Prevalence, proximity and predictors of alcohol ads in Central Harlem

Similarities Between Alcohol and Tobacco Advertising Exposure and Adolescent Use of Each of These Substances

OBJECTIVE

Underage alcohol use is a major public health problem and substantial corporate money supports alcohol advertising across multiple venues. A diverse research literature demonstrates that adolescent exposure to such advertising is associated with drinking attitudes and behavior, but no scientific body has determined these associations to be causal. The objective of this study was to assess the association between alcohol advertising and teen drinking in the context of the "Analogy" criterion of the Bradford Hill criteria and consider a determination that the association between exposure to alcohol advertising and alcohol use is causal.

METHOD

This study was a narrative review on the association between adolescent exposure to alcohol advertising and subsequent alcohol use in the context of domains utilized in the Surgeon General's 2012 Report, Preventing Tobacco Use Among Youth and Young Adults, which concluded, "Advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults."

RESULTS

In every aspect compared (i.e., adolescent knowledge; attitudes toward; initiation of use; continuation of use; mediums of advertisement; the use of mascots, celebrities, and themes; and frequency and density of advertisements and retailers), the findings for both tobacco and alcohol and their association with exposure to advertising are analogous.

CONCLUSIONS

Application of the Analogy criterion of the Bradford Hill criteria comparing alcohol and tobacco supports a judgment that the association between exposure to alcohol advertising and increased adolescent knowledge, attitudes toward, initiation, and continuation of alcohol use are causal in nature.

#digital hood: Engagement with Risk Content on Social Media among Black and Hispanic Youth

The digital neighborhood is the amalgamation of the spaces online where youth connect with others. Just as Black and Hispanic youth live in neighborhoods that influence their health, they are also influenced by online digital neighborhoods. Youth are exposed to social media content featuring substance use, sexual risk, and violence, yet little is known about the extent to which youth engage with such content. Using a modified venue sampling strategy, we administered CASI surveys to 145 Black and Hispanic youth aged 13-24 living in low-income urban neighborhoods. Across social media platforms, respondents reported high levels of exposure to sexual, alcohol, drug, and violence-related content (65-84%). Users reported lower levels of engagement with risk-related content (on an engagement continuum), ranging from passive exposure to dissemination. While negative risks may be amplified in the digital neighborhood, youth appear to strategically limit their engagement with that content. However, because risk behavior messaging is common in these digital neighborhoods, these spaces provide opportunities for health promotion interventions.

Unhealthful Food-and-Beverage Advertising in Subway Stations: Targeted Marketing, Vulnerable Groups, Dietary Intake, and Poor Health

Unhealthful food-and-beverage advertising often targets vulnerable groups. The extent of such advertising in subway stations has not been reported and it is not clear how ad placement may relate to subway ridership or community demographics, or what the implications might be for diets and diet-related health in surrounding communities. Riding all subway lines (n = 7) in the Bronx, NY, USA, investigators systematically assessed all print ads (n = 1586) in all stations (n = 68) in 2012. Data about subway ridership came from the Metropolitan Transportation Authority. Demographic data on surrounding residential areas came from the U.S. Census Bureau. Data on dietary intake and diet-related conditions came from a city health-department survey. There were no ads promoting "more-healthful" food-or-beverage items (i.e., fruits, vegetables, whole grains, nuts, water or milk). There were many ads for "less-healthful" items (e.g., candies, chips, sugary cereals, frozen pizzas, "energy" drinks, coffee confections, hard alcohol, and beer). Ad placement did not relate to the number of riders entering at stations. Instead, exposure to food-or-beverage ads generally, and to "less-healthful" ads particularly (specifically ads in Spanish, directed at youth, and/or featuring minorities), was directly correlated with poverty, lower high-school graduation rates, higher percentages of Hispanics, and/or higher percentages of children in surrounding residential areas. Correlations were robust to sensitivity analyses. Additional analyses suggested correlations between ad exposures and sugary-drink consumption, fruit-and-vegetable intake, and diabetes, hypertension, and high-cholesterol rates. Subway-station ads for "less-healthful" items were located disproportionately in areas home to vulnerable populations facing diet and diet-related-health challenges. The fact that uneven ad placement did not relate to total rider counts suggests ads were not directed at the largest possible audiences but rather targeted to specific groups.

