The following posting by CHW Contributing Writer David Jernigan and his colleagues appeared earlier this month in CDC’s MMWR. For full text and charts, click here.
Excessive alcohol consumption accounted for an estimated 4,700 deaths and 280,000 years of potential life lost among youths aged <21 years each year during 2001–2005 (1). Exposure to alcohol marketing increases the likelihood to varying degrees that youths will initiate drinking and drink at higher levels (2). By 2003, the alcohol industry voluntarily agreed not to advertise on television programs where >30% of the audience is reasonably expected to be aged <21 years. However, the National Research Council/Institute of Medicine (NRC/IOM) proposed in 2003 that “the industry standard should move toward a 15% threshold for television advertising” (3).
Because local media markets might have different age distributions, the Center on Alcohol Marketing and Youth, Johns Hopkins Bloomberg School of Public Health, evaluated the proportion of advertisements that appeared on television programs in 25 local television markets* and resulting youth exposure that exceeded the industry standard (i.e., >30% aged 2–20 years) or the proposed NRC/IOM standard (i.e., >15% aged 12–20 years). Among national television programs with alcohol advertising, placements were assessed for the 10 programs with the largest number of youth viewers within each of four program categories: network sports, network nonsports, cable sports, and cable nonsports (40 total). Of the 196,494 alcohol advertisements that aired on television programs with the largest number of youth viewers in these local markets, placement of 23.7% exceeded the industry threshold and 35.4% exceeded the NRC/IOM threshold.
These results indicate that the alcohol industry’s self-regulation of its advertising could be improved, and youth exposure to alcohol advertising could be further reduced by adopting and complying with the NRC/IOM standard. In addition, continued public health surveillance would allow for sustained assessment of youth exposure to alcohol advertising and inform future interventions.
Nielsen Station Index Local People Meter Market Survey† data for 2010 were used to assess exposure to alcohol advertisements placed on nationally telecast programs among a sample of households in 25 local media markets, as well as the demographic characteristics of program viewers aged ≥2 years in these markets (approximately 98.9% of all U.S. households have televisions) (4). In 2010, these 25 media markets were among the largest in the United States and accounted for 50.3% of the total U.S. population aged 12–20 years living in homes with televisions (5).
Advertising exposure was analyzed first using the current voluntary industry standard, which calls for no alcohol advertising during programs for which persons aged 2–20 years composed >30% of the expected audience. Exposure also was analyzed using the NRC/IOM proposed standard that called on industry to move toward a 15% threshold for television advertising using persons aged ≥12 years as the denominator.§ Alcohol use usually begins in early adolescence; federal surveys begin measuring youth drinking at age 12 years, and age 21 years is the minimum legal age for the purchase of alcohol in all 50 states. The local population was used as the denominator to account for differences in the age distribution of local media markets.
Among nationally televised programs with alcohol advertising, exposure to this advertising was evaluated for the 10 programs with the largest number of youth viewers in each of four program categories: cable sports, cable nonsports, broadcast network sports, and broadcast network nonsports (i.e., 40 programs in total) in each of the 25 television media markets. Nationally, these programs represented 29% of all youth exposure to alcohol advertising on broadcast network nonsports, 20% on broadcast network sports, 20% on cable sports, and 14% on cable nonsports. The total number of gross impressions,¶ an indicator used by the advertising industry to measure advertising exposure, was calculated by summing the placement-specific number of viewers of different ages across all advertising placements for a particular market. A total of 196,494 alcohol product advertisements aired on the 40 programs that were assessed across the 25 markets, or approximately 7,860 advertisements per market; however, not all advertisements appeared in all markets.
Of the 196,494 total alcohol advertisements, 46,493 (23.7%) were placed during programs for which >30% of the audience was aged 2–20 years (range: 31.5% in Houston, Texas, to 16.3% in Washington, DC); and 69,622 (35.4%) were placed during programs that exceeded the 15% threshold (range: 45.2% in Chicago, Illinois, to 25.9% in Portland, Oregon) (Table 1).** Of the 797,571,000 total alcohol advertising impressions among youths aged 12–20 years that resulted from these advertisements, 33.3% were from advertisements that were placed in programs exceeding the 30% threshold (range: 45.4% in Orlando-Daytona Beach-Melbourne, Florida, to 25.2% in Washington, DC); and 54.4% were from advertisements on programs that exceeded the 15% threshold (range: 65.3% in New York, New York, to 42.0% in Boston, Massachusetts) (Table 2).††
David H. Jernigan, PhD, Johns Hopkins Univ, Baltimore, MD. Craig S. Ross, MBA, Joshua Ostroff, Virtual Media Resources, Natick, MA. Lela R. McKnight-Eily, PhD, Robert D. Brewer, MD, Div of Population Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Corresponding contributor: David H. Jernigan, email@example.com, 410-502-4096.
