes); both alcohol initiating drinking [OR=1.09
videotape viewing; use and (1.01–1.18)]. Each 1-h increase per
computer and video game media day in watching music videos
use on typical school and exposure associated with a 31% increased
weekend days Logistic risk for initiating drinking
regression [OR=1.31 (1.17–1.47)]. During the
Frequency of lifetime alcohol to calculate 18-month follow-up, 322 (51%)
drinking (a typical single odds ratios drinkers continued drinking. There
serving); frequency of adjusted for were no significant associations
drinking in past main between media exposure and
30 days confounders maintenance of drinking
Casswell and Zhang (1998). Impact of liking for alcohol Participants in a Computer-based Sample restricted to 36 Structural equation Gender The measure of liking of alcohol
Same sample as Connolly advertising and brand multi-disciplinary questionnaire and 630 of those who Sample modelling advertising was based on responses
et al. (1994) above New allegiance at age 18 years longitudinal study of face-to-face drank beer at age restricted to analysis to three items: ‘alcohol
Zealand 1990/199118 on drinking and growth and supplementary 18 years those who advertisements have plenty of
alcohol-related aggression development interview provided action’; ‘alcohol advertisements
at age 21 years information show the type of people I admire’;
Exposure to alcohol at baseline ‘Comparing alcohol adverts
advertising (e.g. TV, radio, and generally with other ads, which of

cinema advertising and follow-up the following you most agree with?’
sponsorship) Liking of alcohol advertisements at
age 18 predicted beer consumption
Combined average volume of at age 21 [standardized coefficient
beer drunk at own home, 0.36 (SE = 0.06, T = 6.6)]
someone else’s home,
Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use

hotel, tavern or bar, sports
clubs and nightclubs over
previous year; whether
ever experienced problems
with aggression associated
with drinking alcohol
Casswell et al. (2002). Same To identify developmental Participants in a Computer-based Sample restricted to Trajectories Trajectory analysis Gender The measure of liking of alcohol
sample as Connolly et al. trajectories of drinking multi-disciplinary questionnaire and 714 participants of drinking using method of Ease of access to alcohol advertising was based on responses
(1994) and Casswell and between the ages of 18 and longitudinal study of face-to-face who were over 96 Jones et al. Access to licensed premises to three items: ‘alcohol
Zhang (1998) above 26 years and to identify growth and supplementary drinkers of months (2001) Living arrangement advertisements have plenty of
New Zealand 1990/1991 variables at age 18, development interview alcohol at ages Sample Parental consumption action’; ‘alcohol advertisements
18 including liking of alcohol 18, 21 and 26 restricted to Level of education show the type of people I admire’;
advertisements, which years 714 Age of onset of regular drinking ‘Comparing alcohol adverts
predict these trajectories participants generally with other ads, which of
Exposure to alcohol who were the following you most agree with?’
advertising (undefined/no drinkers of Liking of alcohol advertisements at
examples given) alcohol at age 18 did not project trajectories of
ages 18, 21 quantities of alcohol consumed per
Frequency of drinking over occasion for both men and women
past year and typical and 26 years
over the age 18–26 years. Liking of
quantity consumed per alcohol advertisements at age 18
drinking occasion at own marginally predicted being in a
home, someone else’s higher trajectory for frequency of
home, hotel, tavern or bar, drinking for men (OR = 1.6, P =
sports clubs and nightclubs 0.0706) but not for women over the
age 18–26 years
Stacy et al. (2004) USA Impact of TV alcohol Randomized prospective Paper survey 2998 12 Logistic regression Gender Each 1 standard deviation increase in
(California) 2000 commercials on alcohol survey across 20 2250/2998 to calculate Ethnicity alcohol advertising exposure
US seventh grade (normally use middle schools (75%) odds ratios School associated with 44% increase in
12–13 years) Exposure to TV adverts for adjusted for Participation in team sports odds of beer drinking (95% CI:
alcohol aired during 20 main Perception of friends’ alcohol use 27%–61%), 34% increase in odds
popular TV series; and confounders Perceived peer approval of alcohol use of wine/liquor drinking (95% CI:
during professional Intentions to use alcohol 17%–52%) and 26% increase in
baseball, college and Perceptions of adults’ alcohol use odds of consuming three or more
professional basketball, General TV viewing frequency drinks on one occasion (95% CI:
professional soccer and Ad memorability (cued-recall and drawing) 8%–48%) during previous 30 days
hockey, and on
subscription sports
channel in previous
months
Frequency of drinking
alcohol in last 30 days;
frequency of ‘3-drink
episodes’ (≥3 drinks of
typical serving size in a
row over couple of hours)
in past 30 days
(Continued )
233
234
Table 1. Continued
Study [reference] Study objective Alcohol Sample/study Survey method Baseline sample Follow-up Analysis Covariates/ Outcome at follow-up
Country Baseline marketing and media design size (months) confounders analysed
survey date Age group exposure Drinking Follow-up
(years) behaviour outcome rate
measurea

Van den Bulck and Beullens Impact of TV and music Randomized prospective Paper survey 2546 12 Multiple Age Quantity of alcohol consumed while
(2005) Belgium video exposure on the use survey across 15 1648/2546 regression School year going out at the follow-up period
2003 of alcohol whilst going out secondary schools (65%) analyses Gender related to overall TV viewing (β =
13 and 16 years of age Exposure to music video TV accounting for Pubertal development status 0.068, t = 3.46, P = 0.001) and
programmes and normal covariates Smoking status music video exposure (β = 0.073,
TV viewing between 7 am Drinking at baseline t = 3.05, P = 0.004)
and 1 am
Number of alcoholic drinks
usually drank when going
out (to a bar, party, disco,
etc.) ranging from never to
≥9; frequency of going out
Ellickson et al. (2005) Impact of exposure to Randomized controlled Paper survey 3780 30 Regression models Gender 48% of 1206 grade 7 non-drinkers
USA (South Dakota) 1997 different forms of alcohol trial of an alcohol use 3111/3780 accounting for Ethnicity consumed alcohol in previous year
Seventh grade (age advertising on the prevention (82%) covariates TV viewing at grade 9. Controlled for main
12–13 years) initiation of alcohol use programme involving Adult drinking confounders, including exposure to
and the frequency of 41 middle schools in Adult approval of drinking all different types of advertisement
drinking amongst existing South Dakota Peer drinking and the impact of the prevention
Anderson et al.
drinkers, and whether Peer approval of drinking programme, exposure to beer
exposure to a prevention School grades concession stands at sports or music
programme mitigates any Religiosity events predicted drinking onset for
such relationship Parental monitoring non-drinkers in previous 12 months
Exposure to TV beer Alcohol beliefs (OR = 1.42, P < 0.05), whereas
advertisements (aired Deviance exposure to TV beer adverts (OR =
during professional Impulsivity 1.05, P > 0.05), magazines with
football and basketball and Playing sports alcohol advertisements (OR = 1.12,
during four late-night Exposure to prevention programme P > 0.05) and exposure to in-store
shows popular with age advertisements (OR = 1.06, P >
group), magazines with 0.05) did not. Weekly TV viewing,
alcohol advertisements, controlled for alcohol advertisement
beer concession stands and exposure, was inversely related to
in-store advertisement the onset of drinking, explained as a
displays ‘babysitter’ effect, whereby youth
who watch more TV have fewer
Frequency of drinking opportunities to drink. 77% of 1905
alcohol in the past year grade 7 drinkers consumed alcohol
(five options ranging from in the previous year at grade 9.
0 to +20 times) Exposure to beer concession stands
at sports or music events predicted
the frequency of drinking amongst
existing drinkers in previous 12
months (coefficient = 0.09, P <
0.05), as did exposure to magazines
with alcohol advertisements
(coefficient = 0.10, P < 0.05),
whereas exposure to TV beer
adverts (coefficient = −0.01, P >
0.05) and exposure to in-store
advertisements (coefficient = 0.02,
P > 0.05) did not
Snyder et al. (2006) USA Impact of alcohol advertising Randomized survey Telephone interviews 1872 21 Multi-level linear Gender For those aged <21 years, each
1999 expenditures and the sample from 24 588/1872 modelling to Age additional alcohol advertisement
15–26 (52% <21) degree of exposure to Nielsen media (31%) calculate event Ethnicity seen increased the number of drinks
alcohol advertisements on markets rate ratio School status consumed in the previous month by
alcohol use Alcohol sales per capita 1% (event rate ratio = 1.01, 95%
CI: 1.001–1.021). Each additional