Industry self-regulation of alcohol marketing: a systematic review of content and exposure research

BACKGROUND AND AIMS

With governments relying increasingly upon the alcohol industry's self-regulated marketing codes to restrict alcohol marketing activity, there is a need to summarize the findings of research relevant to alcohol marketing controls. This paper provides a systematic review of studies investigating the content of, and exposure to, alcohol marketing in relation to self-regulated guidelines.

METHODS

Peer-reviewed papers were identified through four literature search engines: SCOPUS, Web of Science, PubMed and PsychINFO. Non-peer-reviewed reports produced by public health agencies, alcohol research centers, non-governmental organizations and government research centers were also identified. Ninety-six publications met the inclusion criteria.

RESULTS

Of the 19 studies evaluating a specific marketing code and 25 content analysis studies reviewed, all detected content that could be considered potentially harmful to children and adolescents, including themes that appeal strongly to young men. Of the 57 studies of alcohol advertising exposure, high levels of youth exposure and high awareness of alcohol advertising were found for television, radio, print, digital and outdoor advertisements. Youth exposure to alcohol advertising has increased over time, even as greater compliance with exposure thresholds has been documented.

CONCLUSIONS

Violations of the content guidelines within self-regulated alcohol marketing codes are highly prevalent in certain media. Exposure to alcohol marketing, particularly among youth, is also prevalent. Taken together, the findings suggest that the current self-regulatory systems that govern alcohol marketing practices are not meeting their intended goal of protecting vulnerable populations.

Alcohol-Branded Merchandise Ownership and Drinking

CONTEXTS

Alcohol-branded merchandise (ABM) has a longer shelf-life than other forms of alcohol marketing and the potential to become integrated into children's self-identities.

OBJECTIVE

This review sought to explore the current literature on children's exposure to, and the impact of, ABM.

DATA SOURCES

PsycInfo, Proquest, Science Direct, and ABI-Inform databases were searched from the earliest available date to May 2015. Additional studies were identified by a manual review of the reference lists of retrieved articles and contacting the corresponding author of each included study.

STUDY SELECTION

Articles that reported on child or adolescent ownership of ABM and/or the relationship between ABM ownership and drinking were included.

DATA EXTRACTION

Data on key measures were tabulated; where data of interest were not reported, requests for further information were sent to the articles' authors.

RESULTS

Nine cross-sectional and 4 longitudinal studies were identified. ABM ownership ranged from 11% to 59% and was higher among older children and males. Seven cross-sectional studies reported associations between ABM ownership and drinking-related behaviors. All 4 longitudinal studies reported a significant relationship between ownership at baseline and drinking initiation at follow-up.

LIMITATIONS

The small number of available studies, with different measures of ABM ownership and of associations/effects.

CONCLUSIONS

The few studies exploring ABM ownership are consistent in showing high rates of ownership and associations between ownership and current and future drinking. There is a need for further research into specific aspects of ABM ownership. However, there is also a need for policy interventions to reduce children's access to and ownership of ABM.

"Racism still exists": a public health intervention using racism "countermarketing" outdoor advertising in a Black neighborhood

The negative health effects of racism have been well documented, but how to intervene to redress these effects has been little studied. This study reports on RISE (Racism Still Exists), a high-risk, high-reward public health intervention that used outdoor advertising to disseminate a "countermarketing" campaign in New York City (NYC). Over 6 months, the campaign advertised stark facts about the persistence of racism in the USA. A probability sample of N = 144 participants from two predominantly Black NYC neighborhoods completed measures of health status, health behaviors, and social attitudes. Three months postintervention, statistically significant declines in psychological distress were seen among study participants who were exposed to the campaign compared to those who were not. There were no changes in other hypothesized outcomes. The campaign also generated significant public discourse, particularly in social media. The results suggest that racism countermarketing campaigns may have promise as a community-based intervention to address health inequalities.