- CDC. Alcohol-related disease impact. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. Available at http://apps.nccd.cdc.gov/dach_ardi/default/default.aspx.
- Anderson P, de Bruijn A, Angus K, Gordon R, Hastings G. Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies. Alcohol Alcohol 2009;44:229–43.
- National Research Council and Institute of Medicine. Reducing underage drinking: a collective responsibility. committee on developing a strategy to reduce and prevent underage drinking. Washington, DC: The National Academies Press; 2004.
- Nielsen. 2010 U.S. television universe estimates. New York, NY: Nielsen; 2009.
- Nielsen. 2010 local market television universe estimates. New York, NY: Nielsen; 2009.
- Center on Alcohol Marketing and Youth. Youth exposure to alcohol advertising on television, 2001–2009. Baltimore, MD: Center on Alcohol Marketing and Youth; 2010.
- Siegel MB, Naimi TS, Cremeens JL, Nelson DE. Alcoholic beverage preferences and associated drinking patterns and risk behaviors among high school youth. Am J Prev Med 2011;40:419–26.
- Evans J, Kelly R. Self-regulation in the alcohol industry: a review of industry efforts to avoid promoting alcohol to underage consumers. Washington, DC: Federal Trade Commission;1999.
- Community Preventive Services Task Force. Preventing excessive alcohol consumption. The Guide to Community Preventive Services 2012; Atlanta, GA: Community Preventive Services Task Force; 2013. Available at http://www.thecommunityguide.org/alcohol/index.html.
* Television media markets studied included Atlanta, Georgia; Baltimore, Maryland; Boston, Massachusetts; Charlotte, North Carolina; Chicago, Illinois; Cleveland, Ohio; Dallas, Texas; Denver, Colorado; Detroit, Michigan; Houston, Texas; Los Angeles, California; Miami, Florida; Minneapolis, Minnesota; New York, New York; Orlando, Florida; Philadelphia, Pennsylvania; Phoenix, Arizona; Pittsburgh, Pennsylvania; Portland, Oregon; Sacramento, California; San Francisco, California; Seattle, Washington; St. Louis, Missouri; Tampa, Florida; and Washington, DC. These 25 media markets represent 25 of the 26 largest television markets by population. Raleigh-Durham, North Carolina, the 25th largest market, was excluded because it did not have Nielsen Local People Meter data at of the time of this analysis.
† Introduced by Nielsen in 2002, Local People Meters measure viewing behavior and viewer demographics and have been phased into the largest television markets over the past decade. In comparison with traditional paper diary methods, or with earlier-generation channel-tuning meters supplemented by paper diaries to obtain demographic viewing estimates, Local People Meters are more precise and are now widely accepted by advertisers, television networks, and television stations as the standard for measuring local viewing in larger markets.
§ The rationale for 30% was to limit advertisements to media in which the legal-age adult audience (aged ≥21 years) was proportional to the legal-age adult population, at that time 70%. This standard has most recently been revised to 28.4% underage (71.6% legal age) based on 2010 census data. However, not all youths are at equal risk for drinking. For example, few youths ages 2–11 years engage in drinking behaviors, and the youngest age at which federal surveys begin measuring drinking behavior is 12 years. Thus, the 15% standard is based on the at-risk population of youths aged 12–20 years, which makes up approximately 15% of the U.S. population aged ≥12 years.
¶ An advertising impression occurs when one person sees an advertisement. If an advertisement is seen by five different people, that counts as five impressions. Gross impressions are the sum of impressions for any given advertising campaign, and include multiple exposures for some or all of the people who are exposed to that campaign.
** Table 1 shows the top and bottom five markets with youth audiences in excess of 30%. Portland was the low market on the 15% standard, but was not in the bottom five for the 30% standard, so it does not appear in the table.
†† Data for all 25 markets available at http://www.camy.org.