Alcohol-Branded Merchandise Ownership and Drinking
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Alcohol-Branded Merchandise Ownership and Drinking Sandra C. Jones, BA, MBA, MPH, MAssessEval, PhD CONTEXTS: Alcohol-branded merchandise (ABM) has a longer shelf-life than other forms of abstract alcohol marketing and the potential to become integrated into children’s self-identities. OBJECTIVE: This review sought to explore the current literature on children’s exposure to, and the impact of, ABM. DATA SOURCES: PsycInfo, Proquest, Science Direct, and ABI-Inform databases were searched from the earliest available date to May 2015. Additional studies were identified by a manual review of the reference lists of retrieved articles and contacting the corresponding author of each included study. STUDY SELECTION: Articles that reported on child or adolescent ownership of ABM and/or the relationship between ABM ownership and drinking were included. DATA EXTRACTION: Data on key measures were tabulated; where data of interest were not reported, requests for further information were sent to the articles’ authors. RESULTS: Nine cross-sectional and 4 longitudinal studies were identified. ABM ownership ranged from 11% to 59% and was higher among older children and males. Seven cross- sectional studies reported associations between ABM ownership and drinking-related behaviors. All 4 longitudinal studies reported a significant relationship between ownership at baseline and drinking initiation at follow-up. LIMITATIONS: The small number of available studies, with different measures of ABM ownership and of associations/effects. CONCLUSIONS: The few studies exploring ABM ownership are consistent in showing high rates of ownership and associations between ownership and current and future drinking. There is a need for further research into specific aspects of ABM ownership. However, there is also a need for policy interventions to reduce children’s access to and ownership of ABM. Centre for Health and Social Research, Australian Catholic University, Melbourne, Australia DOI: 10.1542/peds.2015-3970 Accepted for publication Feb 10, 2016 Address correspondence to Sandra C. Jones, Director, Centre for Health and Social Research (CHaSR), Australian Catholic University, Level 5, 215 Spring St, Melbourne, Victoria 3000, Australia. E-mail: sandra.jones@acu.edu.au PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2016 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The author has indicated she has no financial relationships relevant to this article to disclose. FUNDING: Dr Jones is supported by an Australian Research Council Future Fellowship (FT120100932). POTENTIAL CONFLICT OF INTEREST: The author has indicated she has no potential conflicts of interest to disclose. To cite: Jones SC. Alcohol-Branded Merchandise Ownership and Drinking. Pediatrics. 2016;137(5):e20153970 Downloaded from www.aappublications.org/news by guest on February 15, 2021 PEDIATRICS Volume 137, number 5, May 2016:e20153970 REVIEW ARTICLE
Adolescent alcohol use is and current and future consumers.12,13 keywords used were “alcohol brand* associated with a range of physical, Young people, who are developing merchandise OR alcohol brand psychological, and social harms; their self-concepts, use brand ownership OR alcohol promotional and there is increasing evidence ownership as a way of constructing items.” A separate search was that earlier alcohol initiation is and communicating their self-image conducted by using “ABM” as the associated with greater drinking and group membership.13–15 There keyword, but this identified >2000 problems in adult years.1,2 Although is evidence that adolescents actively articles (due to the multiple terms there are numerous influences engage with alcohol marketing and that use that abbreviation), only 8 of on adolescent drinking, including incorporate alcohol brands into which were potentially relevant and individual, family, peer/social group, their self-identity.16,17 Even among all of which were also identified in and community influences, there is children, preference for alcohol- the initial search. substantial evidence that alcohol branded promotional items over The inclusion criteria were as advertising affects alcohol initiation nonalcohol-branded items appears to follows: reported on child or as well as frequency and quantity of prime future drinking.18,19 adolescent ownership of ABM consumption.3–5 (whether as the sole alcohol Much of the research into the effects There have been several systematic marketing exposure variable or of alcohol marketing on young people reviews of the impact of alcohol one of several variables) and/or has focused on print and broadcast advertising and/or promotions on the relationship between children’s media, where advertisements adolescent alcohol use, but these or adolescents’ ABM ownership appear in locations and at times have incorporated a wide range and drinking (initiation, frequency, determined by the marketer. In the of exposures. A review of alcohol or degree), cross-sectional and current environment, the Internet advertising effects identified 7 longitudinal study designs, and and social media provide a platform