Malt Beverage Brand Popularity Among Youth and Youth-Appealing Advertising Content

BACKGROUND

This study examined whether alcohol brands more popular among youth are more likely to have aired television advertisements that violated the alcohol industry's voluntary code by including youth-appealing content.

METHODS

We obtained a complete list of 288 brand-specific beer advertisements broadcast during the National Collegiate Athletic Association (NCAA) men's and women's basketball tournaments from 1999 to 2008. All ads were rated by a panel of health professionals using a modified Delphi method to assess the presence of youth-appealing content in violation of the alcohol industry's voluntary code. The ads represented 23 alcohol brands. The popularity of these brands was operationalized as the brand-specific popularity of youth alcohol consumption in the past 30 days, as determined by a 2011 to 2012 national survey of underage drinkers. Brand-level popularity was used as the exposure variable to predict the odds of having advertisements with youth-appealing content violations.

RESULTS

Accounting for other covariates and the clustering of advertisements within brands, increased brand popularity among underage youth was associated with significantly increased odds of having youth-appeal content violations in ads televised during the NCAA basketball tournament games (adjusted odds ratio = 1.70, 95% CI: 1.38, 2.09).

CONCLUSIONS

Alcohol brands popular among underage drinkers are more likely to air television advertising that violates the industry's voluntary code which proscribes youth-appealing content.

Re-Introducing Bunky at 125: E. M. Jellinek's Life and Contributions to Alcohol Studies

OBJECTIVE

Elvin Morton Jellinek (1890-1963) was one of the founders of modern addiction science. This overview is a brief survey of his life and achievements, intended to re-introduce alcohol scholars to his contributions (and possible failings) as well as stimulate interest and historical research in the field.

METHOD

The article draws largely from the archival collection of the Rutgers Center of Alcohol Studies (CAS) Library and the Jellinek memorial issue of the CAS Information Services Newsletter. Scholarly works and personal and institutional records by or about E. M. Jellinek were assembled and, when necessary, translated into English.

RESULTS

Born in 1890 in New York and raised in Hungary, Jellinek studied at several European universities and worked for various institutions and organizations in Budapest (1914-1920), Sierra Leone, Honduras, and at the Worcester State Hospital, in Massachusetts. In 1941 he became an associate professor of applied physiology at Yale University, where he directed the Yale Summer School of Alcohol Studies from 1941 to 1950. After more than a decade of work with the World Health Organization and several Canadian institutions, he taught and conducted research at the Institute for the Study of Human Problems at Stanford University until his death in 1963. Jellinek was a pioneer in research on the nature and causes of alcoholism and was an early proponent of the disease theory of alcoholism.

CONCLUSIONS

With the help of E. M. Jellinek, the modern era of addiction science was launched with an international outlook that included critical attention to the physical infrastructure and intellectual capital needed to form an interdisciplinary field of basic research, applied science, and clinical practice.

Associations Between Thematic Content and Industry Self-Regulation Code Violations in Beer Advertising Broadcast During the U.S. NCAA Basketball Tournament

BACKGROUND

Beer marketing in the United States is controlled through self-regulation, whereby the beer industry has created a marketing code and enforces its use. We performed a thematic content analysis on beer ads broadcast during a U.S. college athletic event and determined which themes are associated with violations of a self-regulated alcohol marketing code.

METHODS

289 beer ads broadcast during the U.S. NCAA Men's and Women's 1999-2008 basketball tournaments were assessed for the presence of 23 thematic content areas. Associations between themes and violations of the U.S. Beer Institute's Marketing and Advertising Code were determined using generalized linear models.

RESULTS

Humor (61.3%), taste (61.0%), masculinity (49.2%), and enjoyment (36.5%) were the most prevalent content areas. Nine content areas (i.e., conformity, ethnicity, sensation seeking, sociability, romance, special occasions, text responsibility messages, tradition, and individuality) were positively associated with code violations (p < 0.001-0.042). There were significantly more content areas positively associated with code violations than content areas negatively associated with code violations (p < 0.001).

CONCLUSIONS

Several thematic content areas were positively associated with code violations. The results can inform existing efforts to revise self-regulated alcohol marketing codes to ensure better protection of vulnerable populations. The use of several themes is concerning in relation to adolescent alcohol use and health disparities.

Brief intervention, three decades on

This paper provides an overview of brief intervention (BI) research to date and discusses future research needs as well as strategies for more widespread use of BI. Research has firmly established that significant reductions in drinking can be achieved by BI in a variety of health care settings. Despite convincing evidence, however, diffusion of BI in routine health care has been slow. Alcohol is a complex subject since it is often used moderately, without side-effects, and in a socially acceptable way. Although research on BI has accumulated rapidly during the last three decades, many important research challenges and development work remain before BI is widely implemented in routine health care.

