Alcohol use in underage youth is prevalent and associated with serious negative health consequences (Federal Trade Commission, 2008). Alcohol is also heavily marketed; in 2005, 12 companies, representing 73% of sales by volume, reported to the Federal Trade Commission expenditures of just over $3 billion in U.S. advertising and promotions (Federal Trade Commission, 2008). Alcohol companies are bound only by voluntary codes and advertise broadly in many venues accessible to underage youth. Two comprehensive reviews (Anderson, 2009; Smith and Foxcroft, 2009) demonstrated, across 13 longitudinal studies, consistent prospective associations between exposure to alcohol marketing and underage drinking, and findings confirmed in a recent U.K. cohort (Gordon et al., 2010). The individual studies varied widely in their focus and measurement approach and offered mixed results beyond the overall conclusions presented in the reviews. For example, some associations pertained only to certain age or gender subsets (Casswell et al., 2002; Connolly et al., 1994) or applied only to certain types of alcohol (Collins et al., 2007; Ellickson et al., 2005) or drinking outcomes (Henriksen et al., 2008; Robinson et al., 1998). In addition, the reviews combined studies of movie alcohol portrayals with studies of commercial marketing. Studies of alcohol marketing per se varied widely on how the exposure was measured. This is not meant to be a critique of the literature, but to point out the complexity of this particular area of research, reflecting the broad scope of alcohol marketing in the context of the development of drinking behavior and different theoretical approaches to conceptualizing marketing influences.
A number of theoretical models describe how advertising exposure could affect behavior. These are based largely on social cognitive theory (Bandura, 1986) and message interpretation processing models (Austin et al., 2006; Fleming et al., 2004; McGuire, 1985; Unger et al., 2003), which suggest that the way in which individuals interpret and respond to advertising is as important as the exposure itself (Casswell and Zhang, 1998; Grube and Wallack, 1994). Austin and colleagues (2006) concluded that exposure measures were weaker predictors of progression to alcohol use than response variables, such as ad identification and liking of beer brands. Such attitudinal responsiveness to advertising is termed marketing receptivity, as operationalized by Pierce and colleagues (1998) for studies of tobacco marketing and adapted for alcohol by Unger and colleagues (2003) and Henriksen and colleagues (2008). In these studies, marketing receptivity was viewed as a series of steps, each representing higher involvement with marketing. “Low receptivity” was characterized by brand recognition and recall (awareness), “moderate receptivity” by endorsing a favorite alcohol ad, and “high receptivity” by owning or wanting to own branded clothing or other merchandise. This theoretical approach suggests that young people are exposed to alcohol marketing, become aware of and receptive to that marketing, and ultimately develop an interactive relationship with the brand. Thus, there is evidence to support the idea that a pure measure of marketing exposure, while important, may be a weaker predictor of behavior than a measure of an affective or cognitive response. Thus, the difference in the way marketing is assessed could explain some of the heterogeneity of results in the alcohol marketing studies cited earlier.
The intent of marketing is to increase demand by prompting the purchase of the product being advertised and to cultivate brand allegiance. This is accomplished by building brand equity, attributing meaning and emotion to the brand through imagery that associates the brand with lifestyles appealing to the target population (Casswell, 2004; Keller, 2008). Although alcohol marketing may not be aimed at underage drinkers, they are, nevertheless, exposed to and affected by it (Anderson, 2009; Chung et al., 2010; Smith and Foxcroft, 2009). Young people are highly susceptible to image appeals because of their preoccupation with personal image and identity (Giles and Maltby, 2004; Kroger, 2007). They constantly question who they are, how they look, and how they are perceived by their peers (Finkenauer et al., 2002) as they develop a concept of self. Adolescence and young adulthood are often characterized by increased admiration of famous persons (Giles and Maltby, 2004). Alcohol marketing to youth focuses heavily on lifestyle elements and involves popular culture role models, elements that resonate with these young consumers (Chen et al., 2005).
The aim of this research is to better understand how alcohol marketing is associated with underage drinking. A causal interpretation for the association would gain plausibility if the relation was mediated by cognitions that marketers aim to instill in the target population, such as the development of drinker identity or alcohol brand allegiance. As young people identify themselves with the attractive features of the social lifestyle portrayed in alcohol commercials (Morgenstern et al., 2011a,b), they might be more likely to adopt favorable attitudes and begin drinking. Chen and colleagues (2005) demonstrated that affective response to ads related to portrayed lifestyle elements and that liking an ad was associated with ad effectiveness as defined by likelihood of buying/wanting to buy the product. In a reciprocal process, as experimental drinkers gain experience with drinking and become more interested in advertising, they may be more likely to identify themselves as being a drinker (Gerrard et al., 1996). Similarly, adoption of a favorite brand could be influenced by exposure to alcohol marketing, as young people incorporate imagery and attributes associated with a certain brand into their own sense of self (Austin et al., 2006; Casswell, 2004; Casswell and Zhang, 1998). We have previously demonstrated that two-thirds of U.S. underage drinkers had a favorite brand to drink and that the preferred brands were those with highest advertising expenditures. In addition, having a favorite brand was associated with substantially higher binge drinking rates compared with youth who did not have a favorite (Tanski et al., 2011). Among experimental drinkers, these marketing-specific cognitions could mediate the pathway between exposure or receptivity to alcohol marketing and heavy alcohol use, but this has not, to our knowledge, been tested.
