Effectiveness of Regulatory Policies on Online/Digital/Internet-Mediated Alcohol Marketing: a Systematic Review.

BACKGROUND: The rapid growth of social networking sites and video sharing platforms has created an opportunity for the alcohol industry to employ advanced advertising and marketing approaches to target their audiences, increasingly blurring the lines between commercial marketing and user-generated content, which poses a challenge for effective regulation. METHODS: We conducted a systematic search through three peer-reviewed journal databases (WoS, PubMed, Scopus). Studies were included if published in English, after 2004, and assessed statutory regulation or voluntary industry codes, enacted by an EU or nation's governmental agency or private entity, and with the intent to restrict digital alcohol advertising. In addition, we conducted a manual search of gray literature. RESULTS: A total of 4690 records were identified. After duplicate removal and full-text assessment, 14 articles were examined. Our findings indicate that children and adolescents may often be exposed to alcohol advertisements on social media and websites due to industry's self-regulatory age-affirmation systems being largely ineffective at preventing under-aged access. Cases of self-regulatory violations by the alcohol industry, and increasingly innovative 'gray-area' advertising approaches have also been noted. Additionally, research illustrates a lack of developed statutory restrictions of digital alcohol advertising and instead continued reliance on voluntary industry self-regulation. CONCLUSIONS: There is a substantial need for further research to examine the effectiveness of digital alcohol advertising restrictions in social media, websites and image/video sharing platforms. Moreover, there is a necessity for countries to develop comprehensive statutory frameworks, which would effectively restrict and monitor rapidly advancing digital alcohol advertising practices on new digital media.

Effective alcohol policies and lifetime abstinence: An analysis of the International Alcohol Control policy index.

INTRODUCTION: Alcohol abstinence remains common among adults globally, although low and middle-income countries are experiencing declines in abstention. The effect of alcohol policies on lifetime abstinence is poorly understood. The International Alcohol Control (IAC) policy index was developed to benchmark and monitor the uptake of effective alcohol policies and has shown strong associations with alcohol per capita consumption and drinking patterns. Uniquely, the index incorporates both policy 'stringency' and 'impact', reflecting policy implementation and enforcement, across effective policies. Here we assessed the association of the IAC policy index with lifetime abstinence in a diverse sample of jurisdictions. METHODS: We conducted a cross-sectional analysis of the relationship between the IAC policy index score, and its components, and lifetime abstinence among adults (15+ years) in 13 high and middle-income jurisdictions. We examined the correlations for each component of the index and stringency and impact separately. RESULTS: Overall, the total IAC policy index scores were positively correlated with lifetime abstinence (r = 0.76), as were both the stringency (r = 0.62) and impact (r = 0.82) scores. Marketing restrictions showed higher correlations with lifetime abstinence than other policy domains (r = 0.80), including restrictions on physical availability, pricing policies and drink-driving prevention. DISCUSSION AND CONCLUSION: Our findings suggest that restricting alcohol marketing could be an important policy for the protection of alcohol abstention. The IAC policy index may be a useful tool to benchmark the performance of alcohol policy in supporting alcohol abstention in high and middle-income countries.

Benchmarking alcohol policy based on stringency and impact: The International Alcohol Control (IAC) policy index.

This study developed a measurement tool to assess stringency and 'on-the-ground' impact of four key alcohol policy domains to create an alcohol policy index suitable for benchmarking alcohol policy and assessing change over time in middle- and high-income countries. It involved a collaboration between researchers in 12 diverse countries: New Zealand; Australia; England; Scotland; Netherlands; Vietnam; Thailand; South Africa; Turkey; Chile; Saint Kitts and Nevis and Mongolia. Data on the four most effective alcohol policy domains (availability, pricing policy, alcohol marketing, drink driving) were used to create an alcohol policy index based on their association with alcohol per capita consumption (APC) of commercial (recorded) alcohol. An innovation was the inclusion of measures of impact along with the stringency of the legislation or regulation. The resulting International Alcohol Control (IAC) Policy Index showed a very high negative correlation (-0.91) with recorded APC. Greater affordability of alcohol, an impact measure taking into account prices paid and countries' Gross Domestic Product, was predictive of higher APC (-0.80). Countries in which more modes of alcohol marketing are legally allowed and used had higher APC. Legislation on outlet density and drink driving predicted APC whereas trading hours did not. While stringency and impact measures varied between domains in terms of relationship with APC, overall, there was a strong correlation between impact and stringency (0.77). The IAC Policy Index, which includes measures of policy stringency and 'on-the-ground' impacts in relation to four key policy areas, was found to be strongly associated with commercial alcohol consumed in a number of diverse country settings. It showed a larger relationship than previous indices that include more policy dimensions. The index provides a relatively simple tool for benchmarking and communication with policy makers to encourage a strong focus on uptake of these four most effective alcohol policies.

