Trends in Youth Exposure to Alcohol Advertising on Cable Television, United States, 2013–2018

Elsa Pearson, MPH, is a senior policy analyst at Boston University School of Public Health. She tweets at @epearsonbusph.

Alcohol advertising is pervasive in the US. From television to radio to billboards, we are bombarded with ads that promote drinking. What’s more, Americans, in fact, drink a lot. Both realities feed the narrative that alcohol holds a place of honor in American culture.

Federal regulation of alcohol advertising is quite minimal, due to protections under the First Amendment. Instead, the industry mostly relies on self-regulation. In particular, the industry is careful about youth exposure. The proportion of youth in the audience watching an alcohol advertisement cannot exceed the proportion of youth in the general population. As of the 2010 census, 28.4% of the general population is under the age of 21. Thus, 28.4% or less of the viewers of an alcohol ad must also be under 21. If this is true, the ad is considered compliant with industry standards.

Youth exposure to alcohol advertising is a known risk factor for underage drinking. But more research is needed to understand how often youth are exposed to these ads. From there, policy and public health experts can work to mitigate the relationship between the two.

Study design

In an effort to determine how frequently youth are exposed to alcohol advertising, researchers at the Boston University School of Public Health studied advertising data from 2013 to 2018. (Authors Elizabeth Henehan and Craig Ross are in the Epidemiology Department; David Jernigan is in the Department of Health Law, Policy, and Management.)

The authors used data from Nielson, an advertising measurement and data analytics company. These data included the per capita exposure to television alcohol advertisements by age and the date and time of the ads. The researchers chose to limit the study to cable television ads — based on previous research — and to exclude ads that promoted responsible drinking in some way. The authors then summed exposure by age group — 2-11 years, 12-17 years, and 18-20 years — and assessed changes over time. Exposure data from 2013 was used as a comparative baseline for all years through 2018.

Exposure to both compliant and noncompliant ads, per industry standards, was measured. Compliant alcohol advertisements are those for which less than 28.4% of the audience is under 21 years. Noncompliant ads are those for which more than 28.4% of the audience is underage.


The only group whose overall exposure to alcohol advertising increased from 2013 to 2018 was 2-11 years. Children aged 12-17 years and 18-20 years experienced a decrease in overall exposure. The proportion of ads that children were exposed to that were compliant increased for all age groups from 2013 to 2018, reaching nearly 100% for all groups. In other words, overall exposure to noncompliant ads decreased for all age groups.

The authors noted that trends in noncompliant and compliant exposure diverged by age group in 2015 and 2016, respectively. Because of this, they used those years as inflection points and compared exposure before and after (see figure 1 in the paper). From 2013 to 2015, exposure to noncompliant advertisements increased for the 2-11 years group and decreased for the other two groups. From 2015 to 2018, noncompliant exposure decreased for all age groups. From 2013 to 2016, exposure to compliant alcohol ads increased for the 2-11 years group and decreased for the other two age groups. From 2016 to 2018, compliant exposure decreased for all groups.

There are several study limitations. For one, accurate exposure data for young children requires that an adult in the home is accurately recording when children are watching television. (Neilson data rely on households to record who is watching TV when.) Another limitation is the data may generally overestimate exposure as many people may multitask while watching television or leave the room entirely while the set stays on. However, the study’s analyses may actually underestimate youth exposure because the authors chose not to include ads that promote responsible drinking in some way.


The study’s findings are encouraging, showing a general decrease in youth exposure to cable TV alcohol advertising, especially to noncompliant ads. However, the anomaly, the authors posit that the overall increase in exposure in the 2-11 years group could be occurring when these young children watch television with their parents/guardians, almost an unintentional exposure of sorts.

The researchers suggest that youth exposure could be reduced even further by modifying the industry standards of what constitutes compliant exposure. One way to do this would be to account for particular youth subpopulations within the total allowed proportion of underage viewers. For example, stating that children ages 2-11 years can only account for a specific percentage of the viewing audience could minimize their overall exposure to alcohol advertisements.

Exposure to alcohol advertising is a risk factor for underage drinking. As such, reducing exposure must be a key public health target. This study’s findings are reassuring that we’re making progress in the right direction.


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