The prevalence of harmful content on outdoor advertising in Los Angeles: land use, community characteristics, and the spatial inequality of a public health nuisance

OBJECTIVES

Our study sought to examine associations between the content of outdoor advertising and neighborhood ethnic/racial and socioeconomic composition to see whether particular communities disproportionately host harmful content.

METHODS

We constructed a spatial database of photographs taken from June 2012 until December 2012 in 7 identically zoned communities in Los Angeles, California, to compare outdoor advertising area and content. We selected communities to contrast by ethnicity/race, income, education, and youth population.

RESULTS

At-risk communities and communities of color hosted more outdoor advertising depicting harmful content than other communities. Among included neighborhoods, harmful content and the proportion of outdoor advertising overall were most prevalent in communities of Asian Americans and Latino Americans. In all communities, harmful content represented at least 24% of outdoor advertising space.

CONCLUSIONS

This study provides evidence of the potential for land-use decisions to result in spatially inequitable health impacts. Although dictating the placement of outdoor advertising through zoning may seem sensible, such a decision might have the unintended consequence of disadvantaging the well-being of local communities. Neighborhood factors require more contextually nuanced public health and land-use policy.

Are neighborhood conditions associated with HIV management?

OBJECTIVES

HIV infection has become a manageable chronic disease as a result of treatment advances. Secondary prevention efforts have proved inadequate to reduce the estimated incidence of new HIV infections. Epidemiological data suggest that geographical clustering of new HIV infections is a common phenomenon, particularly in urban areas among populations of low socioeconomic status. This study aimed to assess the relationship between neighbourhood conditions and HIV management and engagement in high-risk behaviours.

METHODS

During routine out-patient HIV clinic visits, 762 individuals from the St Louis metropolitan area completed behavioural assessments in 2008. Biomedical markers were abstracted from their medical records. Multi-level analyses were conducted based on individuals' census tracts.

RESULTS

The majority of the sample were male and African American. In the adjusted models, individuals residing in neighbourhoods with higher poverty rates were more likely to have lower CD4 cell counts and be current smokers. In neighbourhoods with higher rates of unemployment, individuals were less likely to have a current antiretroviral prescription. In more racially segregated neighbourhoods, individuals reported more depressive symptoms.

CONCLUSIONS

Despite the advances in HIV disease management, neighbourhood characteristics contribute to disparities in HIV care. Interventions that address neighbourhood conditions as barriers to HIV management may provide improved health outcomes.

Alcohol advertising at Boston subway stations: an assessment of exposure by race and socioeconomic status

OBJECTIVES

We investigated the frequency of alcohol ads at all 113 subway and streetcar stations in Boston and the patterns of community exposure stratified by race, socioeconomic status, and age.

METHODS

We assessed the extent of alcohol advertising at each station in May 2009. We measured gross impressions and gross rating points (GRPs) for the entire Greater Boston population and for Boston public school student commuters. We compared the frequency of alcohol advertising between neighborhoods with differing demographics.

RESULTS

For the Greater Boston population, alcohol advertising at subway stations generated 109 GRPs on a typical day. For Boston public school students in grades 5 to 12, alcohol advertising at stations generated 134 GRPs. Advertising at stations in low-poverty neighborhoods generated 14.1 GRPs and at stations in high-poverty areas, 63.6 GRPs.

CONCLUSIONS

Alcohol ads reach the equivalent of every adult in the Greater Boston region and the equivalent of every 5th- to 12th-grade public school student each day. More alcohol ads were displayed in stations in neighborhoods with high poverty rates than in stations in neighborhoods with low poverty rates.

