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

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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.”

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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.”

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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]

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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,

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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

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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

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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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PEDIATRICS Volume 137, number 5, May 2016                                                                                                       9
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).

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12                                                                                                                                       JONES
Alcohol-Branded Merchandise Ownership and Drinking
                               Sandra C. Jones
                             Pediatrics 2016;137;
      DOI: 10.1542/peds.2015-3970 originally published online April 1, 2016;

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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;

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.

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