Exposure to beer, liquor and
premixed drink advertising dollar spent on alcohol
on TV, radio, magazines advertisements increased the
and billboards in the past number of drinks consumed in the
month. Industry data on previous month by 2.8% (event rate
ratio = 1.028, 95% CI:

amount spent on alcohol
advertisements 1.002–1.056). Seeing more or fewer
advertisements in a particular
Number of alcoholic drinks in month than he or she typically saw
the past months calculated is a predictor of drinking (event rate
from the frequency of ratio = 1.002, 95% CI:
drinking alcohol (past 4 1.001–1.003)
weeks); average quantity
of drinks per day and
maximum quantity of
drinks on one occasion
Sargent et al. (2006) USA Impact of exposure of alcohol Randomized cross Paper survey, with 3577 non-drinkers 12–26 (average Multi-level logistic Grade 357/2406 (15%) initiated drinking
(New Hampshire and use in motion pictures on the sectional survey with follow-up 17 months) regression to Gender alcohol. Exposure predicted use of
Vermont) initiation of alcohol use longitudinal telephone interview 2406/3577 calculate ORs Parental education alcohol during the follow-up period
1999 10–14 Exposure to US box-office hit follow-up on (67%) adjusted for School performance (OR = 1.15, 95% CI: 1.06–1.25).
movies content-coded for non-drinkers at covariates Self-esteem Analysis with quadratic exposure
on-screen alcohol use baseline in 15 middle Maternal support effect (OR = 0.996, 95% CI:
(consumption, implied schools Maternal control 0.992–0.999) showed that the
possession and purchase of Rebelliousness relationship between exposure of
alcohol) Sensation seeking alcohol use in motion pictures and
Smoking status the initiation of alcohol use was
Initiation of alcohol drinking stronger among adolescents in
(unknown to parents) lower exposure categories
Collins et al. (2007) USA Impact of exposure to alcohol Longitudinal survey Paper survey 1786 12 Multivariate with Gender 17% reported past year beer drinking
(South Dakota) 2000 marketing on beer use across 39 schools 1699/1786 logit and Ethnicity at grade 7. OR (95% CI) for beer
Grade 6 (11–12) Exposure to beer ads on TV (95%) and logistic Parental monitoring drinking were: ESPN cable network
(on subscription sports 1740/1786 regression Adult drinking (an American cable TV network
channel, other sports (97%) Peer drinking dedicated to broadcasting and
programmes, other TV Parent approval producing sports-related
programmes), in Friend approval programming 24 h a day) 1.08
magazines, on radio, at School grades (0.83–1.42); other sports beer ads
concessions stands and on Depressed mood 1.19 (1.01–1.40); other TV beer ads
in-store displays Deviance 1.13 (0.95–1.34); magazine reading
Ownership of alcohol Impulsivity 0.96 (0.87–1.06); radio listening
promotional items (hats, Religiosity 1.17 (1.00–1.37); beer concessions
posters or T-shirts) Sports participation 1.01 (0.91–1.13); in-store beer
Weekly TV viewing displays 1.03 (0.92–1.14); beer
Beer drinking over the past Parental education promotional items 1.76 (1.23–2.52).
year Grade 6 beer drinking Joint effect of exposure to ads from
all sources: F(8, 28) = 8.36, P <
0.0001; and from three TV sources:
F(3, 33) = 3.35, P < 0.05. Twenty
percent of youth in 75th percentile
of alcohol marketing exposure at
grade 6 reported past year beer
drinking at grade 7, compared with
13% in 25th percentile
(Continued )
235
236
Table 1. Continued

survey date Age exposure Drinking Follow-up
group (years) behaviour outcome rate
measurea
Fisher et al. (2007) USA Impact of ownership of or Non-random prospective Postal survey 16,882 recruited in 12 Multivariate Age 611/3283 girls (19%) and 384/2228
1998–1999 willing to use alcohol cohort study of never 1996; 11,834 11,834/16,882 logistic Pubertal status boys (17%) initiated alcohol use.
11–18 promotional item on the drinking children of completed (70%) regression Race The odds ratio of alcohol initiation
initiation of alcohol use mothers in Nurses’ follow-up in Analysis Geographical area during the 12-month period was
and subsequent binge Health Study II 1998 and 1999. confined to Social self-esteem 1.74 (1.37–2.19) for girls and 1.78
drinking Sample the 511 Athletic self-esteem (1.36–2.33) for boys for those who
Exposure to alcohol comprised 5511 non-drinkers Global self-esteem owned or were willing to use an
advertisements or TV non-drinkers who Scholastic self-esteem alcohol promotion item compared
commercials; alcohol completed Cigarette smoking with those who did or would not.
promotional item (e.g. hat, alcohol questions Family composition 149/611 drinking girls (24%) and
T-shirt, bag) ownership in 1998 and 1999 Family dinner at home 112/384 drinking boys (29%)
and willingness to use Adults drink at home engaged in binge drinking. The
Siblings <21 drinking odds ratio of binge drinking
Initiation of alcohol drinking Peer drinking amongst drinkers was 1.79
Anderson et al.
(ever sipped or had whole Attitudes and beliefs about alcohol (1.16–2.77) for girls and 0.87
serving of alcoholic consumption (0.51–1.48) for boys for those who
drink); ever binge drinking owned or were willing to use an
(≥5 drinks in few hours) alcohol promotion item compared
in past year with those who did or would not
Pasch et al. (2007) USA Impact of exposure of Sixth grade students in Digital camera and 4137 24 Mixed-effect Gender On average, each school site had 14.8
(Chicago) 2003 outdoor alcohol project Northland GPS positioning of 2586/4137 regression Ethnicity alcohol advertisements within 1500
Mean age 12.2 years advertisements within Chicago, a alcohol (62.5%) models School socio-economic status feet (457 m). 2027/2586 (78%)
1500 feet (457 m) of 63 randomized advertisements; Exposure to other forms of alcohol students followed up were
Chicago schools on controlled trial of an paper survey of advertising non-users of alcohol at baseline, but
alcohol use alcohol use alcohol use and Awareness of outdoor advertising the initiation of alcohol use was not
Outdoor alcohol prevention intentions Prevention programme reported. Exposure to alcohol
advertisements, including programme involving advertisements at sixth grade did
at bus shelters/benches, on 61 public schools in not predict alcohol behaviour
billboards, outside liquor, Chicago amongst sixth grade alcohol users
grocery, or convenience and non-users at eighth grade, but,
stores or outside bars. amongst sixth grade non-users, did
Content-coded on a predict at eighth grade intentions to
22-item system for use (e.g. ‘do you think you will be
theme(s) drinking alcohol in the next
month’), f = 6.29, P = 0.01 and
Drinking behaviour measures outcome expectancies, f = 4.62,
include the frequency of P = 0.03
drinking alcohol over past
30 days; frequency of
drinking ≥5 drinks over
past 2 weeks
Henriksen et al. (2008) USA Influence of alcohol Non-random Paper survey 1527 non-drinking 12 Logistic regression Grade 29% of never drinkers at baseline had