Socio-economic differences in outdoor food advertising in a city in Northern England

OBJECTIVE

To explore differences in the prevalence of outdoor food advertising, and the type and nutritional content of advertised foods, according to an area-based marker of socio-economic position (SEP) in a city in Northern England.

DESIGN

All outdoor advertisements in the city were identified during October-December 2009, their size (in m2) estimated and their location determined using a global positioning system device. Advertisements were classified as food or non-food. Food advertisements were classified into one of six food categories. Information on the nutritional content of advertised foods was obtained from packaging and manufacturer's websites. An area-based marker of SEP was assigned using the location of each advertisement, grouped into three affluence tertiles for analysis.

SETTING

A city in Northern England.

SUBJECTS

None.

RESULTS

In all, 1371 advertisements were identified; 211 (15 %) of these were for food. The advertisements covered 6765 m2, of which 1326 m2 (20 %) was for food. Total advertising and food advertising space was largest in the least affluent tertile. There was little evidence of socio-economic trends in the type or nutritional content of advertised foods.

CONCLUSIONS

Despite an absence of socio-economic differences in the type and nutritional content of advertised foods, there were socio-economic differences in food advertising space. There may also be socio-economic differences in exposure to outdoor food advertising.

Behavior matters

Behavior has a broad and central role in health. Behavioral interventions can be effectively used to prevent disease, improve management of existing disease, increase quality of life, and reduce healthcare costs. A summary is presented of evidence for these conclusions in cardiovascular disease/diabetes, cancer, and HIV/AIDS as well as with key risk factors: tobacco use, poor diet, physical inactivity, and excessive alcohol consumption. For each, documentation is made of (1) moderation of genetic and other fundamental biological influences by behaviors and social-environmental factors; (2) impacts of behaviors on health; (3) success of behavioral interventions in prevention; (4) disease management; (5) quality of life, and (6) improvements in the health of populations through behavioral health promotion programs. Evidence indicates the cost effectiveness and value of behavioral interventions, especially relative to other common health services as well as the value they add in terms of quality of life. Pertinent to clinicians and their patients as well as to health policy and population health, the benefits of behavioral interventions extend beyond impacts on a particular disease or risk factor. Rather, they include broad effects and benefits on prevention, disease management, and well-being across the life span. Among priorities for dissemination research, the application of behavioral approaches is challenged by diverse barriers, including socioeconomic barriers linked to health disparities. However, behavioral approaches including those emphasizing community and social influences appear to be useful in addressing such challenges. In sum, behavioral approaches should have a central place in prevention and health care of the 21st century.

Alcohol advertising on Boston's Massachusetts Bay Transportation Authority transit system: an assessment of youths' and adults' exposure

OBJECTIVES

We investigated the frequency with which alcohol advertisements appeared on Massachusetts Bay Transportation Authority (MBTA) transit lines in Boston, MA, and we calculated adult and youths' exposure to the ads.

METHODS

We measured the nature and extent of alcohol advertisements on 4 Boston transit lines on 2 separate weekdays 1 month apart in June and July of 2008. We calculated weekday ad exposure for all passengers (all ages) and for Boston Public School student passengers (aged 11-18 years).

RESULTS

Alcohol ads were viewed an estimated 1,212,960 times across all Boston-area transit passengers during an average weekday, reaching the equivalent of 42.7% of that population. Alcohol ads were viewed an estimated 18,269 times by Boston Public School student transit passengers during an average weekday, reaching the equivalent of 54.1% of that population.

CONCLUSIONS

Advertisers reached the equivalent of half of all Boston Public School transit passengers aged 11 to 18 years and the equivalent of nearly half of all transit passengers in the Boston area with an alcohol advertisement each day. Because of the high exposure of underage youths to alcohol advertisements, we recommend that the MBTA prohibit alcohol advertising on the Boston transit system.