Article Commentary: Alcohol policy research and the grey literature

This commentary is a tale of two international surveys dealing with alcohol policy. One was conducted by an international public health agency, the World Health Organization, the other by a “social aspect organization,” the International Center for Alcohol Policies, which is funded by the alcohol industry. Although the two studies share a similar survey methodology and common policy aims, the findings and conclusions are very different. Prevalence estimates for a variety of alcohol policies were significantly lower in the ICAP survey, suggesting possible sampling bias or poor survey design. We found the WHO report appropriately cautious in the conclusions drawn, with no instances where the interpretation did not conform reasonably well to the data reported. In contrast, the ICAP survey was faulted in the areas of transparency of the data analyses, the accuracy of the statistical reporting and interpretation of the data. In particular, the ICAP report claims that public education on alcohol was identified by 70% of respondents in “emerging” market countries, when this item was endorsed by only 38% of the sample. If there is any lesson to be learned from this “tale of two surveys,” it is that users of the grey literature need to discriminate between frivolous survey research and more serious attempts to provide accurate and useful information.

Sex And Gender Equity in Research (SAGER): reporting guidelines as a framework of innovation for an equitable approach to gender medicine. Commentary

Sex and gender are important determinants of health and influence research findings in a variety of ways, yet they are often overlooked and underreported. This oversight limits the generalizability of research findings and their applicability to clinical practice. The objective of this paper is to point out how journal editors can influence better reporting of sex and gender in research by establishing a methodological framework directly addressing authors of scientific publications, as well as referees, and indirectly affecting all the stakeholders in the research cycle, from funders to policy-makers and citizens. Such a framework is represented by the Sex And Gender Equity in Research (SAGER) guidelines, developed by the European Association of Science Editors (EASE) to encourage a more systematic approach to the reporting of sex and gender in research across disciplines. The paper includes the rationale and basic principles of the SAGER guidelines.

Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice

AIMS

This paper describes the major findings and public health implications of a cross-site evaluation of a national Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program funded by the US Substance Abuse and Mental Health Services Administration (SAMHSA).

METHODS

Eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the adoption and sustained implementation of SBIRT. The SBIRT cross-site evaluation used a multi-method evaluation design to provide comprehensive information on the processes, outcomes and costs of SBIRT as implemented in a variety of medical and community settings.

FINDINGS

SBIRT programs in the two evaluated SAMHSA cohorts screened more than 1 million patients/clients. SBIRT implementation was facilitated by committed leadership and the use of substance use specialists, rather than medical generalists, to deliver services. Although the quasi-experimental nature of the outcome evaluation does not permit causal inferences, pre-post differences were clinically meaningful and statistically significant for almost every measure of substance use. Greater intervention intensity was associated with larger decreases in substance use. Both brief intervention and brief treatment were associated with positive outcomes, but brief intervention was more cost-effective for most substances. Sixty-nine (67%) of the original performance sites adapted and redesigned SBIRT service delivery after initial grant funding ended. Four factors influenced SBIRT sustainability: presence of program champions, availability of funding, systemic change and effective management of SBIRT provider challenges.

CONCLUSIONS

The US Substance Abuse and Mental Health Services Administration's Screening, Brief Intervention and Referral to Treatment (SBIRT) demonstration program was adapted successfully to the needs of early identification efforts for hazardous use of alcohol and illicit drugs. SBIRT is an innovative way to integrate the management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy.

Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross-site evaluation

AIMS

Since 2003, the US Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA, CSAT) has awarded 32 Screening, Brief Intervention and Referral to Treatment (SBIRT) grants to states, territories and tribal organizations to enhance services for persons with, or at risk for, substance use disorders. The grants supported an expansion of the continuum of care to include screening, brief intervention, brief treatment and referral to treatment in general medical and community settings. This paper describes the SAMHSA SBIRT program in the context of the scientific research that motivated its development, as well as the two cross-site evaluations that are the subject of subsequent papers in this Supplement.

METHODS

A narrative review of research evidence pertaining to SBIRT and of the cross-site evaluation design that made it possible to determine whether the SAMHSA SBIRT grant program achieved its intended aims. The 11 programs within the two cohorts of grant recipients that were the subject of the cross-site evaluations are described in terms of SBIRT service components, performance sites, providers, management structure/activities and patient/client characteristics.

CONCLUSION

The US SAMHSA SBIRT program is an effective way to introduce a variety of new services that extend the continuum of care for substance-involved individuals, ranging from early intervention with non-dependent substance users to referral of more serious cases to specialized substance abuse treatment.

Does industry self-regulation protect young people from exposure to alcohol marketing? A review of compliance and complaint studies

BACKGROUND AND AIMS

Exposure to alcohol marketing is considered to be potentially harmful to adolescents. In addition to statutory regulation, industry self-regulation is a common way to protect adolescents from alcohol marketing exposures. This paper critically reviews research designed to evaluate the effectiveness of the alcohol industry's compliance procedures to manage complaints when alcohol marketing is considered to have violated a self-regulatory code.

METHODS

Peer-reviewed papers were identified through four literature search engines: PubMed, SCOPUS, PsychINFO and CINAHL. Non-peer-reviewed reports produced by public health agencies, alcohol research centers, non-governmental organizations, government research centers and national industry advertising associations were also included.

RESULTS

The search process yielded three peer-reviewed papers, seven non-peer reviewed reports published by academic institutes and non-profit organizations and 20 industry reports. The evidence indicates that the complaint process lacks standardization across countries, industry adjudicators may be trained inadequately or biased and few complaints are upheld against advertisements pre-determined to contain violations of a self-regulatory code.

