Commentary on M orgenstern et al . (2014): As channels for alcohol marketing continue to increase, so will alcohol marketing receptivity and youth drinking

Morgenstern and colleagues demonstrate a clear association between alcohol marketing receptivity and bingedrinking at baseline and between alcohol marketing receptivity and progression to binge-drinking 12 months later [1]. The consistency of this effect across four countries with different marketing and regulatory regimes and different drinking cultures demonstrates the robustness of this relationship. One of the consistent difficulties in undertaking research into the effects of alcohol advertising on young people is selecting a representative sample. The extent to which this impacts upon the generalizability of study findings varies between countries/jurisdictions, studies (factors such as topic sensitivity and respondent burden) and between research groups (factors such as existing relationships with schools and communities). In this study, acceptance rates ranged from 100% of schools approached to participate (seven of seven in Scotland) to 14.0% (35 of 253 in Poland). This raises the question as to whether the participating schools are different in important ways to those which declined to participate— such as in their provision of education and conveying of values regarding substance use, or the make-up of their student bodies. Differences in ethics bodies’ requirements between jurisdictions pose further problems for gathering comprehensive and comparable data. The participation rate ranged from 78% in Germany (active parental consent required) to 92% in Scotland (passive parental consent). The low parental non-consent rate in Scotland (11 parents) suggests that the absence of active consent in the other countries (e.g. 515 in Germany) is consistent with earlier school-based research, which concluded that failure to return consent forms generally reflects latent consent rather than deliberate non-consent [2]. The different processes for consent between countries mean that it is difficult to make accurate comparisons between populations and thus limit our ability to compare the effects of different advertising and regulatory regimes. These issues are particularly important when proindustry economists argue that reported effects are the result of publication bias, omitted variable bias and dissemination bias [3], whereas the reality of complex recruitment and ethics requirements means that we may well be surveying those who are concerned about the negative effects of alcohol advertising and thus underestimating the effects of alcohol marketing. For example, a US study of youth smoking found that active consent resulted in a lesser representation of boys, African Americans, students with poor grades and smokers [4]. Similarly, analysis of early, late and non-respondents to a New Zealand (adult) population health survey concluded that non-respondents are likely to have more problematic behaviours and thus survey data are likely to underestimate the prevalence of binge drinking [5]. The consistency of the relationship between receptivity and binge drinking is informative for public health researchers and policymakers. This consistency demonstrates clearly that the ubiquitous nature of alcohol marketing is an important factor in the initiation of (binge) drinking among young people, with an increased likelihood of binge drinking initiation among never-bingers at baseline who were receptive to alcohol marketing. Industry spokespeople may aim to misdirect consideration of policy solutions by focusing on the argument that absence of differences in effects despite differences in regulatory environments suggests that banning alcohol advertising is not an effective strategy to reduce youth alcohol use. However, in this context it is important to note that Polish respondents predominantly named beer brands (the category of alcohol that is allowed to be advertised in that country) and, importantly, that alcohol marketing is far more complex and widespread than the mainstream advertising channels that are typically the focus of advertising regulation [6]. Morgenstern et al. note that a limitation of their study was the use of a single measure (naming a favourite alcohol advertisement) as a measure of alcohol marketing receptivity. Future research in this area could usefully include other measures of receptivity, such as ownership of alcohol-branded merchandise [7–9] and recognition or recall of recent alcohol advertisements in the relevant jurisdiction [10,11]. Further, it is noteworthy that a number of the respondents named alcohol brands that are not advertised in ‘mainstream’ media. Alcohol marketers are extremely knowledgeable at being where their target market lives and plays—as evidenced by the longstanding association between alcohol marketing and sports, and the surge of alcohol marketing at music festivals and other youth events. As young people have moved away from mainstream media to the internet, social networks and mobile communications, the alcohol industry has moved with them, and alcohol marketing is ubiquitous in online spaces [12,13]. For example, in 2012 an industry report described alcohol brands as ‘shaking up engagement’ on Instagram [14] and the European Centre for Monitoring Alcohol Marketing (EUCAM) reported that alcohol brands created the most engagement on Facebook [15]. Thus, future studies COMMENTARY bs_bs_banner