Picture Me Drinking: Alcohol-Related Posts by Instagram Influencers Popular Among Adolescents and Young Adults.

Research has shown that young people post a lot of alcohol-related posts (i.e., alcoholposts) on social media and these posts have been shown to increase drinking behaviors. Because social influencers (i.e., individuals with the potential to influence large audiences on social media) may have a strong influence on young people, it is important to know whether and how often they post about alcohol. Furthermore, because by using influencers alcohol brands may have found a way to circumvent regulations that prohibit advertising for minors, it is important to understand whether alcohol brands are visible in influencers' posts and whether influencers use disclosures (e.g., "#ad") to notify viewers. In a content analysis of Instagram posts of 178 popular influencers, we investigated: (1) how many and how often influencers post about alcohol, (2) what type of influencers post about alcohol, (3) what the characteristics of influencers' alcoholposts are, and (4) to what extent these alcoholposts are commercialized (e.g., by showing brands and sponsorship disclosures). Results showed four main findings. (1) The majority of influencers (i.e., 63.5%) posted about alcohol recently. (2) Alcoholposts were positive, showed a social context, and were mostly posted by lifestyle influencers. (3) Although a fair amount of alcoholposts (19.5%) showed a clear alcohol brand, only a few of these posts disclosed this as an advertisement, and even fewer gave an educational slogan (i.e., "#no18noalcohol"). (4) Posts with sponsorship disclosures yielded fewer likes and comments than posts without such disclosures. A post hoc additional study that focused solely on minors confirmed these conclusions. These findings suggest that there is a lot to be concerned about in this context, especially since many minors can be exposed to influencers' alcoholposts, potentially leading to increased drinking among this vulnerable age group. We therefore advice future researchers to further investigate this topic, and propose that legislation for alcohol advertising needs to be adjusted to account for the context of social networking sites.

[Ten years of alcohol intoxication among young people in The Netherlands]. / 10 jaar alcoholintoxicaties bij jongeren.

OBJECTIVE: To provide insight into the number of adolescents admitted to hospital with alcohol intoxication in the period 2007-2016. DESIGN: Observational cross-sectional study. METHODS: We used data from the hospital admissions for alcohol intoxication among minors that had been reported to the Dutch Paediatric Surveillance System (NSCK). We also used data on minors who had been admitted to hospital for other alcohol-related reasons. RESULTS: In the period 2007-2016, 4,674 minors were admitted to a hospital in the Netherlands with alcohol intoxication. The number of minors admitted with alcohol intoxication increased annually from 2007 to 2011, after which it became reasonably stable, with a peak in 2015. The average age at which a minor was admitted increased (2007: 14.9 years; 2016: 15.5 years), and this also applied to the duration of loss of consciousness (2007: 2.24 hours; 2016: 3.12 hours). Parents of young people admitted with alcohol intoxication have become markedly stricter; 69% had given permission for consumption of alcohol in 2011; in 2016 that had decreased to 19%. CONCLUSION: Raising the minimum age for obtaining low-alcohol drinks, the creation of better awareness of the consequences of alcohol use and the opening of the Outpatient Adolescents and Alcohol Clinics seem to have had an effect. The average age of young people with alcohol intoxication has increased and parents have become stricter, but binge-drinking is still a serious problem. Further research is needed into characteristics and treatment of the group of young people who end up in hospital.

Brain reactivity to alcohol and cannabis marketing during sobriety and intoxication.

