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Article Excerpt
Each year more than 100,000 Americans die from alcohol-related deaths. (1) Annual costs of health care and lost productivity from alcohol-related deaths, injuries, and illness are estimated at more than $148 billion. (2) Ethnic minorities disproportionately experience alcohol-related problems compared with whites. (3) Despite minimum legal drinking age laws, use and abuse of alcohol among youth is common. In the United States during the previous 30 days, 39% of eighth grade students and 72% of twelfth grade students reported drinking alcohol; 15% and 50%, respectively, reported having been drunk. (4) Alcohol-related car crashes are the number one cause of death for teenagers. (5) Youths who drink earlier in life are more likely to develop alcohol dependence and abuse. (6)
Multiple individual, interpersonal, and environmental factors are associated with the uptake and consumption of alcohol, (7,8) with alcohol marketing being one of them. Over the past 20 years, numerous studies have found that exposure to or awareness of alcohol advertising is associated with higher levels of alcohol drinking among adults, (9) including excessive drinking, and drinking and driving. (10) Youths" exposure to alcohol advertising has been linked to underage drinking, (10,11) binge drinking, (12,13) and precursors to drinking, such as a greater awareness of or liking of the alcohol product advertised, (11,14) mom positive attitudes toward drinking, and a greater intention to drink as an adult. (12)
It is estimated that the alcohol industry spends more than $4.5 billion annually to market its products. (15) In recent years, alcohol marketing has moved away from traditional advertising such as print, radio, and television to nontraditional advertising such as point-of-purchase (POP) materials at retail outlets, bars and restaurants. (16) POP has become one of the largest advertising media in the United States. (17) The amount of money spent on alcohol POP advertising continues to increase. In 1998, $720 million was spent on alcohol POP advertising at stores, (18) an increase from $600 million in 1995. (19) Over one billion dollars was spent on POP advertising at restaurants and bars, of which alcohol is a large proportion. (18)
POP advertising has several advantages for the seller over other types of alcohol marketing. First, in the United States there is minimal federal or state government regulation to decrease alcohol marketing at point of purchase, (20) and local control tends to be strictly limited by states. (21) The adoption of voluntary regulations is rare and tends to focus on marketing in more traditional venues such as television (e.g., major broadcast networks" ban on distilled spirits advertising).
Second, exposure to POP advertising is less subject to individual control (i.e., it is more difficult for people to "switch the channel"). Designed to target consumers at the place where they will actually buy the product, POP advertising draws consumers" attention to the product and reminds them of previous advertising messages or introduces them to new messages.
Third, multiple advertising messages may be used to simultaneously attract customers. Three-dimensional displays, advertisements with moving parts and flashing messages, along with promotional items that can be handled, carried, or worn, augment unidimensional advertisements typically seen in newspapers and magazines and on most billboards. Merchandise catalogs that offer items with alcohol industry logos on them (e.g., mugs and t-shirts) and industry-sponsored contests and give-aways further fill retail environments with alcohol advertising messages.
Fourth, POP advertising has been used increasingly to target audience subgroups such as ethnic minorities. (22) Compared with other avenues such as broadcast television, it is easier to deliver relevant messages to these ethnic groups, since POP advertising such as displays and signs can vary from store to store, appealing to Latino or to African American consumers in their neighborhoods. In three separate studies of alcohol billboard advertising, two in California and one in Chicago, ethnically diverse communities were disproportionately targeted with alcohol advertisements. (23-25)
Previous research has examined the scope and content of alcohol advertising in televised sports, (26) prime time television, (27) music videos, (28) and children's animated films, (29) and on billboards. (23,24) Only one other published study was identified that assessed alcohol POP advertising in retail outlets. (30) This study, which examined alcohol POP advertising among a randomly selected group of 3,961 stores throughout the United States, complements our research by looking at similar types of alcohol marketing (e.g., prevalence and placement of alcohol advertising and alcohol warning signs) and provides a larger context in which to compare our mole geographically focused study. Our research also builds on this study, as it includes some additional areas of focus, including restaurants and bars, the content and ethnic targeting of alcohol marketing, and the association between the amount of ethnically targeted advertising and the size of ethnic groups living in each community.
Methods
Sample
This study is part of a larger project that looked at the impact of environmental influences (e.g., alcohol outlet density, alcohol advertising, and policies to restrict youths' access to alcohol) on teenage alcohol drinking and related injuries in ten urban communities in California. Since teenagers, and the areas they frequent most often, were the focus of this project, high school attendance areas where participating teenagers live define each community. Compared with the state of California, these communities are more ethnically diverse and, as a whole, more economically disadvantaged (see Table 1).
Maps of the school attendance area for the public high school in each community were obtained from the school or the school district and reproduced electronically in MapInfo 3.0 (31) using census block groups as boundaries. On-sale alcohol outlets (i.e., alcohol is sold for consumption on premises, such as bars and restaurants) and off-sale alcohol outlets (i.e., alcohol is sold for consumption off the premises, such as supermarkets or liquor stores) in each community were mapped based on addresses of alcohol-outlet license data purchased...
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