(California) 2003 advertising and longitudinal survey of students 1080/1527 to calculate Gender initiated alcohol use at follow-up.
10–15 promotions on the adolescents from (71%) odds ratios Ethnicity Brand recognition, OR = 1.15
initiation of alcohol use three middle and two Parental drinking (1.02–1.29); brand recall, OR =
Exposure to alcohol high schools in Tracy Peer drinking 1.16 (1.05–1.29) and high
advertising (beer and California (pop Perceived peer drinking receptivity to alcohol marketing,
vodka mix products) and 56,929) in the Survey Perceived peer approval of drinking OR = 1.77 (1.27–1.48) predicted
to alcohol branded items of Teen Opinions Risk taking initiation. When receptivity to
(e.g. T-shirt, lighter, about Retail Unsupervised hours after school alcohol marketing was controlled,
matches, hat or Environments, a Self-reported grades recall and recognition no longer
sunglasses) longitudinal study statistically significantly predicted
primarily of smoking alcohol initiation
Initiation of alcohol use initiation
(either finished a serving
of alcoholic drink ever, in
last 30 days or last 7 days)
and transition to current
drinker (finished ≥1–2
servings of alcoholic drink
in last 30 days)
Hanewinkel and Sargent Influence of exposure to Random selection of 42 Paper survey 3432 never drinkers 12–13 months Generalized linear Age The estimated mean movie alcohol
(2008) alcohol use in movies on schools of which 27 2708/3432 models using Gender exposure was 3.2 h, subsequently
Germany the initiation of alcohol secondary schools (79%) log link, School socio-economic status divided into four quartiles.
2005 use participated in adjusted for Parental drinking pattern Thirty-three percent of students
10–16 (mean age 12.4) Exposure to Germany’s Schleswig–Holstein, clustering Parenting style initiated drinking without parental
box-office hit movies a State of Germany; Friend drinking knowledge and 14% binge drinking
content-coded for 85% of all fifth–ninth School performance (five or more drinks within 2 h).
on-screen alcohol use grade students TV in bedroom Compared with quartile 1, the
(consumption, implied surveyed TV watching time adjusted RRs (95% CI) for drinking
possession and purchase of Sensation seeking/rebelliousness without parental knowledge were
alcohol) including viewing 1.42 (1.16–1.74) for Q2, 1.94
on TV, DVD and video (1.65–2.28) for Q3 and 2.0
(1.69–2.37) for Q4; and for binge
Initiation of alcohol drinking drinking 1.44 (0.96–2.17) for Q2,
(unknown to parents); ever 1.95 (1.27–3.0) for Q3 and 2.23
binge drinking (≥5 drinks (1.48–3.37) for Q4
in a row within 2 h)
(Continued )
237
238
Table 1 Continued
survey date Age group exposure Drinking Follow-up
(years) behaviour outcome rate

