Background

1. Understanding the causes of underage drinking is critical to identify effective interventions. Alcohol marketing is a potentially important influence on youth drinking.

Excessive alcohol consumption contributes to approximately 4,600 deaths and 275,000 years of potential life lost among underage youths annually in the United States.1-8 Some researchers have suggested that alcohol marketing has an important influence on underage drinking.5,6,9-33However, as we will show, the evidence regarding whether alcohol advertising influences youth alcohol consumption is inconsistent because no prior study has examined the influence of alcohol advertising at the brand level. The overall goal of this proposed research is to fill this critical hole in the alcohol research literature.

2. Branding plays an essential role in the alcohol marketing process and the relationship of youth to alcohol products.

Alcohol is marketed not as a general product (e.g., beer, wine, liquor), but as specific brands (e.g., Bud Light, Miller High Life, etc.). A brand is defined as “a set of associations linked to a name, mark, or symbol associated with a product or service”34 and branding is the attaching of a label and meaning to a product in order to create awareness and an image for that product.34 Branding is an essential element of alcohol marketing.19,33,35 Developing brand capital, or the meaning and emotion associated with a brand, is perhaps the most important function of alcohol advertising.19,33 Brands serve as a means of establishing a relationship between the product and the user.33,35-37 Many adolescents develop an identity with alcohol brands before they even start drinking.40 Alcohol branding affects youth’s alcohol-related attitudes39,40 What is not known, however, is whether marketing of alcohol brands affects youths’ drinking behavior.

3. The field of alcohol advertising research is severely limited because of the lack of information about youth alcohol brand preferences and the relationship of brand-specific alcohol advertising exposure to brand-specific alcohol consumption.

Existing research on whether alcohol advertising influences youth drinking has been inconclusive. While many studies suggest that exposure to alcohol advertising is associated with an increased intent to drink or an increased likelihood of drinking among underage youth,11,18-21,38,39,41-85there is also a body of research which has found little or no effect of alcohol advertising on alcohol demand.86-113 The econometric literature which examines the effect of aggregate alcohol advertising on demand is mixed, with some studies showing an effect114-117 and others not.91-113 Similarly, the literature on the effect of advertising bans on alcohol consumption is mixed, with a few studies reporting an effect,118-120 but many others failing to find one.121-131 The inconsistency of the existing literature led the National Academy of Sciences to conclude that “the evidence regarding the causal effects of alcohol advertising on underage consumption is inconclusive.”6

A possible explanation for the failure of many studies to find an effect of alcohol advertising on alcohol demand is that these studies analyzed total (i.e., aggregate) alcohol advertising and did not examine brand-specific advertising effects. However, alcohol is advertised at the brand-level (e.g., Bud Light, Miller High Life, etc.) and youth exposure varies widely by brand. Lumping all brands together–including those to which youth are hardly ever exposed–produces an averaging effect that would dilute out the observed effect of advertising for a specific brand if it were truly influencing youth consumption. In reviewing the econometric studies, Saffer argued that the examination of “product level consumption” rather than the “brand level advertising response function” is likely a major reason for the failure of much of the existing literature to find significant advertising effects.19 Saffer notes that “the product level response function differs from the brand level response function in that advertising induced sales must come at the expense of sales of products from other industries, assuming individual’s spending remains constant.”19 In other words, it is virtually impossible to detect the effects of alcohol advertising unless one specifically studies brand-specific alcohol advertising exposure.

Members of our research team have made unique advances by demonstrating, first, that examining advertising at the level of the specific beverage category (e.g., vodka, rum, whiskey, etc.) rather than overall advertising, provides preliminary evidence that not all types of alcohol are marketed to the same audience.132-134 Specifically, we found that a relationship between the presence of alcohol advertising and the proportion of youth readers in a magazine holds only for certain types of alcohol – flavored alcoholic beverages, vodka, and rum – but not for other types, such as whiskey, scotch, gin, brandy, and liqueurs. Although our studies represent an important advance, they are still limited because we had neither exposure nor consumption data at the brand level. Second, we have demonstrated that it is possible to estimate brand-specific marketing exposure of underage youth by combining brand-specific advertising data with youth audience composition data.135-165 While these studies have demonstrated that there is substantial variability in youth marketing exposure at the brand level, the absence of brand-specific youth consumption data has precluded the possibility of assessing the impact of that advertising on actual alcohol consumption among youth. For example, knowing that youth are heavily exposed to advertising by a certain alcohol brand does not necessarily imply that youth are influenced by those advertisements. If youth do not consume that brand, then the exposure is not meaningful. In order to interpret the potential impact of advertising exposure, then, we need to know whether youth are actually consuming the alcohol brands to whose advertisements they are most heavily exposed.

In other words, a full elucidation of the relationship between alcohol marketing and youth alcohol consumption is not possible unless brand-specific marketing data are examined in combination with contemporaneous data on brand-specific consumption among underage youth. To date, however, there are no available data on brand-specific alcohol consumption among underage youth. This study will fill that critical gap by providing the first nationally-available data on youth alcohol brand preferences and combining that data with state-of-the-art data on youth exposure to alcohol advertising in magazines and on television. This will allow us to conduct the most definitive analysis to date of whether alcohol advertising is linked to youth drinking behavior.

4. The use of brand-specific youth cigarette advertising and consumption data has been productive and has had substantial public health policy implications.