studies, none of which included written in English. Articles excluded for alcohol marketing that blurs ABM.4 A subsequent review of 13 were those in which information on the lines between “advertising” and longitudinal studies5 included 2 that ABM ownership was not provided, social discourse6–8; and alcohol brand focused specifically on ABM20,21 and 2 such as studies that reported sponsorship of sporting and cultural that included ABM ownership among generically on exposure, opinion events enables messages developed a wider range of alcohol marketing pieces, or policy/position statements. by the marketer but communicated exposures.22,23 The authors The searches identified a total of by (or on) the performers, such as concluded that 12 of the 13 studies 435 unique articles, the abstracts on players’ jerseys.9–11 The majority showed that exposure to alcohol of which were reviewed by 2 of these forms of advertising are marketing predicts drinking initiation researchers to identify those that “perishable,” in that they appear at a and increased levels of consumption. referred to or mentioned ABM. place in time and are then replaced However, they did not draw specific Forty-two articles were identified as by other stimuli (eg, the reader conclusions about the effects of ABM, potentially relevant and uploaded turning the page in a magazine or an important distinction given that into Covidence software (www. newer Facebook posts pushing several studies have identified that covidence.org) for full-text review. previous ones down the feed). the association between drinking and On full-text review, 31 articles were ABM ownership is stronger than that excluded (see Table 1); the remaining Alcohol-branded merchandise for other marketing variables.22–25 (ABM), also referred to as alcohol 11 articles consisted of 7 cross- Thus, this review sought to explore sectional and 4 longitudinal studies. promotional items, has a longer shelf- the current literature on child and life than other forms of advertising. adolescent ownership of ABM and The second stage was a manual For example, a branded keyring may the effects of ABM ownership. review of the reference lists of be used, and seen, on a daily basis or retrieved articles, which resulted a branded clothing item may be worn in the inclusion of 1 additional many times and in many locations. article.57 Because this article was Because ABM is generally something METHODS not identified in the database that a person wears or carries on searches and used the term “alcohol their person, it has the potential A 3-stage approach was taken to *Respondents were considered “susceptible” if to become part of, or be used to identifying relevant articles for convey, their self-image. Marketers inclusion in the review. The first was their answer to the question “Do you think you will use alcohol in the next 2 months?” was “yes,” seek not only immediate sales of a systematic search of electronic “probably,” “I don’t know,” or “I don’t think so” their products but also to form databases (PsycInfo, Proquest, and “nonsusceptible” if their answer was “no, “relationships” between their brands Science Direct, and ABI-Inform). The definitely not.” Downloaded from www.aappublications.org/news by guest on February 15, 2021 2 JONES
promotional clothing items,” a search TABLE 1 Reasons for Exclusion at Full-Text Review was re-run in all 4 databases using Reason Number Article Details this term, which resulted in the of identification of 1 additional article Articles (by the same author) for inclusion in Did not include data 6 Commentaries, policy, or position statements26–31 review.58 Not about ABM, other 12 Briefly referred to ABM in the context of broader aspects of alcohol marketing marketing,32–34 including specific forms such as point-of-sale,35,36 The third stage was to contact sponsorship,37 outdoor advertising,38 broadcast media,39,40 video- sharing sites,41 music,42 and provision of free alcohol43 the corresponding author of each Not about alcohol 3 Other products or substances than alcohol44–46 included article and ask whether Not about ownership 2 Assessed preferences for, or exposure to, rather than ownership of they were aware of any further ABM37,47,48 studies that addressed this topic. The Not about ABM, brand- 3 Brand choice,49 brand/advertising awareness,50 or using brand contacted authors provided details of related information to assess consumption51 Not about ABM, 4 Other predictors of susceptibility to drinking52,53 or the development 2 further studies they had authored susceptibility of programs to reduce susceptibility54,55 and 7 authored by others; however, Not about ABM, 1 About industry trends56 all of these had already been industry included in the review (3 articles) or excluded because they did not meet the inclusion criteria (6 articles). Thus, a total of 13 articles were included in the review: 9 reported on cross-sectional studies and 4 on longitudinal studies (see Fig 1 for the PRISMA [Preferred Reporting Items for Systematic Reviews and Meta- Analyses] flow diagram). In cases in which information important for the review was not reported in the original articles, the corresponding author was asked (in the same