measurea
Wills et al. (2008) USA Influence of exposure to Random longitudinal Telephone survey with 6522 8, 16 and 24 Structural equation Age Viewed alcohol use in movies averaged
2003 10–14 alcohol use in movies on digit dial telephone computer-assisted 5503/6522 modelling Gender 31 min at baseline, 35 min at 8
ever use of alcohol, binge survey of adolescents telephone- (84%) at 8 analysis Ethnicity months, 30 min at 16 months.
drinking and aged 10–14 years interviewing months; Parenting (maternal responsiveness and Movie alcohol exposure at baseline
alcohol-related problems procedure 5019 (77%) maternal monitoring) predicted alcohol use at 8 months
Exposure to US box-office hit at 16 Rebelliousness (coefficient = 0.1). Movie alcohol
movies content-coded for months; Sensation seeking exposure between baseline and 8
on-screen alcohol use 4574 (70%) Self-regulation months did not predict alcohol use
(consumption, implied at 24 months School performance at 8 months (coefficient = −0.03),
possession and purchase Availability of alcohol at home but did predict alcohol problems at
of alcohol) Friend’s use of alcohol 16 months (coefficient = 0.13).
Expectancy about alcohol Movie alcohol exposure between 8
Initiation of alcohol drinking Parental use of alcohol and 16 months predicted alcohol use
(unknown to parents); ever Parental education at 16 months (coefficient = 0.08).
binge drinking (≥5 drinks Family structure At all times, alcohol use predicted
in a row); recent binge Family income alcohol problems and there were
drinking; whether Urbanicity significant indirect and independent
experienced problems
Anderson et al.
Region effects of movie exposure at
caused when someone baseline, 8 and 16 months on
drinks alcohol alcohol problems at 24 months
McClure et al. (2008). Influence of ownership of Random digit dial Telephone survey with 4309 non-drinkers 8 and 16 Logistic regression Age ABM ownership increased from 11%
Same sample as Wills alcohol branded telephone survey of computer-assisted 3762/4309 to estimate Gender at baseline to 20% at 16 months.
et al. (2008) above USA merchandise (ABM) on adolescents aged telephone- (87%) at 8 hazards ratios Ethnicity 10% of adolescents tried drinking
2003 the initiation of alcohol 10–14 years interviewing months (HR) Susceptibility to alcohol use (response to for the first time and 5% tried binge
10–14 use and binge drinking procedure 3317/4309 peer offers, intentions and positive drinking during each of the two
ABM (e.g. clothing, (77%) at 16 expectancies) 8-month periods. There was a
headwear, jewellery, key months Exposure to movie alcohol use reciprocal relationship between
chains, shot glasses, Peer drinking susceptibility and ABM ownership.
posters, pens) ownership Parent drinking Ownership of ABM at baseline did
Alcohol availability at home not have a significant direct impact
Initiation of alcohol drinking Sensation seeking on alcohol initiation at 8 months
(unknown to parents); ever Rebelliousness (HR = 1.41, 95% CI: 0.98–2.01),
binge drinking (≥5 drinks Parenting (maternal responsiveness and nor on alcohol initiation between 8
in a row) maternal monitoring) and 16 months (HR = 1.57, 95%
Extracurricular activities CI: 0.99–2.5), but did on initiation
School performance of binge drinking at 8 months (HR
TV viewing length of time = 1.80, 95% CI: 1.28–2.54), but not
Parent report education initiation of binge drinking between
Household income 8 and 16 months (HR = 1.44, 95%
CI: 0.90–2.31). New ownership of
ABM at 8 months had a significant
direct impact on alcohol initiation at
16 months (HR = 2.31, 95% CI:
1.6–3.35) and initiation of binge
drinking at 16 months (HR = 2.22,
95% CI: 1.49–3.32)
a Although some included studies measured additional outcomes, this systematic review was concerned with longitudinal studies measuring self-reported drinking behaviour at follow-up. Thus, it is the only
outcome measure detailed in this table.
et al., 1994; Casswell and Zhang, 1998; Casswell et al., 2002), ing beer, 20% wine and 12% three-drink episodes. At 1-year
by postal survey in one (Fisher et al., 2007) and computer-aided follow-up, each one standard deviation increase in alcohol ad-
telephone interview in three (Snyder et al., 2006; Sargent et al., vertising exposure as measured by the watched TV shows index
2006; McClure et al., 2008; Wills et al., 2008). One study used was associated with a 44% increase in odds of beer drinking
digital photography and GPS positioning to ascertain exposure (95% CI: 27–61%), a 34% increase in odds of wine/liquor
and self-reported questionnaire for consumption data (Pasch drinking (95% CI: 17–52%) and a 26% increase in odds of
et al., 2007). consuming three or more drinks on one occasion (95% CI: 8–
Connolly et al. (1994) investigated the impact of the number 48%) during the previous 30 days, controlling for covariates
of commercial advertisements recalled at ages 13 and 15 years related to drinking behaviour. Self-reported frequency of expo-
on average and maximum amounts of alcohol consumed on an sure was also positively associated with beer drinking, OR =
occasion and on the frequency of drinking and age 18 years 1.21 (95% CI: 1.04–1.41), but not to wine/liquor drinking or
amongst 667 participants in a multi-disciplinary longitudinal three or more drinks on one occasion. The cued-recall memory
study of growth and development in New Zealand. There was test and draw-an-event memory test did not show significant
no significant relationship with wine and spirit consumption. relationships with any of the outcomes, and, although the re-
For males, the number of commercial advertisements recalled lationships were in the direction of positive associations, there
at age 15, but not 13, predicted average (P = 0.047) and max- was one exception, the draw-an-event memory test being as-

imum amounts of beer (P = 0.008) consumed on an occa- sociated with a reduced risk of beer use (OR = 0.86, 95% CI:
sion. For females, the number of commercial advertisements 0.75–0.99).
recalled at age 13, but not 15, predicted the frequency of beer Van den Bulck and Beullens (2005) studied the impact of TV
consumption (P = 0.029). Although significant relationships and music video exposure on the use of alcohol whilst going out
were detected, they could have been due to chance, since results amongst 2546 first- and fourth-year secondary school students
for more than 35 statistical tests were reported. Based on the in Flanders, Belgium. Two-thirds of students (64%) watched
same cohort, Casswell and Zhang (1998) followed 630 aged music videos at least several times a week, and about one-third
18 beer drinkers until age 21 years, and found that liking of watched daily. The quantity of alcohol consumed while going
alcohol advertisements at age 18 predicted beer consumption out at follow-up period related to overall TV viewing (β =
at age 21 [standardized coefficient 0.36 (SE = 0.06, T = 6.6)]. 0.068, t = 3.46, P = 0.001) and music video exposure (β =
The measure of liking of alcohol advertising was based on 0.073, t = 3.05, P = 0.004).
responses to three items: ‘alcohol advertisements have plenty Ellickson et al. (2005) studied the impact of exposure to dif-
of action’; ‘alcohol advertisements show the type of people I ferent forms of alcohol advertising on the initiation of alcohol
admire’; ‘Comparing alcohol adverts generally with other ads, use and the frequency of drinking amongst existing drinkers,
which of the following you most agree with?’ Based on the and whether exposure to a prevention programme mitigates any
same cohort, Casswell et al. (2002) studied 714 participants such relationship amongst US adolescents aged 12–13 years.
who were alcohol drinkers at ages 18, 21 and 26 years, and Forty-eight percent of 1206 grade 7 non-drinkers consumed
found that liking of alcohol advertisements at age 18 did not alcohol during the previous year at grade 9. Bivariate rela-
predict trajectories of quantities of alcohol consumed per occa- tionships found a signicant impact of all types of alcohol ad-
sion for both men and women over the age 18–26 years. Liking vertisement exposure on initiation of drinking. Controlled for
of alcohol advertisements at age 18 marginally predicted being main confounders, including exposure to all different types
in a higher trajectory for the frequency of drinking for men of advertising and the impact of the prevention programme,
(OR = 1.6, P = 0.0706), but not for women over the age 18– exposure to beer concession stands at sports or music events
26 years. predicted the drinking onset for non-drinkers in the previous
Robinson et al. (1998) studied the impact of media expo- 12 months (OR = 1.42, P < 0.05), whereas exposure to TV beer
sure (TV, music video and videotape viewing, and computer adverts (OR = 1.05, P > 0.05), magazines with alcohol adver-
and video game use) on initiation of alcohol use and mainte- tisements (OR = 1.12, P > 0.05) and exposure to in-store
nance of drinking among existing drinkers amongst 1533 14- advertisements (OR = 1.06, P > 0.05) did not. Weekly tele-
to 15-year olds from six public high schools in California. vision viewing, controlled for alcohol advertisement exposure,
During 18-months follow-up, 325 (36%) baseline non-drinkers was inversely related to the onset of drinking, explained as a
initiated drinking and 322 (51%) drinkers continued drinking. ‘babysitter’ effect, whereby youth who watch more TV have
Controlling for the effects of age, gender, ethnicity, and the ex- fewer opportunities to drink. Seventy-seven percent of 1905
posure to other media, each 1-h increase per day in television grade 7 drinkers consumed alcohol in the previous year at
viewing was associated with a 9% increased risk for initiating grade 9. Exposure to beer concession stands at sports or music
drinking [OR = 1.09 (1.01–1.18)]. Each 1-h increase per day events predicted the frequency of drinking amongst existing
in watching music videos was associated with a 31% increased drinkers in the previous 12 months (coefficient = 0.09, P <
risk for initiating drinking [OR = 1.31 (1.17–1.47)]. During 0.05), as did exposure to magazines with alcohol advertise-
18-month follow-up, 322 (51%) drinkers continued drinking. ments (coefficient = 0.10, P < 0.05), whereas exposure to TV
There were no significant associations between media exposure beer adverts (coefficient = −0.01, P > 0.05) and exposure to
and the maintenance of drinking. in-store advertisements (coefficient = 0.02, P > 0.05) did not.
Stacy et al. (2004) studied the impact of TV alcohol commer- Snyder et al. (2006) studied the impact of alcohol adver-
cials on alcohol use amongst 2250 12- to 13-year-old school tising expenditures and the degree of exposure to alcohol ad-
children in California. At baseline, 16% reported drinking beer, vertisements (TV, radio, outdoor advertising and magazines)
15% wine and 8% three-drink episodes in the past month. At on alcohol use amongst 15- to 26-year olds in 24 Nielsen
12-month follow-up, the prevalence was 18% reported drink- local geographical media markets (a company that tracks media
240 Anderson et al.
exposure) in USA. Individuals were randomly sampled within period was 1.74 (1.37–2.19) for girls and 1.78 (1.36–2.33) for
households and households within media markets. Local ge- boys for those who owned or were willing to use an alcohol
ographical markets were systematically selected from the top promotion item compared with those who did or would not.
75 media markets in the US representing 79% of the popu- Out of 611 drinking girls, 149 (24%) and out of 384 drinking
lation. For those aged <21 years, each additional alcohol ad- boys, 112 (29%) engaged in binge drinking. The odds ratio of
vertisement seen increased the number of drinks consumed in binge drinking amongst drinkers was 1.79 (1.16–2.77) for girls
the previous month by 1% (event rate ratio = 1.01, 95% CI: and 0.87 (0.51–1.48) for boys for those who owned or were
1.001–1.021). Each additional dollar per capita spent on alco- willing to use an alcohol promotion item compared with those
hol advertisements increased the number of drinks consumed who did or would not.
in the previous month by 2.8% (event rate ratio = 1.028, 95% Pasch et al. (2007) investigated the impact of exposure of
CI: 1.002–1.056). Seeing more or fewer advertisements in a outdoor alcohol advertisements within 1500 feet (457 m) of 63
particular month than he or she typically saw was a predictor of Chicago school sites of 61 schools that were part of Project
drinking (event rate ratio = 1.002, 95% CI: 1.001–1.003). The Northland Chicago, a randomized controlled trial of an alco-
study has been criticized for the attrition in the study sample hol use prevention programme. On average, each school site
(from 1872 at wave one to 588 at wave four), and for confusing had 14.8 alcohol advertisements within 1500 feet (457 m). Out
correlation with causality (Schultz, 2006; Smart, 2006). How- of 2586, 2027 (78%) students followed up were non-users of