Social-cognitive theoretical models explaining young people's alcohol use have thus far focused on normative beliefs, prototypes, refusal self-efficacy, and alcohol expectancies (Austin et al., 2006; Brown et al., 1987; Dal Cin et al., 2009; Tickle et al., 2006). Alcohol-related cognitions have been assumed to be one of the most proximal predictors of both initiation and maintenance of alcohol use in youth. Expectancies about the pros and cons of drinking are related to drinking in adolescents (Jones et al., 2001; Wiers et al., 1997) and young adults (Bot et al., 2005; Fleming et al., 2004). Further, perceived peer norms on drinking are related to heavy drinking and problem drinking in late adolescence and young adulthood (Borsari and Carey, 2003; Bot et al., 2007; Labrie et al., 2010). As these are robust, well-established predictors of drinking, it is important to examine marketing-specific cognitions in the context of these predictors. If marketing-specific cognitions mediate the relation between alcohol marketing and binge drinking, above and beyond established alcohol-related cognitions, this would underscore their relevance in alcohol marketing models of behavior.
We offer a heuristic model of alcohol marketing receptivity (Fig. 1) that addresses some of these considerations. We posit marketing receptivity as a continuous process that develops side-by-side with the progression of experimental drinking during the underage period. Beginning with distal advertising exposures, receptivity to marketing progresses to noticing and remembering advertising, then active involvement. We hypothesize that distal measures of advertising exposure will be less strongly associated with behavior than proximal ones. Accordingly, we predict a stronger association between owning alcohol-branded merchandise (ABM) and binge drinking compared with, for example, exposure to alcohol brands in movies, based on the assumption that the former reflects an affective response (willingness to wear the logo), not just exposure to the marketing. The model also incorporates marketing-specific cognitions (drinker identity and favorite brand to drink) hypothesized to mediate the association between alcohol marketing and drinking. We assume that marketing-specific cognitions have additional value beyond outcome expectancies and social norms. This study is a first empirical test of this model by assessing measures of alcohol marketing exposure and receptivity in a cross-sectional study of underage drinkers.
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This study provides evidence to suggest a marketing-relevant mechanism that explains the relation between alcohol marketing and heavy drinking. As hypothesized, associations between engagement with marketing and drinking were mediated through marketing-specific cognitions (drinker identity and favorite alcohol brand), rather than through alcohol expectancies and norms, although all 4 cognitions were associated with binge drinking. The mediational analysis provides a rationale for policies to limit exposure to alcohol marketing for underage populations. Confirmation of this mediating process in a longitudinal study would also increase the plausibility of a causal interpretation, as marketing-specific cognitions are endpoints that marketers aim to instill in the target population.
The findings underscore that when testing the role of alcohol marketing in underage drinking from a social-cognitive perspective, it is relevant to assess marketing-specific cognitions as mediators. These cognitions may also be important when studying self-efficacy or drinking motives. Although the alcohol-specific cognitions we assessed in this study (expectancies and norms) are robust, theory-based correlates of alcohol use (Patrick et al., 2010), exclusively focusing on those factors in alcohol marketing research, might underestimate mediating pathways, as we have shown in this study.
The study provides initial evidence to support the heuristic model of advertising receptivity as a continuous process, whereby the adolescent/young adult goes through cycles of exposure and response in which advertising messages are internalized and incorporated into his or her identity. We suggest the process begins with alcohol advertising exposure and proceeds to awareness, cognitive response, and engagement with interactive marketing, a process that proceeds in a reciprocal fashion along with higher stages of alcohol use. This process is independent of age in the underage drinker group that we studied, but further research, especially in early adolescents, would be needed to confirm this.
As hypothesized by the model, the strength of the association with behavior was stronger for ownership of ABM, a proximal measure that captured both exposure and a positive affective reaction to marketing, compared with more distal, yet specific, exposure measures like movie alcohol brand exposure, which assessed only marketing exposure. From a theoretical standpoint, the stronger correlation between proximal advertising receptivity measures (owning ABM), as opposed to more distal measures, is logical, given that the latter captures only exposure and not the individual's engagement in the marketing process. In addition, among exposure measures, the better-specified movie alcohol brand exposure retained an association with behavior, while a poorly specified one, Internet time, did not.
