Reducing Adolescents' Exposure to Alcohol Advertising and Promotion During Televised Sports

According to the World Health Organization (WHO), “the global burden related to alcohol consumption, in terms of both morbidity and mortality, is considerable in most parts of the world.”¹ Globally, alcohol consumption causes 1.8 million deaths (3.2%), results in 58.3 million disability-adjusted life-years (4.0%) lost, is the leading risk factor for disease burden in low-mortality developing countries, and is the third largest risk factor in developed countries.¹ Alcohol-related problems are most apparent among young persons, with Jernigan and Mosher² arguing that such problems have “reached crisis proportions around the globe.” In the United States, a recent article³ concluded that “the prevalence and toll of underage drinking in the United States remain high,” and the US Federal Trade Commission⁴ acknowledged that “underage drinking is a leading public health and social problem in the United States, associated with the three leading causes of death among youth—unintentional injury, homicide, and suicide.”

There is increasing evidence that exposure to alcohol advertising in adolescence influences patterns of alcohol consumption, specifically heavier drinking behavior. In 2007, the Center on Alcohol Marketing and Youth reported that the alcohol industry in the United States spent more than US $923 million on 340 337 television advertisements, an increase of more than 50.8% from 2001.³ During this period, “youth aged 12 to 20 were 22 times more likely to see a product advertisement for alcohol than an alcohol-industry funded ‘responsibility’ message.”³

The media, particularly television and advertising, is an important influence on the values, attitudes, and behaviors of children and young persons, and alcohol manufacturers use advertising, sponsorship, and related promotions to market their products to adults and young persons.² Although there is some debate about the influence of alcohol marketing, research suggests a link between exposure to alcohol advertising and attitudes and behaviors related to alcohol among young persons.⁵ A number of studies have demonstrated that exposure to alcohol advertising is a predictor of the likelihood, frequency, and amount of alcohol consumption in later life. A recent review of longitudinal studies examining the association of alcohol advertising and media exposure with adolescent alcohol use concluded 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.”⁶ Although standards for causality may be impossible to meet for this particular relationship, the balance of empirical evidence to date indicates that adolescents' exposure to alcohol advertising and promotion probably leads to underage drinking.

US studies have revealed that young persons view significant hours of televised sport and consequently have considerable exposure to alcohol advertising. For example, a 2001 study of US children and sports media commissioned by the Amateur Athletic Foundation and ESPN found that more than 9 of every 10 children aged 8 to 17 years view or hear sports media.⁷ Not surprisingly, television was the most popular medium, with 88% of those surveyed reporting they view sports through television, 55% reporting they watch sports on television at least once per week, and 13% reporting they watch sports on television every day. The investigators⁷ reported that these findings were consistent with earlier research conducted in 1999. A more recent study⁸ confirmed that children “between the ages of 6 and 11 years, see a substantial amount of alcohol advertising on television and that this exposure is about equally divided between the broadcast and cable networks.” The weight of research evidence has shifted toward recognizing that advertising and promoting alcohol on television most likely influences adolescents' subsequent levels of alcohol consumption⁹ and that a substantial portion of this advertising and promotion is associated with televised sports.⁸

Despite mounting evidence of the extent to which public health issues are associated with the consumption of alcohol among adolescents, the WHO argues that “alcohol policy is rarely dictated by scientific evidence, despite major advances in the understanding of drinking patterns, alcohol-related problems, and policy interventions.”¹ The most common policy response to this problem has been for governments to support alcohol industry self-regulation in the form of a voluntary code, which typically limits the times when alcohol advertising can be broadcast. In the United States, the 3 major alcohol supplier trade associations (the Beer Institute, the Distilled Spirits Council of the United States, and the Wine Institute) have adopted voluntary advertising and marketing codes that contain provisions relating to both the content and the placement of marketing efforts.⁴ A key element of these codes is the requirement for any alcohol-related advertisement only to be broadcast if the advertiser is assured that at least 70% of the intended audience comprises adults aged 21 years or older (a reflection of the fact that only 30% of the US population is younger than 21 years). In its most recent review of the compliance rate for the codes, the Federal Trade Commission found that the majority of advertisers met this requirement and recommended no need to change this baseline requirement.⁴ In contrast, the independent Center on Alcohol Marketing and Youth reported that youth exposure to alcohol advertising on television had increased by 38% between 2001 and 2007, and concluded that the 30% threshold has not been effective in reducing youth exposure to alcohol advertising on television over that time.³