e-mail as the request for further relevant studies) to provide this information; for example, 8 articles did not report ownership by gender and 6 did not provide the wording of the question(s) asked. In 5 cases, no response was obtained from the corresponding author or he or she was unable to provide these data. RESULTS Cross-sectional Studies FIGURE 1 Of the 9 cross-sectional studies, 6 Study selection. were conducted in the United States and 1 each in the Philippines, Uganda, reported; where odds ratios (ORs) ABM ownership was twice as likely and Australia. The articles were and/or adjusted ORs (aORs) for among susceptible adolescents as published between 2003 and 2015, drinking initiation were provided nonsusceptible adolescents† and 4 with data collected between 2000 these are reported below. †Respondents were considered “susceptible” if and 2012 (see Table 2 for ownership and Table 3 for associations). There A survey of 7th- to 12th-grade their answer to the question “Do you think you will use alcohol in the next 2 months?” was “yes, was considerable variation between students (N = 260) in a Midwestern ” “probably,” “I don’t know,” or “I don’t think so” the articles in the nature of the US state found that >36% owned ≥1 and “nonsusceptible” if their answer was “no, analyses conducted and statistics items of ABM (mean: 4.5 items).57 definitely not.” Downloaded from www.aappublications.org/news by guest on February 15, 2021 PEDIATRICS Volume 137, number 5, May 2016 3
TABLE 2 Ownership of ABM Study Country (Data Study Sample ABM Extent of Ownership Survey Item(s) Collection Period) Design Type Workman (2003)57 USA (2000–2001) C-S N = 260 seventh- to Clothing 36.5%; boys = girls “Do you own something that has twelfth-graders; an alcohol brand name on it, aged 12–18 y; 59.2% such as a T-shirt or a hat?” female [yes/no]a “If you own something with an alcohol brand name on it, what is it? Please check every item that you own. For each item that you check, please estimate how many items you own”a “Do you want to own something (or something else) with an alcohol brand name on it?” [yes/no]a (plus questions re brand names and source of ABM) Workman (2004)58 USA (2001) C-S N = 320 university Clothing 44.7%; males > “Do you own an item of clothing students; aged females that has an alcohol brand 18–24 y; 43.7% name on it?” [yes/no]a female “If you own a clothing item with an alcohol brand name on it, what is it? Please check every item that you own. For each item that you check, please estimate how many items you own”a “Do you want to own something (or something else) with an alcohol brand name on it?” [yes/no]a (plus questions re brand names and source of ABM) McClure et al (2006)21 USA (2000–2001) C-Sb N = 2406 fifth- to Any 14.2%; boys > girls “Do you own something that eighth-graders; has the name of a beer or aged 10–14 y; 53.8% an alcohol brand on it, like a female T-shirt, a backpack, or a hat?” [those answering yes were asked to list the types of items owned] Hurtz et al (2007)24 USA (2003) C-S N = 2125 sixth- to Any 20%; boys > girls “Have you ever owned an item— eighth-graders; age like a T-shirt, lighter, matches, not stated; 53.1% hat, or sunglasses—with an female alcohol brand name on it?” [yes/no/don't know] Gordon et al (2011)59 Scotland (2007) C-S N = 920 second-year Any 45% (clothing); boys “Can you look at each of these students; aged > girlsc cards and tell me which, if any, 12–14 y; 52.9% of these you have ever done?... female Owned clothing, such as football or other sports-tops, or other personal items with an alcohol brand name or logo on it” [yes/no/don't know]a McClure et al (2013)25 USA (2009) C-Sd N = 1734 ever-drinkers; Any 33%; not reported by Single item: “Do you own aged 15–20 y (65% gender something with an alcohol 18–20 y); 49% brand on it?” female Swahn (2013a)60 Philippines (2011) C-S N = 5290 students; Any 14.7%; not reported …students who have a T-shirt, aged 11–16 y by gender pen, backpack, or other item, (primarily 13–16 y); with an alcohol brand logo 56.4% female on it [question wording not reported] Downloaded from www.aappublications.org/news by guest on February 15, 2021 4 JONES
TABLE 2 Continued Study Country (Data Study Sample ABM Extent of Ownership Survey Item(s) Collection Period) Design Type Swahn (2013b)61 Uganda (2011) C-S N = 457 urban youth; Any 25.9%; not reported …youth who have a T-shirt, aged 14–24 y; 69% by gender pen, backpack, or other item, female with an alcohol brand logo on it [question wording not reported] Jones et al (2015)62 Australia (2012) C-S N = 210 secondary Any 59.0%; boys = girlse Six items: “Do you own any students; aged [hats/T-shirts/cups or bottle 12–17 y (primarily holders/bags or coolers/ 13–15 y); 52.3% sports equipment/other female products]?” Collins et al (2007)22 USA (2001–2002) L N = 1786 sixth- Any 19%; not reported by “Do you own any hats, posters, or grade students gender T-shirts that advertise alcohol (resurveyed seventh (beer, wine, liquor, or wine grade); mean: 11.8 coolers) [yes/no] y at baseline; 51% female Fisher et al (2007)23 USA (1998–1999) P-C N = 5511; aged 11–18 Any 26% owned or willing “Have you ever bought or been y at baseline; 59.6% to use; boys > girls given stuff like a hat, T-shirt, female bag, or cards with the name of an alcohol drink on it (like Coors beer, Absolut vodka, or Kahlua)?” [yes/no]a “Do you think you would ever use something with the name of an alcohol drink on it?” [yes/no]a Henriksen et al (2008)20 USA (2003–2004) L N = 1080; sixth- to Any 21% owned, 19% “Have you ever owned an item— eighth-graders wanted to own; like a T-shirt, lighter, matches, (never-drinkers boys > girls hat, or sunglasses with an at baseline); aged alcohol brand name on it?” 10–15 y; 57.3% [yes/no] female “Would you want to own or use an item with an alcohol brand name on it?” [yes/no] McClure et al (2009)63 USA (2004–2005) L N = 6522 at baseline Any 11% at wave 2, Asked about ownership, type, (5503 wave 2, 5019 increasing to 20% brand, source [question wave 3, 4575 wave at wave 4; boys > wording not reported] (plus 4); aged 10–14 y girls questions re brand names and source of ABM) C-S, cross-sectional; L, longitudinal; males = females, ownership does not differ between male and females; males > females, indicates ownership higher among males than females; P-C, prospective cohort. a Additional detail obtained from corresponding author. b Longitudinal survey (2 time points) but ABM ownership only collected at follow-up. c Not reported in article; data obtained from author (July 17, 2015). d Remaining sample from McClure et al21 study. e Not reported in article; data obtained from author (July 27, 2015). times as likely among established last 7 days, more than twice as likely characteristics, parenting style, and drinkers, suggesting a relationship to be weekly drinkers, and 3 times as peer drinking) and accounting for with both susceptibility and drinking likely to report having been drunk in clustering by school (aOR = 1.5). initiation. A subsequent study in the last 7 days. Of 2125 California middle school university students aged 18 to 25 A survey of fifth- to eighth-grade students in sixth to eighth grade, years (N = 320) found a higher rate students (N = 2406) in New England one-fifth (20.0%) reported owning of ownership of (clothing) ABM: found 14.2% (n = 341) reported ≥1 items of ABM.24 ABM ownership 44.7% owned ≥1 items.58 Ownership owning ≥1 ABM items.21 ABM was associated with an increased was significantly higher among owners were significantly more likelihood of ever drinking (OR = 6.7) established drinkers than susceptible likely to have initiated alcohol and having drunk alcohol in the last experimental drinkers, and ABM use (OR = 2.3), adjusting for 30 days (OR = 1.8). After controlling owners were significantly more likely covariates (including demographic for demographic characteristics, to report having drunk alcohol in the characteristics, personality peer and parent drinking, risk taking, Downloaded from www.aappublications.org/news by guest on February 15, 2021 PEDIATRICS Volume 137, number 5, May 2016 5
TABLE 3 Cross-sectional Studies: Association Between ABM Ownership and Drinking Study Country (Data Collection Sample ABM Type Association Period) Initiation Recency Drunkenness Workman (2003)57 USA (2000–2001) 260 Seventh- to twelfth-graders; 59.2% female Clothing + NR NR Workman (2004)58 USA (2001) 320 University students (18–25 y); 43.7% Clothing + + + female McClure et al (2006)21 USA (2000–2001) 2406 Fifth- to eighth-graders (never-drinkers Any + NR NR at baseline); 53.8% female Hurtz et al (2007)24 USA (2003) 2125 Students in sixth to eighth grade; 53.1% Any + + NR female Gordon et al (2011)59a Scotland (2007) 920 Junior secondary students aged 12–14 y; Any + NR NR 52.9% female McClure et al (2013)25 USA (2009) 1734 Ever-drinkers aged 15–20 y; 49% female Any NR NR + Swahn (2013a)60 Philippines (2011) 5290 Students, primarily aged 13–16 y; 56.4% Any NR ? ? female Swahn (2013b)61 Uganda (2011) 457 Urban youth aged 14–24 y; 69% female Any NR ? ? Jones et al (2015)62 Australia (2012) 210 Secondary students aged 12–17 y; 52.3% Any + — NR female NR, not reported/assessed; +, significant association between ABM ownership and behavior; 0, no significant association; ?, significant in bivariate, not significant in the multivariate analysis. a A subsequent article by the same authors on wave 2 of this project (2-stage cohort study) reported that involvement with alcohol marketing at baseline was predictive of uptake of drinking and increased frequency of drinking, but data were not separately reported for individual forms of marketing (eg, ABM). and parental supervision, both analysis this was associated with limited variables, and/or did not associations remained significant an increased likelihood of current separately report the associations (aORs = 3.3 and 1.5, respectively). alcohol use (OR = 1.86) and for ABM when controlling for other experience of drunkenness (OR = variables.57–62 Three controlled for In a cross-sectional survey25 of 1.43). A survey of urban youth aged demographic characteristics (age/ 1734 ever-drinkers aged 15 to 20 14 to 24 years living in the slums of year level, gender, race/ethnicity), years (remaining participants from Kampala, Uganda (n = 457), found individual characteristics (eg, school an earlier longitudinal study63 25.9% of these vulnerable young