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.

Exposure to Online Alcohol Marketing and Adolescents' Drinking: A Cross-sectional Study in Four European Countries.

AIMS: The Internet is the leading medium among European adolescents in contemporary times; even more time is spent on the Internet than watching television. This study investigates associations between online alcohol marketing exposure and onset of drinking and binge drinking among adolescents in four European countries. METHOD: A total of 9038 students with a mean age of 14.05 (SD 0.82) participated in a school-based survey in Germany, Italy, the Netherlands and Poland. Logistic regression analyses of cross-sectional cross-country survey data were undertaken. Exposure to online alcohol marketing, televised alcohol advertising and ownership of alcohol-branded items was estimated to be controlled for relevant confounders. Onset of drinking and binge drinking in the past 30 days were included in the study as outcome variables. RESULTS: Adjusted for relevant confounders, higher exposure to (online) alcohol marketing exposure was found to be related to the odds of starting to drink (p < 0.001) and the odds of binge drinking in the past 30 days (p < 0.001). This effect was found to be consistent in all four countries. Active engagement with online alcohol marketing was found to interact more strongly with drinking outcomes than passive exposure to online alcohol marketing. CONCLUSIONS: Youngsters in the four European countries report frequent exposure to online alcohol marketing. The association between this exposure and adolescents' drinking was robust and seems consistent across national contexts.

Adolescents' experiences and perceived (dis)advantages of the three main outlet types for alcohol purchases.

Based on the existing literature, relevant determinants of availability for on-premises locations, off-premises locations, and the Internet were qualitatively explored and categorized by "experts" consisting of underage alcohol purchasers. In total, 14 focus group discussions were conducted with 94 Dutch adolescents. For on-premises locations, the high prices were perceived as the biggest disadvantage, and the ease to circumvent legal age limits as the biggest advantage. For off-premises locations, the cheap pricing was perceived as the most positive aspect, and the legal age limit as the biggest disadvantage. For online purchases, the waiting time was perceived as the most negative aspect, and the proximity of online stores as the biggest advantage.

Alcohol sales to underage buyers in the Netherlands in 2011 and 2013.

PURPOSE: Measuring vendors' compliance and possible change in compliance with the legal age limits on alcohol sales in 2011 and 2013. METHODS: In 2011 and 2013, representative mystery shopping studies were conducted. In total, 2,737 underage mystery shopping alcohol purchase attempts were conducted both in off-premise (supermarkets, liquor stores, and take away restaurants) and on-premise (bars and sports bars) outlets as well as from alcohol home delivery services. RESULTS: Average compliance increased significantly from 28.2% in 2011 to 46.5% in 2013, and asking proof of age (ID) also increased significantly from 43.9% in 2011 to 54.1% in 2013. CONCLUSIONS: Both asking proof of age and, ultimately, compliance with the legal age limits increased significantly. Nevertheless, still 53.5% of the adolescents could purchase alcohol themselves, which makes alcohol largely available through the various premises.

Underage alcohol sales--it only takes a minute: a new approach to underage alcohol availability.

OBJECTIVE: Because minors generally report higher accessibility than one would expect on the basis of the "compliance rates" established by researchers (the percentage of stores that comply with age limits for sales of age-restricted products such as alcoholic beverages), we propose a new method to better depict the availability of age-restricted products for minors as an alternative to the compliance approach, which in our view is too narrow. METHOD: Underage mystery shoppers were assigned to buy alcohol in a store of their preference, using any (legally allowed) purchase method. The time required to buy alcohol was the main outcome variable. As a benchmark, the time required to buy soft drinks was recorded. RESULTS: All underage mystery shoppers succeeded in buying alcohol, which means 100% availability. On average, buying alcohol took less than 10 minutes (including travel and shopping time), which was 2 minutes more than when purchasing soft drinks. CONCLUSIONS: Compliance at an outlet level can misrepresent the actual availability to minors. Both the proposed approach to availability and a new approach to age validation indicate that the general assumption that the traditional methods of age validation can effectively prevent the commercial availability of age-restricted products to minors should be seriously questioned.

One more beer? Serving alcohol to pseudo-intoxicated guests in bars.