Drugs of abuse stimulate striatal dopamine release and activate reward pathways. This study examined the impact of alcohol and cannabis marketing on the reward circuit in alcohol and cannabis users while sober and intoxicated. It was predicted that alcohol and cannabis marketing would increase striatal activation when sober and that reward sensitivity would be less during alcohol and cannabis intoxication. Heavy alcohol (n = 20) and regular cannabis users (n = 21) participated in a mixed factorial study involving administration of alcohol and placebo in the alcohol group and cannabis and placebo in the cannabis group. Non-drug users (n = 20) served as between group reference. Brain activation after exposure to alcohol and cannabis marketing movies was measured using functional magnetic resonance imaging and compared between groups while sober and compared with placebo while intoxicated. Implicit alcohol and cannabis cognitions were assessed by means of a single-category implicit association test. Alcohol and cannabis marketing significantly increased striatal BOLD activation across all groups while sober. Striatal activation however decreased during intoxication with alcohol and cannabis. Implicit associations with cannabis marketing cues were significantly more positive in alcohol and cannabis users as compared with non-drug using controls. Public advertising of alcohol or cannabis use elicits striatal activation in the brain's reward circuit. Reduction of marketing would reduce brain exposure to reward cues that motivate substance use. Conversely, elevated dopamine levels protect against the reinforcing potential of marketing.

European longitudinal study on the relationship between adolescents' alcohol marketing exposure and alcohol use.

BACKGROUND AND AIMS: This is the first study to examine the effect of alcohol marketing exposure on adolescents' drinking in a cross-national context. The aim was to examine reciprocal processes between exposure to a wide range of alcohol marketing types and adolescent drinking, controlled for non-alcohol branded media exposure. DESIGN: Prospective observational study (11-12- and 14-17-month intervals), using a three-wave autoregressive cross-lagged model. SETTING: School-based sample in 181 state-funded schools in Germany, Italy, Netherlands, Poland. PARTICIPANTS: A total of 9075 eligible respondents participated in the survey (mean age 14 years, 49.5% male. MEASUREMENTS: Adolescents reported their frequency of past-month drinking and binge drinking. Alcohol marketing exposure was measured by a latent variable with 13 items measuring exposure to online alcohol marketing, televised alcohol advertising, alcohol sport sponsorship, music event/festival sponsorship, ownership alcohol-branded promotional items, reception of free samples and exposure to price offers. Confounders were age, gender, education, country, internet use, exposure to non-alcohol sponsored football championships and television programmes without alcohol commercials. FINDINGS: The analyses showed one-directional long-term effects of alcohol marketing exposure on drinking (exposure T1 on drinking T2: ß = 0.420 (0.058), P < 0.001, 95% confidence interval (CI) = 0.324-0.515; exposure T2 on drinking T3: ß = 0.200 (0.044), P < 0.001, 95% CI = 0.127-0.272; drinking T1 and drinking T2 on exposure: P > 0.05). Similar results were found in the binge drinking model (exposure T1 on binge T2: ß = 0.409 (0.054), P < 0.001, 95% CI = 0.320-0.499; exposure T2 on binge T3: ß = 0.168 (0.050), P = 0.001, 95% CI = 0.086-0.250; binge T1 and binge T2 on exposure: P > 0.05). CONCLUSIONS: There appears to be a one-way effect of alcohol marketing exposure on adolescents' alcohol use over time, which cannot be explained by either previous drinking or exposure to non-alcohol-branded marketing.

Reducing alcohol use during pregnancy via health counseling by midwives and internet-based computer-tailored feedback: a cluster randomized trial.