grades, personality factors), and supplemented by a sample of African- people owned ≥1 items of ABM61; in social influences (eg, peer drinking, American youth), one-third (33%) bivariate analyses, ABM ownership parental drinking, parenting reported owning ABM and ownership was associated with increased style).21,24,25 had both a direct association likelihood of current alcohol use with binge drinking and indirect Longitudinal Studies (OR = 6.34), problem drinking (OR = associations (mediated by drinker 6.36), and reported drunkenness All 4 of the longitudinal studies were identity and having a favorite alcohol (OR = 5.91). However, in both of conducted in the United States. ABM brand). The article did not report on these studies, the relationship was the sole exposure focus in 1 drinking initiation or recent drinking. between ABM ownership and article,63 1 of 2 components of alcohol A survey of 920 adolescents in the drinking behavior was not significant marketing awareness or receptivity second year of high school (aged in the multivariate analyses. in 2 articles,20,23 and 1 of several 12–14 years) in Scotland found 45% alcohol marketing exposures in 1 owned ≥1 items of alcohol-branded Of 210 secondary students aged 12 article.22 The articles were published clothing, far exceeding any other to 17 years surveyed in New South between 2007 and 2009, with data form of involvement with alcohol Wales, Australia, 59.0% reported collected between 1998 and 2005 marketing.59 ABM ownership was owning at least 1 item of ABM.62 (see Table 2 for ownership and Table significantly higher among drinkers ABM ownership was significantly 4 for effects). All 4 studies controlled than nondrinkers (51% compared associated with alcohol initiation for a range of known covariates, as with 43%; P < .05).64 (but not drinking recency among well as baseline drinking. initiators), perceived peer drinking, The Philippines’ arm of the Global and perceptions that friends would A study in South Dakota elementary School–based Student Health Survey think it was a good idea for them to school students explored associations asked 5290 students aged 11 to 16 drink alcohol. between exposure to alcohol years about their alcohol use and marketing in sixth grade (mean exposure to alcohol marketing.60 Six of the cross-sectional studies age of 11.8 years) and drinking One in eight (14.7%) reported did not report controlling for intentions and behaviors in seventh owning an item of ABM; in bivariate covariates, controlled for only a few grade.22 A total of 1786 students Downloaded from www.aappublications.org/news by guest on February 15, 2021 6 JONES
TABLE 4 Longitudinal Studies: Impact of ABM Ownership on Drinking Study Country (Data Sample Predictor Drinking Initiation Other Drinking Behavior Collection Period) Collins et al USA (2001– 1786 Elementary school Owned ABM at Unadjusted OR = 3.5; aOR = 1.8 OR = 1.8 for drinking in last year; OR (2007)22 2002) students surveyed in sixth baseline (year 7 drinking controlling = 1.6 for intending to drink in next grade and seventh grade; for year 6 drinking) 6 months 51% female Fisher et al USA (1998– 5511 Adolescents aged 11 to 18 Owned/willing aOR = 1.7 for girls and 1.8 for aOR = 1.8 for binge drinking for girls (2007)23 1999) y at baseline; 59.6% female to use ABM at boys (not significant for boys) baseline Henriksen et USA (2003– 1080 Sixth- to eighth-graders Owned/wanted Unadjusted OR = 2.8; aOR = 1.8 Drinking last 30 d: unadjusted OR = al (2008)20 2004) (never-drinkers at baseline); to own ABM at (never-drinkers at baseline 3.2; aOR = 1.7 57.3% female baseline who initiated drinking) McClure et al USA (2004– 6522 Adolescents aged 10–14 Owned ABM at HR = 1.4 at wave 3; HR = 1.6 at HR = 1.8 for binge drinking at wave (2009)63 2005) y at baseline (5503 wave 2, wave 2 wave 4 3; HR = 1.4 for binge drinking 5019 wave 3, 4575 wave 4) at wave 4; also, indirect impact via increases in susceptibility to drinking HR, hazard ratio completed the survey at both time (8 months), wave 3 (16 months), characteristics, individual points; 19% owned an item of ABM at and wave 4 (24 months).63 The characteristics, and social influences. baseline. Controlling for sixth-grade prevalence of ABM ownership One study also controlled for drinking, baseline ownership of ABM increased from 11% at wave 2 to exposure to a range of other forms was associated with an increased 20% at wave 4. Using a cross-lagged of alcohol marketing,22 1 study likelihood of drinking in the seventh panel model, the authors identified controlled for television viewing grade (OR = 1.76) and intending to a reciprocal relationship between and exposure to alcohol portrayals drink in the next 6 months (OR = ABM ownership and susceptibility in movies,63 1 controlled for alcohol 1.65). to drinking (3 items that assessed brand recall and recognition,20 and 1 A national survey of 5511 response to peer offers, intentions, controlled for talking to friends about adolescents aged 11 to 18 years at and positive expectancies) and alcohol advertisements.23 baseline found 26% owned or were both direct and indirect effects of ABM ownership on drinking Demographic Correlates of ABM willing to use an item of