Towards a global policy against alcohol marketing to youth: Challenges and recommendations for research

A significant body of work now indicates that adult onset of alcoholism and alcohol-related problems can be traced back to underage drinking.1,2 Despite numerous countries’ efforts to curtail underage drinking, it remains a significant global public health issue,3,4 and alcohol marketing has been identified as one of the primary contributors to this growing problem.5 Among various tools countries can use to curtail underage drinking, an important one is formulating and implementing policies that govern alcohol marketing practices, especially those directed toward children and adolescents. Developing such policies, however, must be based on sound scientific evidence, which could come in at least two forms: demonstration of impact of drinking and a marketing causal vector that links advertising with underage consumption of alcohol. By impact, we mean that the evidence needs to point to the effects of underage drinking. It would show the deleterious effects not only on individuals themselves, but also on their social networks, communities, and society as a whole, thus compelling the need for change. Second, the evidence needs to demonstrate a marketing causal vector, ability to make a causal link between the marketing or advertisement of alcohol, either directly or indirectly, to youth, on the one hand, with subsequent underage consumption of alcohol, on the other. A substantial body of work demonstrates both these aspects.5-8 A number of countries have sound policies in place restricting the direct marketing of alcohol to children and adolescents and/or imposing stringent restrictions on alcohol marketing to which youth are indirectly exposed; a comprehensive list is compiled in the Global Health Observatory data repository.9 Globally, however, much more needs to be done, including in amassing evidence about the effectiveness of such policies in curtailing underage alcohol consumption. Are such policies effective and what challenges must the scientific community face to contribute to that literature? These are some of the questions we raise in this editorial. We frame our discussion around challenges along two pillars: enacting effective marketing policies and evaluating the effectiveness of such policies in curtailing underage advertising exposure.