摘要：Objectives. We examined whether alcohol advertising on cable television is associated with adolescent viewership. Methods. Using Nielsen data for every national cable alcohol advertisement from 2001 to 2006 (608 591 ads), we examined whether ad incidence in a given advertising time slot was associated with adolescent viewership (i.e., the percentage of the audience that was aged 12–20 years) after we controlled for other demographic variables. Results. Almost all alcohol ads appeared in time slots with audiences made up of 30% or fewer underage viewers. In these time slots (standardized by duration and number of viewers), each 1-percentage-point increase in adolescent viewership was associated with more beer (7%), spirits (15%), and alcopop (or low-alcohol refresher; 22%) ads, but fewer wine (−8%) ads ( P < .001 for all). For spirits and alcopops, associations were stronger among adolescent girls than among adolescent boys ( P < .001 for each). Conclusions. Ad placements for beer, spirits, and alcopops increased as adolescent viewership rose from 0% to 30%, especially for female viewers. Alcohol advertising practices should be modified to limit exposure of underage viewers. Underage alcohol use is a national public health problem. In 2005, 36% of ninth graders and 51% of 12th graders reported drinking in the past 30 days; 33% of 12th graders reported binge drinking (i.e., having ≥ 5 drinks in 2 hours) during that time. 1 One study estimated that underage drinking accounts for 17.5% of total US consumer expenditures for alcohol. 2 Each year, about 5000 US deaths of persons younger than 21 years are attributable to underage alcohol use (mostly through alcohol-impaired driving, homicide, suicide, and drowning). 3 , 4 Underage drinking is linked to sexual and other violence, unintentional injury, pregnancy, unprotected sexual intercourse, delinquent behaviors, other substance use, and academic problems. 5 – 10 Those who begin drinking at 14 years or younger have a 47% lifetime incidence of alcohol dependence compared with 9% for those who begin drinking at 21 or older. 11 Evidence suggests that alcohol advertising influences underage drinking. A longitudinal study found that both regional alcohol advertising expenditures and individual exposure to alcohol ads were associated with subsequent underage drinking. 12 In a longitudinal study of seventh graders, watching television programs containing alcohol commercials was associated with drinking alcohol and consuming 3 or more drinks in a single setting. 13 A study of sixth and seventh graders found that exposure to alcohol advertising was associated with both drinking and intention to drink. 14 Other studies have shown that beer advertisements generate high levels of awareness among children and adolescents 15 – 17 and that awareness is associated with favorable beliefs about drinking and intention to drink. 15 Television is the most heavily used form of media among adolescents. 18 The average child aged 8 to 18 years watches 3 hours of television per day. In particular, cable television has rapidly supplanted broadcast television as this age group's dominant medium. 18 Similarly, alcohol advertising on cable has increased dramatically. 19 From 2001 to 2006, alcohol advertisements and expenditures on cable increased 176% (from 51 019 to 140 930 ads) and 137% (from $157 million to $372 million), respectively; cable now hosts 95% of all alcohol advertisements on national television networks. By comparison, total reported advertising expenditures for all product categories on cable television increased only 35% over the same period, and alcohol advertising on broadcast television has changed relatively little (unpublished data, Nielsen Monitor-Plus, Nielsen Media Research, Inc., 2002–2006). As both underage viewers and alcohol advertisers have turned toward cable, total exposure of underage viewers to alcohol ads has increased, with cable becoming the largest source of exposure of underage viewers. 19 Policymakers have argued about how best to limit exposure of underage viewers. At the end of 2003, the beer and spirits industries strengthened their voluntary guidelines, shifting the maximum underage viewership threshold from 50% to 30% (a standard previously adopted by the wine industry in 2000). 20 – 22 The Institute of Medicine and 20 state attorneys general have countered that more-stringent measures are needed. 23 , 24 One critical question is whether exposure of underage viewers to alcohol ads is an incidental by-product of advertising aimed purely at audiences 21 years and older. If so, then strong advertising restrictions to reduce the exposure of underage viewers might inadvertently prevent advertisers from reaching audiences 21 years and older as well. If exposure of underage viewers were incidental, ad incidence should, after the demographics of audiences 21 years and older are controlled for, demonstrate no association with underage viewership. Thus, we used Nielsen data from 2001 to 2006 to study whether the incidence of alcohol ads on national cable networks was associated with viewership by audiences aged 12 to 20 years.