Drs. Siegel and King of our proposed research team played a major role in developing a new line of research in the field of cigarette advertising. In 1993, the status of cigarette advertising research was similar to the status of alcohol advertising research today. There were mixed results among studies of the relationship between youth exposure to cigarette advertising and youth smoking. Siegel and King hypothesized that a major reason for the inconsistency of results was that the previous literature examined the effects of aggregate cigarette advertising. In response, they developed a new line of research that looked specifically at brand-specific advertising in relation to brand-specific cigarette consumption among adolescents. Combining and analyzing cigarette brand preference data and data on cigarette advertising expenditures in magazines, Siegel and King developed a strong new body of evidence that cigarette advertising affects youth smoking.166-172 This scientific evidence has had substantial implications for tobacco policy, especially for the regulation of cigarette advertising. Since the 1996 publication of Dr. Siegel and colleagues’ seminal investigation,168 there has been a proliferation of cigarette brand-level research. Since 2009 alone there have been at least 11 published articles in the field of cigarette brand research.173-183 Moreover, Siegel et al.’s initiation of the field of brand-specific cigarette advertising research led to the widespread adoption of cigarette brand preference questions on national surveys, including the Monitoring the Future survey (in 1998) and the National Youth Tobacco Survey (in 1999). The research questions being posed in this proposal have similarly important policy relevance for preventing youth alcohol consumption. The scientific rigor and potential value of this type of research has already been demonstrated in the tobacco control arena.

5. Despite a widely recognized need for brand-specific youth alcohol consumption data, there are no existing published data on youth alcohol brand preferences.

In 2003, a National Academy of Sciences report on alcohol and youth recommended that the federal government collect alcohol brand preference data from underage drinkers: “The committee recommends that a market surveillance mechanism be established to monitor underage use of alcohol according to brand.”6 These data, the report affirms, would be critical to determine the influence of cigarette advertising on youth and whether regulatory intervention would be appropriate.6 However, no federal agency has collected these data and currently, there are no plans to do so. The proposed research will fill this void by providing the first nationally-available data on alcohol brand preferences among underage youths.

6. We have developed and successfully pilot tested what is, to the best of our knowledge, the first survey of alcohol brand preference among nationally-representative youth.

A major reason for the absence of studies on alcohol brand use among youth is the lack of an established methodology to collect such data. There are hundreds of major alcohol brands so researchers have assumed that it would take too long to collect such data, making brand research costly and unfeasible. In fact, our research team has developed, pilot-tested, and established the feasibility and validity of a new methodology to measure alcohol brand preferences among youth. By using a combination of carefully crafted skip patterns, piping questions, and internet forms that include lists of brands with check boxes, our survey instrument can assess alcohol brand preferences in a reasonable time frame. We conducted two pilot tests which demonstrated: (1) our ability to feasibly ascertain comprehensive data on brand-specific alcohol consumption among youth; (2) our ability to use a pre-existing internet panel to administer the survey to a nationally-representative sample of underage youth; and (3) the validity of the estimates derived from this survey methodology. We now seek funding to put this method into the field with a national sample of underage youth (ages 13-20).

7. Collecting data on youth alcohol brand preferences would contribute to alcohol epidemiology and prevention beyond its implications for the study of advertising.

Understanding the brands of alcohol that youth consume would contribute not only towards a better understanding of whether alcohol advertising preferentially reaches underage youth and affects youth drinking behavior, but also towards a better understanding of underage drinking behavior itself. First, determining the drinking patterns for specific brands of alcohol would greatly enhance our understanding of the factors that influence youth alcohol use. For example, identifying differences in alcohol brands consumed by different age groups and by youths with differing frequencies of alcohol use may provide insights into the factors that influence the progression of alcohol use behavior.

Second, our data will allow us to calculate the total monthly alcohol dose for each specific type and brand of alcoholic beverage. In particular, it will allow us to describe the alcohol brands used by heavy drinkers and to identify the relationship between the brands of alcohol consumed and problem drinking behavior, including early signs of alcohol dependence. In short, having a complete database of brand-specific alcohol consumption prevalence, including the frequency and volume of use, will allow us to provide the most comprehensive description to date of alcohol drinking behavior among youth.

Third, identifying the patterns of alcohol brand consumption among youth will help evaluate the feasibility of including alcohol brand use questions on federal or national surveys. A number of national surveys assess cigarette brand preference, which is feasible because cigarette brand use is concentrated among a relatively small number of brands. If our work demonstrates that similar to cigarette use, alcohol brand consumption is concentrated among a relatively small number of brands, this might make it feasible to assess youth alcohol brand preference in national or federal surveys because only a limited number of brands would need to be listed. We will share our alcohol brand preference data widely through a dedicated web site, so that other researchers can use these data in conducting brand-specific alcohol research.

8. Summary

In summary, the proposed research is significant because it responds to a national priority of the Institute of Medicine, filling an important gap in the scientific literature on alcohol epidemiology and prevention by providing a comprehensive picture of brand-specific alcohol consumption patterns and brand-specific alcohol advertising exposure of underage youth. This research will allow us to determine whether differential exposure to brand-specific alcohol advertising is associated with differences in alcohol brand preferences and consumption among underage youth. The research has important policy relevance for effective alcohol use prevention. Moreover, developing and demonstrating a methodology to ascertain, for the first time, alcohol brand consumption patterns among a nationally representative sample of youth could help national public health agencies and the federal government to meet the 2003 National Academy of Sciences goal of establishing a market surveillance mechanism to monitor underage use of alcohol according to brand.

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