ABM.23 At Ownership 12-month follow-up 19% of girls initiation. Adolescents who owned and 17% of boys who were never- ABM at 8 months were more likely Studies that focused on younger drinkers at baseline had initiated to have initiated drinking at 16 adolescents, and reported data alcohol use; those who owned or months (hazard ratio‡ =1.41) and by age, generally found that ABM were willing to use ABM were more nonsusceptible adolescents who ownership increases with age21,63 likely to have done so (OR = 1.74 for owned ABM at 8 months were and/or with increasing grade level.57 girls, OR = 1.78 for boys). more likely to become susceptible The majority of cross-sectional to drinking by 16 months (hazard studies found that ABM ownership is A study of alcohol marketing ratio = 1.66). They found a similar higher among males in both receptivity in 1080 California middle reciprocal relationship between ABM school20,21,24,59,63 and university58 and high school students (never- ownership and susceptibility, and samples. Two studies, 1 in the United drinkers at baseline) found 21% direct and indirect effects of ABM, for States57 and 1 in Australia,62 found owned at least 1 item, and 19% binge drinking. that boys and girls were equally wanted to own an item, of ABM.20 likely to report owning ABM, although The longitudinal studies20,22,23,63 Those who owned or wanted to own in the US study boys owned more all reported data from analyses ABM at baseline were more likely items on average.57 Ownership by that controlled for a wide range of to have initiated alcohol use at the gender was not available for 4 known covariates, demographic 12-month follow-up (OR = 1.77) and articles.22,25,60,61 Although most of to be current drinkers (OR = 1.75). ‡More commonly used in medical sciences to the studies did not separately report A 4-wave national survey of 6522 describe survival rates or treatment effects, in and/or did not find differences in this context a hazard ratio is the percentage US adolescents (4309 of whom effects by gender, 1 study found that change in the hazard (eg, drinking initiation) for were never-drinkers) collected a 1-unit increase in the predictor (e.g., ownership after adjusting for covariates the data on ABM ownership at wave 2 of ABM). relationship between ABM ownership Downloaded from www.aappublications.org/news by guest on February 15, 2021 PEDIATRICS Volume 137, number 5, May 2016 7
and early alcohol initiation was only study was conducted more recently all of the countries in which this significant for girls (aOR = 3.3)21 than the US studies. issue has been studied. Studies from and another found that ABM outside the United States suggest ownership was a significant predictor Source of ABM lower rates of ABM ownership in of initiation for both genders but lower-income countries than in McClure et al21 noted that it is of binge drinking only for girls higher-income countries; however, important to consider the source (OR = 1.79).23 differences in the nature of the of ownership of ABM because of question(s) asked make comparisons likely differences in the influences ABM ownership has also been found across countries and time points on youth drinking. They posited that to be higher among those who report difficult. an adolescent who purchases their that their peers drink21,23 and those own ABM may have a preexisting Of the 8 cross-sectional studies scoring high on rebelliousness, positive attitude toward drinking, that focused on children/younger sensation seeking, and engagement whereas an adolescent who receives adolescents (ie, sample solely or in risk behaviors,21 with inconsistent an item of ABM from a parent may predominantly aged
ever-drinking and nonsignificant for single yes/no question to detailed and thus contributes to social current drinking (compared with 3.3 exploration of the number and type norms. Few studies have assessed and 1.5 for ABM ownership),22 of items owned). Future research in exposure to ABM owned/worn by and no significant association for this area would benefit from the use peers,§ and none have asked about other measures of receptivity such as of consistent questions across time exposure in the home beyond being able to name a favorite alcohol points and jurisdictions. personal ownership; future research brand.20 could explore the effects of ABM An Internet survey of reasons for Given the wide variations in reported exposure via important others as selection of specific alcohol brands prevalence of ABM ownership well as cumulative exposure (dose- among 13- to 20-year-olds in the between studies conducted in response effects). Future research United States identified that 10.2% different countries, future research could explore parents’ awareness stated that their choice of brand was could explore the nature and extent of the effects of ABM and the influenced by their ownership of of ABM available in the different messages parents believe they are products with the brand’s logo.49 It is jurisdictions as well as whether communicating (and adolescents noteworthy that 30.8% of these 1031 this availability has changed over believe they are receiving) by young people also reported that their time. Cross-jurisdictional