Association Between Adolescent Viewership and

Alcohol Advertising on Cable Television

Paul J. Chung, MD, MS, Craig F. Garfield, MD, MAPP, Marc N. Elliott, PhD,
Joshua Ostroff, BA, Craig Ross, MBA, David H. Jernigan, PhD,
Katherine D. Vestal, MPH, and Mark A. Schuster, MD, PhD

The research aims to study whether the incidence of alcohol ads on

national cable networks was associated with viewership audiences aged 12
to 20 years. Evidence suggests that alcohol advertising influences underage
drinking. A longitudinal study found that both regional alcohol advertising
expenditures and individual exposure to alcohol ads were associated with
subsequent underage drinking.
Television is the most heavily used form of media among adolescents.
The average child aged 8 to18 years watches 3 hours of television per day. In
particular, cable television has rapidly supplanted broadcast television as
this age groups dominant medium. Similarly, alcohol advertising on cable
has increased dramatically. As both underage viewers and alcohol
advertisers have turned toward cable, total exposure of underage viewers to
alcohol ads has increased, with cable becoming the largest source of
exposure of underage viewers.
The researchers obtained television viewership data from Nielsen
Media Research (NMR) for each alcohol ad appearing on a national cable
network from 2001 to 2006 (unpublished data, Nielsen Media Research, Inc.,
20022006). NMR measures television audiences for national networks by
using a representative sample of about 9000 households (>18000 persons).
They received aggregate viewership data broken down into NMR-defined
categories for age, gender, race/ethnicity, and household income. Only
product ads were considered, as opposed to advertiser-sponsored public
service announcements (e.g., Drink responsibly) or corporate or event
messages (e.g., We are proud to honor ourOlympic athletes).
Alcohol brands were classified as beer (including ale), spirits, alcopops,
or wine by Impact Databank, a market research firm serving the alcohol
industry.2527 Alcopops (e.g., Mikes Hard Lemonade, Smirnoff Ice) are
commonly referred to as low-alcohol refreshers, malternatives, flavored malt
beverages, or ready-to-drink flavored alcoholic beverages.28
Ad and expenditure data were obtained from Nielsen Monitor-Plus
(unpublished data,
Nielsen Monitor-Plus, Nielsen Media Research, Inc., 20022006). This data set
included the date, time, network, alcohol brand, and cost of each ad from
2001 to 2006. The time each ad appeared was classified by using a
conventional television classification system of dayparts
defined by time of day and weekday versus weekend (Ad and expenditure
Using advertising industry data from Nielsen Media Research, researchers
examined all 600,000 national cable alcohol ads shown from 2001 through
2006 to audiences with less than 30 percent of viewers between the ages of

12 and 20 ) after controlling other demographic variables. Among the

findings:
Audiences with a higher percentage of youth between the ages of 12
and 20 were exposed to a higher frequency of alcohol ads, even after
accounting for other factors that might explain ad placement
decisions.
Each 1-percentage-point increase in adolescent viewership was
associated with a 7-percent increase in beer ads, a 15-percent
increase in spirits ads and a 22-percent increase in ads for lowalcohol refreshers/alcopops flavored alcoholic beverages that taste
similar to juice or soda.
In contrast, wine ads decreased by 8 percent with each 1percentage-point increase in adolescent viewership; this finding
suggests that alcohol advertisers can, in fact, successfully avoid
adolescent audiences.
This study had unique strengths. It captured a census, rather than
merely a sample, of alcohol advertising on cable; focused on national cable,
which accounts for almost all nationally televised alcohol ads, airs numerous
ads from all 4 alcohol industries (versus national broadcast television, which
is used mainly by beer advertisers), and is growing as an alcohol advertising
venue much faster than other types of television (i.e., national broadcast,
local broadcast). The use of Nielsen data allowed the researchers to
examine many of the same viewership demographics used by alcohol
advertisers, was an additional strength.
The study may have been limited because it didn't include national
broadcast statistics. Beer expenditures, for example, remain greater on
broadcast than on cable channels. And the study could not address whether
the association between ad incidence and adolescent viewership was
intentional.
The study showed that across the vast majority of time slots,
adolescent viewers, especially girls, were exposed to more beer, spirits, and
alcopop ads on cable television than would be expected through incidental
exposure. This finding suggests that the underage viewership threshold of
30% adopted by the various industries has been ineffective in reducing
adolescent exposure to ads. Moreover, the wine industrys relative success in
reaching young adults while avoiding adolescents suggests that more-careful
discrimination between the 2 groups may be possible. Which regulatory
strategy would be most effective is unclear; one study suggests that a 15%
threshold (recommended by the Institute of Medicine and 20 state attorneys
general) might substantially reduce adolescent exposure.36 Regardless,
given the growing evidence of alcohol advertisings effect on underage
drinking, underage drinkings public health impact, and the industrys current
ineffectiveness in reducing exposure of underage viewers to alcohol ads,

more-stringent guidelines may be indicated, and ongoing monitoring of

industry self-regulation is warranted.

REACTIONS:
Many teenagers experiment with alcohol. By the time they reach their
mid teens, around one in two consume alcohol at least occasionally while
increasing numbers drink to the point of drunkenness.
For years, alcohol has been the substance of abuse most commonly
used by teens, and the public health consequences of underage drinking are
considerable. Numerous studies and national statistics report that
adolescents are involved in a significant proportion of the injuries, violence
and crime that stem from binge drinking and other forms of alcohol abuse.
Moreover, studies have shown that starting to drink as an adolescent has
been linked with much greater risks of lifelong problem drinking.
Multiple studies suggest that alcohol ads can have substantial
influence on underage drinking attitudes and behaviors. But there's not too
much doubt that advertising and marketing affect the behavior of both
children and adults. Common sense tells us that if it didn't work, companies
probably wouldn't be spending so much money on it. So, it's a lot harder for
parents, teachers and clinicians to successfully encourage kids to delay
drinking when so many things they're seeing on television, on billboards,
on movie screens, on the Internet are telling them otherwise."
"There are many pressures on teens to drink. One very powerful
influence is advertising from television to billboards, it's everywhere. Our
study found their ability to be critically aware of advertising as well as their
ability to resist peer pressure are both key skills for avoiding alcohol," says
Dr. Jennifer A. Epstein, lead author and assistant professor of public health in
the Division of Prevention and Health Behavior at Weill Cornell Medical
College.
Indeed there is a need to standardize alcohol advertisers. Selfregulation is not working to protect young people from exposure to alcohol
advertising. Ongoing monitoring and greater restriction on when these ads
can air are needed to safeguard our youth. Various measures should be
introduced
to reduce underage exposure, including: banning alcohol
advertising during live sports programming; and further restricting the times

at which alcohol adverts can be broadcast.

It points to the idea that if we want to

decrease teen exposure to alcohol ads, we're going to need more stringent guidelines.

School can be the best instrument for these teens to recognize the
negative effects of alcohol. But, the best person to guide the teens are the
parents. They should set good example to their kids. The parents should be
familiar with their kids peer group. Where social influences conflict, young
people will tend to follow the influence most important to them. So, during
the teenage years, if parents disapprove of drinking and friends encourage it,
the likelihood is that young people will follow the example of their peer
groups, not their parents.