BACKGROUND: Consuming large quantities of alcohol might result in negative consequences for both individual drinkers (alcohol dependency and addiction) and society (violence, traffic crashes). In order to decrease the prevalence of alcohol abuse, many countries have adopted regulations prohibiting the catering industry to serve alcohol to intoxicated guests. This article investigated compliance with these regulations in the Netherlands. METHODS: A study was conducted in which pseudo-intoxicated actors tried to order alcoholic drinks in 58 bars. A 2 × 2 design was used, based on (i) the number of actors involved (1 vs. 2) and (ii) the level of intoxication (moderately vs. very drunk). In contrast to earlier studies, research accomplices checked afterward whether the bartenders noticed that the actors appeared intoxicated. RESULTS: In 86% of the cases, the actors were able to buy alcohol, without comments or questions. In 10%, the actors were refused entrance by a bouncer. Only in 4%, the bartender refused to serve. In 81% of the cases, the bartenders remembered the actors: In 93% of those cases, they noticed that the actor appeared intoxicated. Only the "very drunk" script involving 2 actors led to refusals. CONCLUSIONS: The results show that compliance with the regulations regarding overserving to intoxicated guests is problematic in the Netherlands. Misinterpretations of the situation could be ruled out: Most bartenders noticed that the actors appeared intoxicated but served nonetheless.

Young poker faces: compliance with the legal age limit on multiple gambling products in the Netherlands.

Gambling is an activity that can be performed on-premise (slot machines in casinos, bars and restaurants) or off-premise (scratch cards and lottery tickets). Although the addictive potential may depend on the specific gambling product, early onset increases the likelihood for future pathological gambling. To delay the onset of gambling behavior and to reduce gambling-related problems, many countries have introduced age limits that should decrease the availability of gambling products to underage individuals. In this study we evaluated compliance to the legal age limit, making use of a mystery shopping method. We distinguished between (1) off-premise scratch cards (n = 51); (2) off-premise lottery tickets (n = 49); (3) on-premise slot machines in casinos (n = 88); and (4) on-premise slot machines in the catering industry (n = 100), and we focus on the factors, such as characteristics of the establishment, buyer, and vendor, that may account for possible differences. The 288 visits demonstrate that gambling products are highly available and accessible to under-aged customers; young customers are still able to gamble despite the legal regulations. The compliance rates fluctuate and appear to be related to the specific gambling product in question. Furthermore, age verification activities and certain outlet- and buyer characteristics, as well as characteristics associated with the purchase attempt, may influence compliance.

Improving shop floor compliance with age restrictions for alcohol sales: effectiveness of a feedback letter intervention.

PURPOSE: In this study, we investigated the effects and handling of an intervention to increase compliance with age limits regarding alcohol sales. The intervention tested in this field experiment was a feedback letter sent to alcohol outlets about their individual compliance results based on a mystery shopping study. METHOD: We measured compliance in 146 alcohol outlets (cafeterias, supermarkets, bars, liquor stores and youth centres) in one region in the Netherlands with 15-year-old mystery shoppers. About half (n=72) of the outlets received the intervention letter (the experimental group). After this intervention, we measured compliance again (n=138). Then we sent the same letter to the control group and interviewed all the outlets regarding their handling of the intervention (n=106). RESULTS: After the experimental group received the letter, compliance increased significantly (from 18.1% to 32.4%). In the control group, compliance did not change. Of the outlets interviewed, 81% stated that they had received the letter, and the action most commonly taken was to bring the letter to the attention of their staff. CONCLUSIONS: Positive feedback letters are more often copied and shared integrally with personnel, compared with negative letters. Compliance with respect to underage alcohol sales can be improved, although compliance levels remain low in the Netherlands.

Why should I comply? Sellers' accounts for (non-)compliance with legal age limits for alcohol sales.

BACKGROUND: Availability is an important predictor of early and excessive alcohol consumption by adolescents. Many countries have implemented age limits to prevent underage purchases of alcohol. However, shop-floor compliance with these age limits appears to be problematic. This study addresses the issue of non-compliance with age limits. Which measures do vendors take to avoid underage alcohol sales, and what do they report as important reasons to comply or not with age limits for alcohol sales? METHODS: Open-ended telephone interviews were conducted with store managers selling alcohol (N = 106). Prior to the interviews, all outlets were visited by an underage mystery shopper in order to measure compliance with the legal age limits on alcohol sales. The interview results are compared against actual compliance rates. RESULTS: Several measures have been taken to prevent underage sales, but the compliance level is low. Furthermore, open coding resulted in 19 themes, representing both valid and invalid arguments, that vendors mentioned as relevant to their decisions of whether to comply with the law. Compliance with age limits is dependent on the knowledge of the rules and the ability and motivation to follow the rules. The ability aspect in particular seems to be problematic, but in many cases, the motivation to actively comply with the age limits is lacking. CONCLUSIONS: To enhance compliance, it is important to raise the awareness of the importance of age limits and to connect possible violations of the regulations to negative consequences.