ever, attrition was greatest among the heaviest drinking segment alcohol at baseline, but initiation of alcohol use was not re-
of the sample, suggesting under-estimation in the findings, and ported. The exposure to alcohol advertisements at sixth grade
although the study provided associational, prospective evidence did not predict alcohol behaviour amongst sixth grade alcohol
on alcohol advertising effects on youth drinking, it addressed users and non-users at eighth grade, but, amongst sixth grade
limitations of other research, particularly the unreliability of non-users, did predict at eighth grade intentions to use (e.g. ‘do
exposure measures based on self-reporting (Snyder and Slater, you think you will be drinking alcohol in the next month’),
2006). f = 6.29, P = 0.01; and outcome expectancies, f = 4.62,
Sargent et al. (2006) conducted a randomized school-based P = 0.03.
cross-sectional survey, with longitudinal follow-up amongst Henriksen et al. (2008) used a non-random longitudinal sur-
2406 non-drinkers at baseline 12–26 months later, to evaluate vey to investigate the influence of alcohol advertising and pro-
the impact of exposure to alcohol use in popular contemporary motions on the initiation of alcohol use amongst 1080 non-
movies and incident alcohol drinking. Baseline median expo- drinking students. Twenty-nine percent of never drinkers at
sure to alcohol use in 601 movies was 8.6 h, [inter-quartile range baseline had initiated alcohol use at follow-up. Brand recogni-
(IQR) = 4.6–13.5]. Out of 2406 students, 357 (15%) initiated tion, OR = 1.15 (1.02–1.29); brand recall, OR = 1.16 (1.05–
drinking alcohol. Exposure predicted the use of alcohol during 1.29); and high receptivity to alcohol marketing, OR = 1.77
the follow-up period (OR = 1.15, 95% CI: 1.06–1.25). The (1.27–1.48) predicted initiation. When receptivity to alcohol
analysis with quadratic exposure effect (OR = 0.996, 95% CI: marketing was controlled, recall and recognition no longer sta-
0.992–0.999) showed that the relationship between exposure tistically significantly predicted alcohol initiation.
of alcohol use in motion pictures and initiation of alcohol use Hanewinkel and Sargent (2008) studied the impact of ex-
was stronger among adolescents in lower exposure categories. posure to alcohol use in movies on initiation of alcohol use
Collins et al. (2007) carried out a school-based longitudi- amongst 3432 never drinking German adolescents. Estimated
nal survey that evaluated the impact of exposure of alcohol mean movie alcohol exposure was 3.2 h, subsequently di-
marketing on beer use amongst 1786 grade 6 students (11- to vided into four quartiles. One-third (33%) of students initiated
12-year olds) 1 year later. Seventeen percent reported past year drinking without parental knowledge and 14% initiated binge
beer drinking at grade 7. The odds ratios (95% CI) for beer drinking (five or more drinks within 2 h) over 12- to 13-month
drinking were ESPN cable network (an American cable televi- follow-up. Compared with quartile 1, the adjusted RRs (95%
sion network dedicated to broadcasting and producing sports- CI) for drinking without parental knowledge were 1.42 (1.16–
related programming 24 h a day) 1.08 (0.83–1.42); other sports 1.74) for Q2, 1.94 (1.65–2.28) for Q3, and 2.0 (1.69–2.37)
beer ads 1.19 (1.01–1.40); other TV beer ads 1.13 (0.95–1.34); for Q4; and for binge drinking 1.44 (0.96–2.17) for Q2, 1.95
magazine reading 0.96 (0.87–1.06); radio listening 1.17 (1.00– (1.27–3.0) for Q3, and 2.23 (1.48–3.37) for Q4. The un-adjusted
1.37); beer concessions 1.01 (0.91–1.13); in-store beer displays dose–response curve showed that the response was greatest for
1.03 (0.92–1.14); beer promotional items 1.76 (1.23–2.52). The relatively low exposure adolescents. Adjusting for covariates
joint effect of exposure to advertisements from all sources: accentuated this effect, because the attenuation was larger for
F(8, 28) = 8.36, P < 0.0001, and from three TV sources: the highly exposed adolescents; this was probably due to risk
F(3, 33) = 3.35, P < 0.05. Twenty percent of youth in the 75th factors for alcohol use tending to cluster among the high ex-
percentile of alcohol marketing exposure at grade 6 reported posure adolescents who are at risk for alcohol use for reasons
past year beer drinking at grade 7, compared with 13% in the other than their excessive media exposure. In another study,
25th percentile. Hanewinkel et al. (2008) found a positive dose–response rela-
Fisher et al. (2007) conducted a non-random, prospective tionship between lack of parental movie restriction and risk of
cohort study to investigate the impact of ownership of or will- initiation of binge drinking amongst the same sample.
ingness to use an alcohol promotional item on the initiation Wills et al. (2008) studied the impact of exposure to alco-
of alcohol use and binge drinking (five or more alcohol drinks hol use in movies on ever use of alcohol, binge drinking and
over a few hours at least once over the past year). Out of 3283 alcohol-related problems amongst a random sample of 6522 US
girls, 611 (19%) and of 2228, 384 boys (17%) initiated alcohol 10- to 14-year olds. A previous survey had shown that 83% of
use. The odds ratio of alcohol initiation during the 12-month movies viewed by the sample, including 57% of movies rated
as acceptable for child viewing, depicted alcohol use, with relationship between hours of movie alcohol exposure and initi-
over half (52%), including one in five (19%) of child accept- ation of drinking without parental knowledge and binge drink-
able movies, containing at least one alcohol brand appearance, ing, steeper for low hours of exposure than higher; the study by
exposing the adolescents on average to 5.6 h of movie use Sargent et al. (2006) found a linear association between movie
and 244 alcohol brand appearances (Cin et al., 2008). In the exposure portraying alcohol use and onset of alcohol use from
impact study, viewed alcohol use in movies averaged 31 min zero incidence at zero exposure to an incidence of 20% when
at baseline, 34 min at 8-month follow-up, and 30 minutes at exposure reached 11 h. Two (Robinson et al., 1998; Ellickson
16-month follow-up. Movie alcohol exposure at baseline pre- et al., 2005) of the three studies that measured the impact of ex-
dicted alcohol use at 8 months (coefficient = 0.1). Movie al- posure on maintenance of drinking amongst baseline drinkers
cohol exposure between baseline and 8 months did not pre- included an interval level exposure measure, one of which
dict alcohol use at 8 months (coefficient = −0.03) but did (Ellickson et al., 2005) found a dose–response relationship with
predict alcohol problems at 16 months (coefficient = 0.13). the frequency of drinking. Six of the seven studies (Connolly
Movie alcohol exposure between 8 and 16 months predicted et al., 1994; Stacy et al., 2004; Van den Bulck and Beullens
alcohol use at 16 months (coefficient = 0.08). At all times, 2005; Sargent et al., 2006; Snyder et al., 2006; Pasch et al.,
alcohol use predicted alcohol problems and there were signif- 2007) on alcohol use of the total sample of non-drinkers and
icant indirect and independent effects of movie exposure at drinkers at baseline included an interval level exposure mea-