A policy-relevant issue is whether certain more proximal marketing exposures such as ownership of ABM are a cause of binge drinking or simply a marker for an attitudinally susceptible individual. Our previous longitudinal study used a cross-lagged prospective analysis to demonstrate a reciprocal relationship between attitudinal susceptibility to drinking, ABM ownership, and future drinking (McClure et al., 2006). In that analysis, we found that ownership of ABM was both a risk factor and a marker of an attitudinally susceptible youth, thus implicating the marketing strategy in the development and progression of problem drinking. Such longitudinal research will be pivotal as marketing evolves to be more interactive.
There were findings that we did not expect. Exposure to alcohol brands in movies was more strongly associated with cognitions and behavior than having a favorite alcohol ad. Past studies have shown that liking an ad is associated with an affective response to marketing and a change in behavior (Austin et al., 2006; Casswell, 2004; Casswell and Zhang, 1998; Fleming et al., 2004; Unger et al., 2003), and yet, choosing a favorite ad (a hypothesized marker of marketing receptivity) in this study was associated with none of the mediators, or with binge drinking, net covariates. This could be explained if having a favorite ad mainly taps the entertainment value of the advertisement. For instance, a teen may like a particular Super Bowl ad even if he or she has no particular allegiance to the brand being advertised. In addition, the null finding for TV time and Internet time should be interpreted with caution. Each was a single-item measure and subject to measurement error. More importantly, the fact that these measures are not associated with mediating cognitions in the full sample should not be taken to mean that TV or Internet alcohol advertising is not important. Both were general measures that included exposure to a broad range of programming as well as commercial alcohol advertising. It is plausible that the specific influence of TV or Internet commercial advertising remains a risk factor. Given the multiple programming and viewing options for TV, more specific measures of the alcohol content embedded in this medium are needed. Cued-based recall measures (Morgenstern et al., 2011a,b) could be a promising method of capturing specific TV and Internet alcohol marketing exposure. Methods for capturing brand placement in TV programming might also prove to be important. Future studies should focus on assessing marketing exposure and receptivity more specifically and study additive effects.
Considering the evolving mix of alcohol marketing, including product placement in movies, print ads, branded merchandise, TV commercials, and marketing on the Internet including interactive games and promotions, future studies are warranted that focus on cumulative rather than individual effects of alcohol marketing. The complexity of alcohol marketing research lies in assessing the full exposure and the affective and cognitive impact that it has on young people (Meier, 2011). As it is impossible to gather complete data on exposure, it is relevant to focus research on articulated themes. First, elucidating how context alters marketing effects is pivotal. For example, how would the impact of seeing a movie with alcohol brand placement in a movie theater with friends differ from watching it alone on TV at home? Second, some marketing exposures might have interaction or additive effects. Showing alcohol ads during commercial breaks in movies containing ample alcohol cues (Engels et al., 2009) might produce different effects than ads interspersed within a sports game or a National Geographic documentary. Third, it is unknown whether marketing influences population subsets differentially, based on age, gender, interests, and brand preference. Although it seems likely, for example, that image-based lifestyle marketing focused on younger age groups (such as an urban party scene) would have a stronger impact on underage drinkers than those targeting older age groups (such as beer ads that emphasize quality of ingredients), this has not been well studied. Hence, we know little about how the fit between brand, type of alcohol, and target group affects drinking (Engels and Koordeman, 2011). Fourth, the impact of alcohol marketing on young people's drinking, especially that which appeals to affective and emotional aspects, could be mediated both through explicit cognitions as we tested in the current study, but also through more implicit, automatic processing (Wiers et al., 2007). This is worthy of further exploration. Finally, there is little research that triangulates on different approaches to study the same question; further insight could be gained by combining epidemiological with experimental–observational designs and experimental research in which the direct, immediate effects of alcohol marketing on behavior (alcohol use) and physiology can be tested stringently. Experimental research could also provide the opportunity to test mediators and moderators in a causal design, and functional magnetic resonance imaging studies may be able to add to biological plausibility of a causal interpretation (Ariely and Berns, 2010).
The cross-sectional design of this study limits the ability to show that exposure precedes the development of favorable alcohol cognitions or binge drinking. The sample, while national, was not representative and may be less generalizable to minority groups. Moreover, because the analysis was limited to underage youth, who had already begun to experiment with alcohol, the results do not apply to drinking onset but only to the transition from onset to binge drinking. Drinker identity and having a favorite brand to drink would probably be less relevant to nondrinkers, because some experience with drinking is needed for an individual to access these cognitions. Although we controlled for a number of covariates, it is possible that an unmeasured confounder exists that might further explain the relationship between marketing exposures, mediating cognitions, and drinking behaviors. The finding that age was not a moderator in this group of underage drinkers does not mean that age should not be considered; further studies of this model for young adolescents is indicated. Finally, as discussed, the measures of TV and Internet advertising exposure available for use in this study were relatively nonspecific time-based measures and may not have captured specific marketing exposure. Hence, the lack of an association with drinking should not be taken to mean that such exposures are not important or influential.