Effects of a national information campaign on compliance with age restrictions for alcohol sales.

PURPOSE: To investigate the effect of a national information campaign, introduced by the Dutch Food Retail Organization, named "Under 20? Show Your ID!," on compliance with age restrictions on alcohol sales. The compliance level after the campaign was compared with a baseline compliance, that we calculated based on 458 preintervention compliance measurements. METHODS: Data were collected using the method of mystery shopping. Three teams, each consisting of two 15-year-old mystery shoppers, conducted 105 alcohol purchase attempts in supermarkets in three regions in the Netherlands. RESULTS: A compliance rate of 24.8% was found, which is a significant improvement compared with Dutch basement compliance rate from the past (14.9%), but is nominally still very low. CONCLUSIONS: This mass media intervention campaign failed to increase compliance to an acceptable level. Also the specific goal of the campaign (ask everybody under <20 years old for identification [ID]) failed because fewer than half of the 15-year-old mystery shoppers in the study were asked to show their ID when purchasing alcoholic beverages.

Determinants of parental support for governmental alcohol control policies.

AIM: To explore determinants that predict parental support for governmental alcohol control policies in the Netherlands. METHOD: A questionnaire was administered among 1550 parents, containing six possible predictors to explain support for alcohol control policies. RESULTS: Parental support can be explained by five partly normative predictors (R(2)=.503). Parents with lower drinking frequencies are stricter and more supportive than parents who consume more alcohol. Higher-educated parents are stricter than lower-educated parents. CONCLUSION: In general, parents do support governmental alcohol control policies. Communication of the fact that youth alcohol consumption is problematic tends to increase parental support. Also, if policy makers are able to influence parents' opinions on the consequences of alcohol consumption, as well as the norm of not consuming alcohol before 16 years of age, then parental support increases. Parents' experiences with drunken youths also explain support. Factual knowledge does not influence support, so information campaigns alone do not increase parental support.

Shop floor compliance with age restrictions for tobacco sales: remote versus in-store age verification.

To compare traditional in-store age verification with a newly developed remote age verification system, 100 cigarette purchase attempts were made by 15-year-old "mystery shoppers." The remote system led to a strong increase in compliance (96% vs. 12%), reflecting more identification requests and more sale refusals when adolescents showed their identification cards.

There's alcohol in my soap: portrayal and effects of alcohol use in a popular television series.

Two studies are reported addressing the media influences on adolescents' alcohol-related attitudes and behaviours. A content analysis was conducted to investigate the prevalence of alcohol portrayal in a Dutch soap series. The coding scheme covered the alcohol consumption per soap character, drinking situations and drinking times. Inter-coder reliability was satisfactory. The results showed that alcohol portrayal was prominent and that many instances of alcohol use reflected undesirable behaviours. To assess the influence of such alcohol cues on adolescents, a 2x2 experiment was conducted focusing on the separate and combined effects of alcohol portrayal in the soap series and surrounding alcohol commercials. Whereas the alcohol commercials had the expected effects on adolescents' attitudes, the alcohol-related soap content only appeared to have unexpected effects. Adolescents who were exposed to the alcohol portrayal in the soap series had a less positive attitude towards alcohol and lower drinking intentions. Implications of these findings for health policy and future research are discussed.

Mystery shopping and alcohol sales: do supermarkets and liquor stores sell alcohol to underage customers?

PURPOSE: The Dutch national policy regarding alcohol and youth relies on retailers' willingness to refuse to sell alcohol to underage customers. This study examined unobtrusively whether supermarkets and liquor stores do indeed comply with the legal age restrictions for alcohol sales. METHODS: A research protocol was developed based on the methodology of mystery shopping. Using the protocol, 150 supermarkets and 75 liquor stores were visited by 15-year-old adolescents who tried to buy soft alcoholic beverages (legal age, 16 years), and 75 liquor stores were visited by 17-year-old adolescents who tried to buy strong alcoholic beverages (legal age, 18). RESULTS: Of all 300 buying attempts, 86% were successful. In supermarkets, 88% of all attempts succeeded. In liquor stores, a difference was found between the purchase of strong alcohol by 17-year-olds (89%) and the purchase of soft alcoholic beverages by 15-year-olds (77%). In only 71 of all visits, mystery shoppers were asked for an ID. In 39% of these cases, they were still able to buy alcohol. Female adolescents were more successful in buying alcohol than male adolescents. CONCLUSIONS: The results show that supermarkets and liquor stores generally fail to see the need for extra care when young customers try to buy alcohol. Legal age restrictions without enforcement and facilitation clearly do not suffice to protect adolescents from early exposure to alcohol.