Individual and Group Racism and Problem Drinking Among African American Women

This study investigated whether perceived individual and group racism were associated with problematic drinking patterns among urban African American women. In this cross-sectional survey, 139 African American women aged 21 to 49 years who consumed alcohol at least once per month were recruited from and interviewed at varied community sites in Central Harlem, New York City. Drinking patterns were assessed with the CAGE, a commonly used four-item screening measure. Frequent heavy drinking was measured with a single item used in the Centers for Disease Control Behavioral Risk Factor Surveillance System. The results showed that, controlling for household income and education level, individual racism was associated with drinking patterns suggestive of alcohol dependence but not frequent heavy drinking. Group racism was not associated with either outcome. The results replicate and extend findings in previous studies and contribute to building literature on the effects of racism on health-damaging behaviors.

Early adolescent, multi-ethnic, urban youth's exposure to patterns of alcohol-related neighborhood characteristics

This study identified heterogeneous classes of alcohol-related neighborhood characteristics to which multi-ethnic, early adolescents in urban communities are exposed. The sample comprised 4,215 youth from 42 community areas in Chicago, Illinois who completed surveys at the beginning of 6th grade (2002). Neighborhood measures included: (1) mean number of alcohol outlets per 1,000 population per community area; (2) alcohol purchase attempt rate by pseudo-underage youth; (3) average number of alcohol advertisements within 1,500 feet of each school per community; and (4) a Census 2000-based deprivation index. Parents and community leaders provided data on perceived neighborhood problems and parental prevention actions, and neighborhood strength and preventive action by communities, law enforcement, and community organizations, respectively. Multilevel latent class analysis identified the number and characteristics of heterogeneous latent neighborhood classes in which these youth are exposed. Five classes best described the heterogeneity among the sample: (1) Low social capital/low exposure/high access to alcohol (19.8%), (2) Low social capital/low exposure/low access to alcohol (24.5%), (3) Moderate social capital/low exposure/high access to alcohol (30.0%), (4) Moderate social capital/moderate exposure/low access to alcohol (20.1%), and (5) High social capital/moderate exposure/high access to alcohol (5.6%). The racial/ethnic distribution among the classes varied considerably. Results suggest there is substantive heterogeneity among this seemingly homogeneous urban population. Further, they highlight the socioeconomic disadvantage of these inner-city communities and the resource disparity across the racial/ethnic groups. Understanding the nuances among communities may lend to development of more efficacious preventive interventions and policy initiatives, inform theory, and help prioritize limited resources.

Understanding African American men's perceptions of racism, male gender socialization, and social capital through photovoice

In this study we used a participatory qualitative research approach--photovoice--to collect information about African American men's perceptions of the factors that influenced their own health and the health of their communities. Photovoice was conducted as part of the "Men as Navigators (MAN) for Health" project, an evaluation of a male lay health advisor (LHA) intervention in central North Carolina. Twelve African American men living in both urban and rural communities took photographs and discussed the photos in six photo discussion sessions. Analysis involved identifying recurring themes from the photos and transcriptions of photo discussions. The results suggest that race and racism, male gender socialization, and social networks and social capital all have important influences on African American men's health. The implications for further research and public health practice are discussed.

Association between residential exposure to outdoor alcohol advertising and problem drinking among African American women in New York City

We evaluated the association between residential exposure to outdoor alcohol advertising and current problem drinking among 139 African American women aged 21 to 49 years in Central Harlem, New York City. We found that exposure to advertisements was positively related to problem drinking (13% greater odds), even after we controlled for a family history of alcohol problems and socioeconomic status. The results suggest that the density of alcohol advertisements in predominantly African American neighborhoods may add to problem drinking behavior of their residents.