CONCLUSIONS

The current alcohol industry marketing complaint process used in a wide variety of countries may be ineffective at removing potentially harmful content from the market-place. The process of determining the validity of complaints employed by most industry groups appears to suffer from serious conflict of interest and procedural weaknesses that could compromise objective adjudication of even well-documented complaints. In our opinion the current system of self-regulation needs major modifications if it is to serve public health objectives, and more systematic evaluations of the complaint process are needed.

Alcohol marketing in the Americas and Spain during the 2014 FIFA World Cup Tournament

BACKGROUND AND AIMS

To identify the nature of visual alcohol references in alcohol advertisements during televised broadcasts of the 2014 FIFA World Cup Tournament matches and to evaluate cross-national differences according to alcohol marketing policy restrictiveness.

DESIGN

Content analysis using the Delphi method and identification of in-game sponsorships.

SETTING

Television broadcasts of the 2014 FIFA World Cup in Argentina, Brazil, Canada, Finland, France, Mexico, Spain and the United States.

CASES

Eighty-seven alcohol advertisements; 20 matches.

MEASUREMENTS

Quantitative rating scales, combined with the Delphi rating technique, were used to determine compliance of the alcohol advertisements with the International Alliance for Responsible Drinking's (IARD) Guiding Principles. Recordings of five matches from four countries were also used to identify the number of in- and out-of-game alcohol brand appearances.

FINDINGS

A total of 86.2% of all unique alcohol advertisements contained at least one violation of IARD's Guiding Principles, with violation rates ranging from 72.7% (Mexico) to 100% (Brazil). Countries with the least restrictive marketing policies had a higher prevalence of violations in guidelines designed to protect minors. There were 2.76 in-game alcohol brand appearances and 0.83 out-of-game alcohol brand appearances per minute. Brand appearances did not differ across countries or according to a country's marketing policy restrictiveness.

CONCLUSIONS

Self-regulation and statutory policies were ineffective at limiting alcohol advertising during the 2014 FIFA World Cup Tournament television broadcasts. Most advertisements contained content that violated the self-regulation codes, and there were high levels of within-broadcast brand appearances.

Vulnerability to alcohol-related problems: a policy brief with implications for the regulation of alcohol marketing

BACKGROUND AND AIMS

The concern that alcohol advertising can have detrimental effects on vulnerable viewers has prompted the development of codes of responsible advertising practices. This paper evaluates critically the concept of vulnerability as it applies to (1) susceptibility to alcohol-related harm and (2) susceptibility to the effects of marketing, and describes its implications for the regulation of alcohol marketing.

METHOD

We describe the findings of key published studies, review papers and expert reports to determine whether these two types of vulnerability apply to population groups defined by (1) age and developmental history; (2) personality characteristics; (3) family history of alcoholism; (4) female sex and pregnancy risk; and (5) history of alcohol dependence and recovery status.

RESULTS

Developmental theory and research suggest that groups defined by younger age, incomplete neurocognitive development and a history of alcohol dependence may be particularly vulnerable because of the disproportionate harm they experience from alcohol and their increased susceptibility to alcohol marketing. Children may be more susceptible to media imagery because they do not have the ability to compensate for biases in advertising portrayals and glamorized media imagery.

CONCLUSION

Young people and people with a history of alcohol dependence appear to be especially vulnerable to alcohol marketing, warranting the development of new content and exposure guidelines focused on protecting those groups to improve current self-regulation codes promoted by the alcohol industry. If adequate protections cannot be implemented through this mechanism, statutory regulations should be considered.

Industry self-regulation of alcohol marketing: a systematic review of content and exposure research

BACKGROUND AND AIMS

With governments relying increasingly upon the alcohol industry's self-regulated marketing codes to restrict alcohol marketing activity, there is a need to summarize the findings of research relevant to alcohol marketing controls. This paper provides a systematic review of studies investigating the content of, and exposure to, alcohol marketing in relation to self-regulated guidelines.

METHODS

Peer-reviewed papers were identified through four literature search engines: SCOPUS, Web of Science, PubMed and PsychINFO. Non-peer-reviewed reports produced by public health agencies, alcohol research centers, non-governmental organizations and government research centers were also identified. Ninety-six publications met the inclusion criteria.

RESULTS

Of the 19 studies evaluating a specific marketing code and 25 content analysis studies reviewed, all detected content that could be considered potentially harmful to children and adolescents, including themes that appeal strongly to young men. Of the 57 studies of alcohol advertising exposure, high levels of youth exposure and high awareness of alcohol advertising were found for television, radio, print, digital and outdoor advertisements. Youth exposure to alcohol advertising has increased over time, even as greater compliance with exposure thresholds has been documented.

CONCLUSIONS

Violations of the content guidelines within self-regulated alcohol marketing codes are highly prevalent in certain media. Exposure to alcohol marketing, particularly among youth, is also prevalent. Taken together, the findings suggest that the current self-regulatory systems that govern alcohol marketing practices are not meeting their intended goal of protecting vulnerable populations.