studies parental provision, or condoning of choice was influenced by the fact that could explore the differential extent ownership, of ABM. they “identify with this brand,” given and effects of ABM ownership in Implications for Policy that having a favorite alcohol brand countries with differing social norms or advertisement has been shown to and legal drinking ages. Including Although this review identified a be an indicator of susceptibility to a broad age range of participants surprisingly small number of studies future drinking.20,65 in such studies would enable on adolescents’ ownership of ABM exploration of reasons for age-related and the effects of this ownership on There is preliminary evidence that drinking behaviors, these studies differences in ABM ownership, even very young children may have showed strong and consistent including differences in accessibility an interest in ABM, with parents in effects of ABM ownership on young as well as appeal of different ABM a qualitative study describing ABM people’s drinking-related attitudes product types. items that appealed to their primary and behaviors. Given that these school–aged children.62 A study associations were stronger than for of preferences for ABM compared Studies not included in this other marketing variables, which with similar nonalcohol-branded review that focused on alcohol are subject to legislative controls in items among third- to fifth-graders media literacy often included a many jurisdictions to reduce youth (not included in the review because measure of preference for ABM exposure, there is a clear need for did not assess ownership of ABM) over other branded or nonbranded strategies to reduce youth ownership identified an association between merchandise.18,66 These studies of ABM. preferences for ABM and perceived generally positioned preference for ABM as a measure of receptivity to There are a number of gaps in the desirability and identification with alcohol marketing. Future research evidence base to be addressed before alcohol ads.47 This was a cross- could explore the extent to which we can fully understand the extent sectional survey that did not assess allowing young children to own ABM of, and reasons for, this apparently causation, and further research could may enhance their attention to and strong association between ABM explore whether allowing young engagement with alcohol brands and and current and future drinking. children to own ABM may enhance alcohol advertising more generally, However, as set out in the first part of their positive views of alcohol the extent to which preference for this review, there are aspects of ABM advertising and alcohol per se. ABM drives and/or reflects interest that differentiate it from other forms Implications for Research in alcohol, and children’s motivations of alcohol marketing. Unlike alcohol for wanting to purchase or own ABM. advertising in traditional or even The small number of studies new (electronic) media, ABM has the identified suggests a need for more potential to become a part of, and to research into the nature, extent, and This research gap is particularly communicate, a young person’s self- effects of ABM. The questions used important given that ABM is a identity. Qualitative research from to measure ABM ownership varied largely unregulated form of alcohol both New Zealand and the United between studies, in terms of both marketing; exposure to ABM occurs their breadth (eg, some focused only in home, social, and educational §Workman58 asked respondents whether they had on clothing and others on all forms environments; and this exposure seen someone at school/university today wearing of ABM) and depth (ranging from a is mediated by friends and family something with an alcohol brand on it. 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Kingdom has found that teenagers questionnaire regarding alcohol The small body of evidence that does associate desirable characteristics policies but not ABM). exist shows a high prevalence of ABM with specific alcohol brands, identify Restrictions on the placement of ownership among adolescents and brands that fit their self-image, and alcohol advertisements, such as on associations between ownership believe that this association endows television or in magazines, are put and current and future drinking. them with positive attributes that are in place by governments due to the There is a need for further research associated with that brand in the eyes recognition that these exposures into specific aspects of ABM of their peers.16,17 ABM is accessible have the potential to increase young ownership, including types and to children and teenagers and people’s susceptibility to drinking. sources of ABM, and more current enables them to identify with a brand Due to its nature, it would not longitudinal studies that reflect even before they begin drinking; this be feasible to impose placement changes in the alcohol marketing relationship with an alcohol brand restrictions on ABM (governments landscape. However, there is also a as part of “who I am” may thus have would be unlikely to legislate where clear need for policy interventions to the potential to facilitate drinking people could wear their branded reduce young people’s access to and initiation. hat or use their branded keyring), ownership of ABM and to increase In 2008, reporting the strong although it would be possible to parents’ and other stakeholders’ association between ABM impose restrictions on where ABM awareness of the insidious nature of ownership and drinking status can be sold or distributed. Perhaps this form of alcohol marketing. 