A similar view that self-regulation by the alcohol industry has failed to deliver optimal health outcomes was put forward by the Alcohol and Other Drugs Council of Australia, which argued that the self-regulation of alcohol advertising and promotion is ineffective and that alcohol advertising and sponsorship of major sporting events needs to be reviewed to discourage heavy drinking at these events.¹⁰ In its 2005 submission to the development of the National Alcohol Strategy, the Alcohol and Other Drugs Council of Australia noted that the promotion of alcohol products had increased substantially during the late 1990s and the early part of the 21st century. Under the Australian Commercial Television Industry Code of Practice, alcohol advertising may only be broadcast in Australia during classification periods in which adolescents are less likely to be watching (pay television has no restrictions on the time of day that alcohol can be advertised). However, live sports events have an exemption, so that alcohol advertisements are able to be shown as an accompaniment to a live sporting broadcast, at any time of the day on weekends and during public holidays, or if the event is broadcast from another time zone.

A recent move to address this exemption through the Alcohol Toll Reduction Bill (aimed to limit the broadcasting of alcohol advertisements on television to the hours between 9 PM and 5 AM, thereby removing the current exemption) failed to become law. The senate inquiry into the Alcohol Toll Reduction Bill concluded that the advertising of alcohol products during coverage of live sports events on commercial television was particularly concerning; however, alcohol industry groups, advertisers, and broadcasters argued that there was a lack of evidence to support changing the current regulations. Furthermore, FreeTV, the body that represents the interests of commercial television stations, argued that even though children were exposed to alcohol advertising during sports broadcasts, this did not mean children would be interested in the product, or that these advertisements were targeted at young persons.¹¹

The counterarguments put forward by the alcohol industry in both cases are counterintuitive to empirical research findings about the detrimental effects of alcohol advertising through sports on adolescent health. Since 2002, there have been repeated calls from medical and community groups to better regulate alcohol advertising. In 2002, the American Medical Association's policy paper on alcohol issues called for the alcohol industry to play a significant role in changing unhealthy social norms associated with alcohol consumption, something that might best be done through supporting real reform to advertising practices.¹² A year later, the National Research Council and Institute of Medicine of the National Academy of Science explicitly called for a reduction in underage exposure to unsuitable messages in alcohol advertising and marketing.¹³ In 2005, the Association to Reduce the Impact of Alcohol Advertising in Ontario concluded that “alcohol industry self-regulation in Canada is limited as means of preventing public harm [and that] improvements need to occur, especially to control advertisements targeting minors.”¹⁴ In 2006, the Committee on Communications from the American Academy of Pediatrics recommended changes to advertising practices to limit the amount and content of alcohol advertisements that minors view.¹⁵

Despite these calls for change and the increasing empirical evidence of the links between alcohol advertising through sports and alcohol consumption by adolescents, the amount of alcohol advertising observed by adolescents has increased, the majority of which is associated with sports broadcasts. The influence on adolescent health is likely to be exacerbated by the current global economic crisis, with governments seeking to increase alcohol taxes at the same time as media outlets are losing advertising revenues, both of which put more pressure on alcohol manufacturers and retailers to market more strategically, and potentially to flout any existing self-regulatory voluntary codes of practice.

A complete ban on all television advertising and promotion of alcohol appears to offer the greatest opportunity to reduce the exposure of adolescents to such promotional messages; however, in many countries, this is unpalatable to the respective alcohol industries, especially given their dependence on the placement of advertisements during sports programming. In the absence of concomitant bans being put in place for other media (ie, movies, Internet, print, radio), a ban of television advertising would in all likelihood merely shift the advertising focus of alcohol manufacturers and retailers (ie, as evidenced by the sharp increase in print media advertising when television advertising of tobacco was banned). A ban on alcohol advertising through sports would be an important starting point, particularly given the appeal of sports programming and celebrities among adolescents.

Many organizations and learned societies have argued for substantive public investment in counteradvertising campaigns targeting responsible drinking, enhanced restrictions on the volume and frequency of all alcohol advertising to which adolescents are exposed, the development of punitive sanctions for breaching advertising codes of practice, and a meaningful complaints process. Despite these calls for action, a major public health issue persists. The WHO concluded its 2004 alcohol policy report by noting that “the introduction or implementation of alcohol policies does require, among other things, political will, financial resources, expertise, and public awareness and support.”¹ Clearly, there is a mismatch between mounting research evidence and political will in countries like the United States, Canada, and Australia. It is time for governments to put commercial considerations aside and address a significant adolescent health issue by banning alcohol advertising and promotion through televised sports and exploring the potential usefulness of other regulatory measures.