baseline, 8 and 16 months on alcohol problems at 24 months. sure, and all studies found a dose–response relationship. For
Using the same cohort, McClure et al. (2008) studied the im- example, in the study by Stacy et al. (2004), each one standard
pact of ownership of alcohol branded merchandise (ABM) on deviation increase in alcohol advertising exposure was asso-
initiation of alcohol use and binge drinking. ABM ownership ciated with a 44% increase in odds of beer drinking, a 34%
increased from 11% at baseline [the 8-month measurement pe- increase in odds of wine/liquor drinking and a 26% increase in
riod reported by Wills et al. (2008)] to 20% 16 months later. odds of consuming three or more drinks on one occasion dur-
Ten percent of adolescents tried drinking for the first time and ing the previous 30 days; in the study by Snyder et al. (2006)
5% tried binge drinking during each of the two 8-month peri- of US individuals aged 15–26 years, for each additional ad-
ods. There was a reciprocal relationship between susceptibility vertisement seen, the number of drinks consumed increased by
to alcohol use (three survey items that assessed response to 1%, and for each additional dollar spent per capita on alcohol
peer offers, intentions and positive expectancies) and ABM advertisements, the number of drinks consumed increased by
ownership. The ownership of ABM at baseline did not have a 3%; in the study by Collins et al. (2007), youth in the 75th
significant direct impact on alcohol initiation at 8 months (HR percentile of alcohol marketing exposure at grade 6 were 50%
= 1.41, 95% CI: 0.98–2.01), nor on alcohol initiation between more likely to be drinking at grade 7 than youth in the 25th per-
8 and 16 months (HR = 1.57, 95% CI: 0.99–2.5), but did on centile; finally, in the study by Pasch et al. (2007), the greater
initiation of binge drinking at 8 months (HR = 1.80, 95% CI: the exposure to outdoor advertising near schools, the greater
1.28–2.54), but not on initiation of binge drinking between 8 the intention to drink (although, this study found no impact on
and 16 months (HR = 1.44, 95% CI: 0.90–2.31). New own- drinking behaviour, possibly due to a lack of statistical power).
ership of ABM at 8 months had a significant direct impact on It is clear, therefore, that longitudinal studies demonstrate that
alcohol initiation at 16 months (HR = 2.31, 95% CI: 1.6–3.35) alcohol advertising, amongst other factors, encourages youth
and initiation of binge drinking at 16 months (HR = 2.22, 95% drinking.
CI: 1.49–3.32). As explained in the introduction, this review focused on lon-
gitudinal studies because the dimension of time makes them
a particularly powerful way of untangling cause and effect.
DISCUSSION Nonetheless, cross-sectional studies, although only providing
a snapshot of advertising exposure and levels of drinking, have
This review identified 13 longitudinal studies that have investi- consistently reported correlations between increased exposure
gated the relationship between adolescent exposure to alcohol and greater likelihood of current drinking (see Kuo et al., 2003;
advertising and promotion and drinking. Twelve of the thirteen McClure et al., 2006; Hanewinkel et al., 2007; Hurtz et al.,
studies found evidence that such exposure predicts both the 2007). For example, the cross-sectional study of Hanewinkel
onset of drinking amongst non-drinkers and increased levels of et al. (2007) found a dose–response relationship between ex-
consumption among existing drinkers. In each case, researchers posure to alcohol use from popular contemporary movies and
controlled for key confounding variables, including family and alcohol use without parental knowledge and binge drinking in
peer drinking, and relevant demographic variables. The study Germany. Therefore, despite their inherently weaker design,
that did not find an effect on behaviour examined the impact cross-sectional studies do corroborate the effects found by lon-
of exposure to outdoor advertising placed within 453 metres gitudinal studies. Advertising influences youth drinking.
of schools (Pasch et al., 2007). This study found an impact of Furthermore, both cross-sectional and longitudinal studies
exposure on intentions to drink in the next month. are likely to underestimate any effects, because they focus prin-
Seven (Robinson et al., 1998; Ellickson et al., 2005; Sargent cipally on advertising, which is only a part of the promotional
et al., 2006; Hanewinkel and Sargent, 2008; Henriksen et al., effort that is put behind alcohol products. As noted in the intro-
2008; Wills et al., 2008) of the eight studies that measured the duction, for instance, the most recent estimate for expenditure
impact of exposure on initiation of drinking included an inter- on alcohol advertising in the UK is actually only a quarter
val or continuous level exposure measure, and all seven studies of that for alcohol promotion as a whole. While some of the
found a dose–response relationship. For example, in the study selected studies looked at promotion (e.g. merchandising) as
by Hanewinkel and Sargent (2008), there was a dose–response well as advertising, none looked at the cumulative impact that
242 Anderson et al.
a coherent and fully fledged ‘marketing communications mix’ Austin EW, Pinkleton BE, Fujioka Y. (2000) The role of interpre-
(Kotler et al., 2005) may have. This communication effort is, tation processes and parental discussion in the media’s effects on
in turn, only part of a company’s marketing strategy that also adolescents’ use of alcohol. Pediatrics 105:343–9.
Bonomo YA, Bowes G, Coffey C et al. (2004) Teenage drinking and
includes price promotions, packaging, distribution and product the onset of alcohol dependence: a cohort study over seven years.
design. Addiction 99:1520–8.
Three limitations should be considered in interpreting the re- Bonomo Y, Coffey C, Wolfe R et al. (2001) Adverse outcomes of
sults of this review. First, it included 13 studies that are compar- alcohol use in adolescents. Addiction 96:1485–96.
Booth A, Brennan A, Meier PS et al. (2008) The independent re-
atively heterogeneous. We controlled for quality by including view of the effects of alcohol pricing and promotion. Sheffield:
only longitudinal studies that followed a cohort of individu- School of Health and Related Research. http://www.dh.gov.uk/en/
als. We did not attempt to quantify the quality of other study Consultations/Liveconsultations/DH_086412. (October 2008, date
characteristics. One of the limitations of observational stud- last accessed).
ies is the relationship between the variables of interest and Casswell S. (1995) Does alcohol advertising have an impact on public
health? Drug Alcohol Rev 14:395–404.
other confounding factors. Whilst all the studies to some ex- Casswell S, Pledger M, Pratap S. (2002) Trajectories of drinking from
tent, measured and controlled for other variables likely to be 18 to 26 years: identification and prediction. Addiction 97:1427–
associated with drinking uptake, it is impossible to know if all 37.
relevant variables were measured and adjusted for, and thus Casswell S, Zhang J. (1998) Impact of liking for advertising and brand