12 months later, Henriksen et al20 more feasible, given governments’ called on government to take action general unwillingness to legislate ACKNOWLEDGMENTS to document the nature and extent alcohol marketing, would be to exert of ABM: “more detailed information pressure on the alcohol industry I thank Ms Georgia Draper for is needed about the production and to self-regulate to restrict the assistance with the identification and distribution of alcohol promotional distribution of ABM in forms that screening of articles for inclusion in items” (p 34). They also noted that would be appealing, and locations the review, Ms Kelly Andrews for her the findings on alcohol marketing that would be accessible, to young advice and review of the manuscript, receptivity (measured by ownership/ people. and Ms Kate Francis and Dr Mairtin desire to own ABM) are “consistent McDermott for assistance with with the research on tobacco Conclusions interpreting varying study findings. marketing receptivity, which formed This review identified a surprisingly I also thank the several authors of the evidence base for banning small number of studies on the included studies who took the time to cigarette promotional items in the prevalence and effects of ABM provide additional unpublished details United States” (p 34) and called for ownership by young people. A total of of their methodology and findings. a similar policy for ABM. However, 7 14 articles were identified, with the years later, there is still no systematic earliest in 2003 and the most recent collection of data on its production, in 2015. The most powerful evidence ABBREVIATIONS availability, or restrictions (in the comes from longitudinal studies; ABM: alcohol-branded United States or elsewhere; the however, there is an absence of such merchandise World Health Organization asks data reported in the past decade aOR: adjusted odds ratio about sponsorship and product (the included studies collected data OR: odds ratio placement in their periodic between 1998 and 2005). REFERENCES 1. Jefferis BJMH, Power C, Manor O. 3. Grenard JL, Dent CW, Stacy AW. 5. Smith LA, Foxcroft DR. The effect of Adolescent drinking level and adult Exposure to alcohol advertisements alcohol advertising, marketing and binge drinking in a national birth and teenage alcohol-related portrayal on drinking behaviour in cohort. Addiction. 2005;100(4): problems. Pediatrics. 2013;131(2): young people: systematic review of 543–549 e369–e379 prospective cohort studies. BMC Public 2. Pitkänen T, Kokko K, Lyyra A-L, 4. Anderson P, de Bruijn A, Angus K, Health. 2009;9(9):51 Pulkkinen L. A developmental approach Gordon R, Hastings G. Impact of alcohol 6. Carah N, Brodmerkel S, Hernandez L. to alcohol drinking behaviour in advertising and media exposure on Brands and sociality: alcohol adulthood: a follow-up study from age adolescent alcohol use: a systematic branding, drinking culture 8 to age 42. Addiction. 2008;103(suppl review of longitudinal studies. Alcohol and Facebook. Convergence. 1):48–68 Alcohol. 2009;44(3):229–243 2014;20:259–275 Downloaded from www.aappublications.org/news by guest on February 15, 2021 10 JONES
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Alcohol-Branded Merchandise Ownership and Drinking Sandra C. Jones Pediatrics 2016;137; DOI: 10.1542/peds.2015-3970 originally published online April 1, 2016; Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/137/5/e20153970 References This article cites 62 articles, 3 of which you can access for free at: http://pediatrics.aappublications.org/content/137/5/e20153970#BIBL Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Adolescent Health/Medicine http://www.aappublications.org/cgi/collection/adolescent_health:med icine_sub Substance Use http://www.aappublications.org/cgi/collection/substance_abuse_sub Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://www.aappublications.org/site/misc/Permissions.xhtml Reprints Information about ordering reprints can be found online: http://www.aappublications.org/site/misc/reprints.xhtml Downloaded from www.aappublications.org/news by guest on February 15, 2021
Alcohol-Branded Merchandise Ownership and Drinking Sandra C. Jones Pediatrics 2016;137; DOI: 10.1542/peds.2015-3970 originally published online April 1, 2016; The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pediatrics.aappublications.org/content/137/5/e20153970 Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. Pediatrics is owned, published, and trademarked by the American Academy of Pediatrics, 345 Park Avenue, Itasca, Illinois, 60143. Copyright © 2016 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 1073-0397. Downloaded from www.aappublications.org/news by guest on February 15, 2021
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