O impacto da publicidade de bebidas alcoólicas sobre o consumo entre jovens: revisão da literatura internacional

OBJETIVO: Problemas relacionados ao consumo de álcool são freqüentes, especialmente entre a população jovem. A publicidade de bebidas alcoólicas é um dos fatores passíveis de modificação com impacto no aumento do consumo de álcool. MÉTODO: Foi realizada uma revisão bibliográfica de trabalhos que investigaram de diversos pontos de vista o impacto da publicidade do álcool sobre o consumo. A busca foi feita nas bases de dados Medline, SciELO, PsychoInfo e Google Scholar no período entre 1990 e 2008 e utilizou-se a técnica de " bola de neve" para a indicação de autores mais profícuos na área. Obtiveram-se mais de uma centena de artigos. RESULTADOS: O conjunto de trabalhos aponta que fatores como exposição à publicidade e atratividade da publicidade de bebidas alcoólicas estão relacionados com uma maior expectativa de consumo futuro e com um consumo maior e mais precoce, principalmente entre adolescentes e adultos jovens. Apesar das dificuldades metodológicas, estudos econométricos mais recentes consideram que a redução e/ou banimento de publicidade teria efeito de redução do consumo de álcool. Questões referentes às bases neurofisiológicas do processo de tomada de decisões e da liberdade de escolha no contexto da exposição à publicidade também são discutidas. CONCLUSÕES: O conhecimento atual sobre o tema indica que a redução da exposição à publicidade tem impacto sobre o consumo de álcool, principalmente entre os mais jovens.

Alcohol and tobacco marketing: evaluating compliance with outdoor advertising guidelines

BACKGROUND

Historically, the alcohol and tobacco industries have been the biggest users of outdoor advertising. However, the 1999 Master Settlement Agreement (MSA) outlawed tobacco billboards and transit furniture (e.g., bus, bench) ads, and the Outdoor Advertising Association of America (OAAA) has pledged to voluntarily eliminate ads for alcohol and tobacco within 500 feet of schools, playgrounds, and churches.

METHODS

Outdoor advertisements were observed (2004-2005) in a sample of urban census tracts (106 in pre-Katrina southern Louisiana and 114 in Los Angeles County) to evaluate tobacco and alcohol advertisers' compliance with the MSA and the OAAA Code of Industry Principles. Data were analyzed in 2007-2008.

RESULTS

More than one in four tobacco ads in Louisiana failed to comply with the MSA. In Los Angeles, 37% of alcohol ads and 25% of tobacco ads were located within 500 feet of a school, playground, or church; in Louisiana, roughly one in five ads promoting alcohol or tobacco fell within this distance. In Los Angeles, low-income status and the presence of a freeway in the tract were associated with 40% more alcohol and tobacco billboards near children. In Louisiana, each additional major roadway-mile was associated with 4% more tobacco ads-in violation of MSA-and 7% more small ads near schools, playgrounds, and churches; city jurisdiction accounted for 55% of MSA violations and more than 70% of the violations of OAAA guidelines.

CONCLUSIONS

Cities must be empowered to deal locally with violations of the MSA. Legislation may be needed to force advertisers to honor their pledge to protect children from alcohol and tobacco ads.

Reducing youth exposure to alcohol ads: targeting public transit

Underage drinking is a major public health problem. Youth drink more heavily than adults and are more vulnerable to the adverse effects of alcohol. Previous research has demonstrated the connection between alcohol advertising and underage drinking. Restricting outdoor advertising in general and transit ads in particular, represents an important opportunity to reduce youth exposure. To address this problem, the Marin Institute, an alcohol industry watchdog group in Northern California, conducted a survey of alcohol ads on San Francisco bus shelters. The survey received sufficient media attention to lead the billboard company, CBS Outdoor, into taking down the ads. Marin Institute also surveyed the 25 largest transit agencies; results showed that 75 percent of responding agencies currently have policies that ban alcohol advertising. However, as the experience in San Francisco demonstrated, having a policy on paper does not necessarily mean it is being followed. Communities must be diligent in holding accountable government officials, the alcohol industry, and the media companies through which advertising occurs.