Commentary on White et al. (2017): Adolescent drinking and exposure to advertising-behaviour does not occur in a social vacuum.

Abstract

The estimation of potential exposure young people have to alcohol advertising highlights the importance of placing alcohol prevention and intervention initiatives in their social and cultural contexts. The work conducted by White and colleagues 1 reports findings which, intuitively, make sense: increased exposure to (positive) alcohol advertising is associated with increased likelihood of teenage drinking and risky drinking behaviours. The calculation of estimated exposure through targeted rating points (TRPs) is a novel way of quantifying the extent to which adolescents are exposed to mainly positive messages about alcohol. Alcohol advertising has become more pervasive and targeted 2. Television advertisements remain the most common form of advertising; however, print media, street advertising, targeted social media campaigns and sponsorship of major sporting teams all brand alcohol consistently as a normal part of life 3-5. While the alcohol industry argues that alcohol branding is intended only for adults over the legal purchase age for alcohol 6, the portrayal of alcohol use as a fun, adventurous, relaxing or exhilarating activity are messages received readily by a consumer of any age 7. The prevention of risky drinking practices, particularly among adolescents and young adults, remains a common priority for research in the addiction sciences. Multiple school programmes teach students about the risks of alcohol consumption and strategies to resist peer pressure to drink alcohol 8, 9. While these individual-based interventions have a role in responding to harms associated with alcohol consumption, a critical perspective on wider alcohol culture is necessary to understand behaviour. White and colleagues calculate that, in 2011, Australian adolescents were exposed to 880 TRPs, or at least nine television advertisements per month 1. This estimate does not include exposure to street or print advertising, social media campaigns and sports sponsorship. In contrast, adolescents who take part in a school-based prevention programme, such as the Australian CLIMATE Schools programme 10, are exposed to six sessions at most of education on safe drinking practices. These education programmes are therefore required to compete with many years of prior exposure to alcohol advertising, as well as concurrent and ongoing messaging from the alcohol industry. It is necessary to ask how effective prevention programmes can be in the face of the tsunami of advertising promoting positive cultural attitudes towards alcohol use. In Australia, gambling advertising has been banned recently from being screened during televised sports matches 11. The argument behind this legislation is that children are exposed to advertising that promotes betting on the game being televised, as a normal and fun adult activity associated with participating in sport, without also being informed about the risks of gambling 12. The lack of similar restrictions on alcohol advertising is testimony to the success of Australian alcohol industry lobbying at both state and Federal governments. The industry has vehemently opposed increases in taxation and reduced opening hours to reduce alcohol-related harm 13, 14. Changes to alcohol advertising policies are also contested strongly. This is why research which illustrates the potential impacts of alcohol advertising, such as the study cited here, is necessary to create a strong evidence base to challenge the promotion of a problematic alcohol culture. It is vital that researchers who seek to influence policy remain aware of the influence the alcohol industry has on government policy and social and cultural norms about drinking. From a clinician or interventionist point of view, considering wider cultural norms and contexts reduces the ‘individual focus’ of treating problem drinkers favoured by industry (i.e. it is the drinker, not the drink, that is the problem). It may also encourage patients and clinicians to consider how drinking behaviours are influenced by wider cultural cues, including alcohol promotion. From a public health perspective, wider considerations of alcohol culture also changes the lens of focus away from the individual's choice to drink alcohol, as well as the associated ‘choice’ and ‘blame’ discourses that often accompany messages about problematic drinking and alcohol dependence 15. Instead, public health initiatives may take a top–down approach by challenging cultural and social norms around drinking. Alcohol access and consumption and reducing its related harms remains a complicated issue. It is unlikely that one intervention or law will reduce underage drinking successfully, as well as problematic drinking at all ages. Multiple measures are probably needed, including changes to access—both to how individuals can access alcohol, and how and when the alcohol industry can access consumers with advertising. None. Thank you to Wayne Hall for comments on a draft of the commentary, and for his ongoing contribution to my understanding of alcohol policy.