allegiance on drinking and alcohol-related aggression: a longitudi-
not possible to know if residual confounder influenced the nal study. Addiction 93:1209–17.
analysis. Chen MJ, Grube JW. (2002) TV beer and soft drink advertising: what
Second, there is a possibility that publication bias may have young people like and what effects? Alcohol Clin Exp Res 26:900–6.
affected the studies identified for inclusion. Other cohort stud- Chen MJ, Grube JW, Bersamin M et al. (2005) Alcohol advertis-
ies that examined the relationship between advertising exposure ing: what makes it attractive to youth? J Health Commun 10:553–
65.
and youth drinking but found no association may not have been Cin SD, Wirth KA, Dalton MA et al. (2008) Youth exposure to al-
published or may have been published with no reference to ad- cohol use and brand appearances in popular contemporary movies.
vertising and so would not be retrieved by our search strategy. Addiction 103(12):1925–1932.
Third, the way in which exposure to advertising was opera- Collins RC, Ellickson PL, McCaffrey D et al. (2007) Early adolescent
exposure to alcohol advertising and its relationship to underage
tionalized varied across studies (e.g. receptivity, influence and drinking. J Adolesc Health 40:527–34.
awareness). An important methodological challenge in evaluat- Collins RL, Schell T, Ellickson PL et al. (2003) Predictors of beer
ing evidence on the effect of advertising on drinking behaviour advertising awareness among eighth graders. Addiction 98:1297–
of adolescents is to achieve standardization and consistency in 306.
measuring of exposure to alcohol advertising (for an example Connolly GM, Casswell S, Zhang JF et al. (1994) Alcohol in the mass
media and drinking by adolescents: a longitudinal study. Addiction
of standardization, see Jernigan and Ross (2007)). 89:1255–63.
Currie C, Roberts C, Morgan A et al. (2004) Health Behaviour in
School-Aged Children (HBSC) Study: International Report from
CONCLUSION the 2001/2002 Survey. Copenhagen: WHO.
De Bellis MD, Clark DB, Beers SR et al. (2000) Hippocampal volume
in adolescent-onset alcohol use disorders. Am J Psychiatry 157:737–
This review found consistent evidence to link alcohol adver- 44.
tising with the uptake of drinking among non-drinking young Ellickson PL, Collins RL, Hambarsoomians K et al. (2005) Does
people, and increased consumption among their drinking peers. alcohol advertising promote adolescent drinking? Results from a
longitudinal assessment. Addiction 100:235–46.
This evidence comes from high quality longitudinal studies and Englund MM, Egeland B, Oliva EM et al. (2008) Childhood and
is corroborated by weaker cross-sectional ones. Because it fo- adolescent predictors of heavy drinking and alcohol use disorders
cuses on mass media advertising, it almost certainly underes- in early adulthood: a longitudinal developmental analysis. Addiction
timates the impact of wider alcohol promotion and marketing. 103(Suppl 1):23–35.
These findings are not surprising: exactly the same conclusions Fisher LB, Williams Miles I, Austin B et al. (2007) Predictors of
initiation of alcohol use among US adolescents findings from a
have emerged from reviews of the impact of tobacco (Lovato prospective cohort study. Arch Pediatr Adolesc Med 161:959–66.
et al., 2003) and food (Hastings et al., 2003) marketing on Hanewinkel R, Morgenstern M, Tanski SE et al. (2008) Longitudinal
young people. study of parental movie restriction on teen smoking and drinking in
Germany. Addiction 103(10):1722–1730.
Hanewinkel R, Sargent JD. (2009) Longitudinal study of exposure to
REFERENCES entertainment media and alcohol use among German adolescents.
Pediatrics in press.
Aitken PP. (1988) Children and cigarette advertising. In White P (ed). Hanewinkel R, Tanski SE, Sargent JD. (2007) Exposure to alcohol use
Pushing Smoke: Tobacco Advertising and Promotion. Copenhagen: in motion pictures and teen drinking in Germany. Int J Epidemiol
World Health Organization Regional Office for Europe and the 36:1068–77.
Commission of the European Communities, 33–68. Harrison L, Godfrey C. (1989) Alcohol advertising controls in the
Aitken PP, Eadie DR, Leathar DS et al. (1988) Television advertise- 1990’s. Int J Advert 8:167–80.
ments for alcoholic drinks do reinforce under-age drinking. Br J Hastings GB, Stead M, McDermott L et al. (2003) Review of re-
Addict 82:1399–419. search on the effects of food promotion to children—final report
Anderson P, Baumberg B. (2006) Alcohol in Europe: A Pub- and appendices. Prepared for the Food Standards Agency. Published
lic Health Perspective. http://ec.europa.eu/health/ph_determinants/ on Food Standards Agency website. Available at http://www.food.
life_style/alcohol/documents/alcohol_europe.pdf (June 2008, date gov.uk/multimedia/pdfs/foodpromotiontochildren1.pdf (28 April
last accessed). 2005, date last accessed).
Austin EW, Knaus C. (2000) Predicting the potential for risky be- Henriksen L, Feighery EC, Schleicher NC et al. (2008) Receptivity
havior among those ‘too young’ to drink as the result of appealing to alcohol marketing predicts initiation of alcohol use. J Adolesc
advertising. J Health Commun 5:13–27. Health 42:28–35
Hibell B, Andersson B, Bjarnason T et al. (2004) The ESPAD Report Saffer H. (1996) Studying the effects of alcohol advertising on con-
2003: Alcohol and Other Drug Use Among Students in 35 European sumption. Alcohol Health Res World 20:266–72.
Countries. Stockholm, Sweden: The Swedish Council for Informa- Sargent JD, Willis TA et al. (2006) Alcohol use in motion pictures and
tion on Alcohol and Other Drugs (CAN) and The Pompidou Group its relation with early-onset teen drinking. J Stud Alcohol 67:54–65.
at the Council of Europe. www.espad.org Schultz DE. (2006) Challenges to study on alcohol advertising effects
Hurtz SQ, Henriksen L, Wang Y et al. (2007) The relationship be- on youth drinking. Arch Pediatr Adolesc Med 160:857.
tween exposure to alcohol advertising in stores, owning alcohol Smart RG. (2006) Limitations of study on alcohol advertising effects
promotional items, and adolescent alcohol use. Alcohol Alcohol on youth drinking. Arch Pediatr Adolesc Med 160:857.
42:143–9. Smith LA, Foxcroft DR. (2007) The effect of alcohol advertising
Jefferis BJMH, Powwer C, Manor O. (2005) Adolescent drinking and marketing on drinking behaviour in young people: a sys-
level and adult binge drinking in a national birth cohort. Addiction tematic review. Available at http://www.aerc.org.uk/documents/pdf/
100:543–9. finalReports/051_Effect_of_alcohol_advertising.pdf.
Jernigan D. (2006) The Extent of Global Alcohol Marketing and Its Snyder LB, Fleming-Milici F, Slater M et al. (2006) Effects of alco-
Impact on Youth. Background Paper Prepared for the World Health hol advertising exposure on drinking among youth. Arch Pediatr
Organization. Geneva: World Health Organization. Adolesc Med 160:18–24.
Jernigan D, Ross C. (2007) Measurement issues in underage youth Snyder L, Slater M (2006) In Response. Arch Pediatr Adolesc Med
exposure to advertising on television. http://www.camy.org/action/ 160:858.
pdf/TelevisionMonograph.pdf (October 2008, date last accessed). Spear L. (2002) Adolescent brain and the college drinker: Biological
Kotler P, Wong V, Saunders J et al. (2005) Integrated marketing com- basis of propensity to use and misuse alcohol. J Stud Alcohol Suppl