BACKGROUND: Effective interventions are needed to reduce neurobehavioral impairments in children due to maternal alcohol use during pregnancy. Currently, health-counseling interventions have shown inconsistent results to reduce prenatal alcohol use. Thus, more research using health counseling is needed to gain more knowledge about the effectiveness of this type of intervention on reducing alcohol use during pregnancy. An alternative and promising strategy is computer tailoring. However, to date, no study has shown the effectiveness of this intervention mode. OBJECTIVE: The aim was to test the effectiveness of health counseling and computer tailoring on stopping and reducing maternal alcohol use during pregnancy in a Dutch sample of pregnant women using alcohol. METHODS: A total of 60 Dutch midwifery practices, randomly assigned to 1 of 3 conditions, recruited 135 health counseling, 116 computer tailoring, and 142 usual care respondents from February to September 2011. Health-counseling respondents received counseling from their midwife according to a health-counseling protocol, which consisted of 7 steps addressed in 3 feedback sessions. Computer-tailoring respondents received usual care from their midwife and 3 computer-tailored feedback letters via the Internet. Usual care respondents received routine alcohol care from their midwife. After 3 and 6 months, we assessed the effect of the interventions on alcohol use. RESULTS: Multilevel multiple logistic regression analyses showed that computer-tailoring respondents stopped using alcohol more often compared to usual care respondents 6 months after baseline (53/68, 78% vs 51/93, 55%; P=.04). Multilevel multiple linear regression analyses showed that computer-tailoring respondents (mean 0.35, SD 0.31 units per week) with average (P=.007) or lower (P<.001) alcohol use before pregnancy or with average (P=.03) or lower (P=.002) social support more strongly reduced their alcohol use 6 months after baseline compared to usual care respondents (mean 0.48, SD 0.54 units per week). Six months after baseline, 72% (62/86) of the health-counseling respondents had stopped using alcohol. This 17% difference with the usual care group was not significant. CONCLUSIONS: This is the first study showing that computer tailoring can be effective to reduce alcohol use during pregnancy; health counseling did not effectively reduce alcohol use. Future researchers developing a health-counseling intervention to reduce alcohol use during pregnancy are recommended to invest more in recruitment of pregnant women and implementation by health care providers. Because pregnant women are reluctant to disclose their alcohol use to health professionals and computer tailoring preserves a person's anonymity, this effective computer-tailoring intervention is recommended as an attractive intervention for pregnant women using alcohol. TRIAL REGISTRATION: Dutch Trial Register NTR 2058; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2058 (Archived by WebCite at http://www.webcitation.org/6NpT1oHol).

Adolescent alcohol intoxication in the Dutch hospital departments of pediatrics: a 2-year comparison study.

PURPOSE: To monitor the prevalence of, and the circumstances leading to, adolescent alcohol intoxication admissions in Dutch hospital departments of pediatrics. METHODS: Data were collected in 2007 and 2008, using the Dutch Pediatric Surveillance System, in which pediatricians received questionnaires on varying issues, including adolescent alcohol intoxication admissions. RESULTS: The adolescents treated in 2008, as in 2007, were average youth across proportion of gender, educational level, school performances, family structure, siblings, familiarity with medical or aid agencies, alcohol use, and other (illicit) drug use. In 2008, 13% more adolescents were treated. These adolescents showed a trend of having a younger average age, higher blood alcohol concentrations, and longer durations of mental impairment. About 45% of the adolescents who were treated for alcohol intoxication had purchased alcohol from a commercial place, despite that 51 times the specific adolescent had not reached the legal age of 16 years old. About one-third of the youngsters consumed alcohol at home or at a friend's home. CONCLUSIONS: The number of adolescents suffering from alcohol intoxication increased in 2008 compared with 2007. Parental (lack of) involvement and responsibilities of commercial sales personnel are discussed.

Adolescent alcohol intoxication in the Dutch hospital Departments of Pediatrics.

OBJECTIVE: This study was conducted to investigate the number and characteristics of adolescent alcohol intoxication cases in hospital Departments of Pediatrics. The study also analyzes drinking patterns and intoxication characteristics. METHOD: Data were collected using the Dutch Pediatric Surveillance System, in which about 92% of general pediatricians and 83% of academic pediatricians participate. In 2007, questionnaires were collected every month within 56 hospitals. A total of 297 adolescent alcohol intoxications were reported, of which 231 cases were analyzed. RESULTS: Hospital-admitted adolescents in this study are 12-18 years old, with an average age of 15.3 years. Intoxicated adolescents appear to be a representative sample of the Dutch population on all background variables (gender, educational level, family structure). CONCLUSIONS: This study shows the serious nature of adolescent intoxication and may indicate that more strict governmental alcohol control policies are required.