munication strategy. In Kotler P, Wong V, Saunders J, Armstrong G, 14:71–81.
(eds). Principles of Marketing. 4th European edn. Harlow: Pearson Stacy AW, Zogg JB, Unger JB et al. (2004) Exposure to televised
Education, 717–57. alcohol ads and subsequent adolescent alcohol use. Am J Health
Kuo M, Wechsler H, Greenberg P et al. (2003) The marketing of Behav 28:498–509.
alcohol to college students: the role of low prices and special pro- Tapert SF, Cheung EH, Brown GG et al. (2003) Neural response to
motions. Am J Prev Med 25:204–11. alcohol stimuli in adolescents with alcohol use disorder. Arch Gen
Lovato C, Linn G, Stead LF et al. (2003) Impact of tobacco advertis- Psychiatry 60:727–35.
ing and promotion on increasing adolescent smoking behaviours. The Drink Pocket Book. (2006) http://store.warc.com/DisplaySection.
The Cochrane Database of Systematic Reviews, Issue 3. Art. no. aspx?ProductID=538.
CD003439. doi: 10.1002/14651858.CD003439. UK Cabinet Office. (2003) Interim Analytical Report, Strat-
McClure AC, Dal Cin S et al. (2006) Ownership of alcohol-branded egy Unit Alcohol Harm Reduction Project. London: Prime
merchandise and initiation of teen drinking. Am J Prev Med 30:277– Minister’s Strategy Unit (http://www.strategy.gov.uk/files/pdf/SU%
83. 20interim_report2.pdf).
McClure AC, Stoolmiller M, Tanski SE et al. (2009) Alcohol branded Van Den Bulck J, Beullens K. (2005) Television and music video ex-
merchandise and its association with drinking attitudes and out- posure and adolescent alcohol use while going out. Alcohol Alcohol
comes among US adolescents. Arch Pediatr Adolesc Med in press. 40:249–53.
Pasch KE, Komro KA, Perry CL et al. (2007) Outdoor alcohol ad- Wells JE, Horwood LJ, Fergusson DM. (2004) Drinking patterns in
vertising near schools: what does it advertise and how is it related mid-adolescence and psychosocial outcomes in late adolescence
to intentions and use of alcohol among young adolescents? J Stud and early adulthood. Addiction 99:1529–41.
Alcohol Drugs 68:587–96. Wills TA, Sargent JD, Gibbons FX et al. (2009) Movie exposure
Pitkänen T, Kokko K, Lyyra A-L et al. (2008) A developmental ap- to alcohol cues and adolescent alcohol problems: a longitudinal
proach to alcohol drinking behaviour in adulthood: a follow-up analysis in a national sample. Psychol Addict Behav in press.
study from age 8 to age 42. Addiction 103(Suppl 1):48–68. Wingood GM, DiClemente RJ, Bernhardt JM et al. (2003) A prospec-
Robinson TN, Chen HL, Killen JD. (1998) Television and music video tive study of exposure to rap music videos and African American
exposure and risk of adolescent alcohol use. Pediatrics 102:e54–9. female adolescents’ health. Am J Public Health 98:437–9.

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Alcohol & Alcoholism Vol. 44, No. 3, pp. 229–243, 2009 doi: 10.

SPECIAL ISSUE: THE MESSAGE AND THE MEDIA

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INTRODUCTION mid-teens tend to be the ones with heavier consumption, alcohol

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Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use

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Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use

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Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use

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