Background Exposure to alcohol marketing is prevalent and is associated with both initiation and progression of alcohol use in underage youth. The mechanism of influence is not well understood, however. This study tests a model that proposes alcohol-specific cognitions as mediators of the relation between alcohol marketing and problematic drinking among experimental underage drinkers. Methods This paper describes a cross-sectional analysis of 1734 U.S. 15–20 year old underage drinkers, recruited for a national study of media and substance use. Subjects were queried about a number of alcohol marketing variables including television time, internet time, favorite alcohol ad, ownership of alcohol branded merchandise (ABM), and exposure to alcohol brands in movies. The relation between these exposures and current (30 day) binge drinking was assessed, as were proposed mediators of this relation, including marketing-specific cognitions (drinker identity and favorite brand to drink), favorable alcohol expectancies and alcohol norms. Paths were tested in a structural equation model that controlled for socio-demographics, personality and peer drinking. Results Almost one-third of this sample of ever drinkers had engaged in 30 day binge drinking. Correlations among mediators were all statistically significant (range 0.16 – 0.47) and all were significantly associated with binge drinking. Statistically significant mediation was found for the association between ABM ownership and binge drinking through both drinker identity and having a favorite brand, which also mediated the path between movie brand exposure and binge drinking. Peer drinking and sensation seeking were associated with binge drinking in paths through all mediators. Conclusions Associations between alcohol marketing and binge drinking were mediated through marketing-specific cognitions that assess drinker identity and brand allegiance, cognitions that marketers aim to cultivate in the consumer.

Objective-Low self-esteem in adolescents has been associated with a number of risk and protective factors in previous studies, but results have been mixed. Our objective was to examine characteristics associated with low self-esteem in a large national sample of young adolescents.Design/Methods-Population-based correlational study. A sample of 6522 adolescents, aged 12-16 years, was surveyed by phone as part of a national study of media and substance use. Selfesteem was measured with three questions that assessed global self worth and physical appearance. Multivariate logistic regression was used to examine the relation between self-esteem and socio-demographics, child personality characteristics, weight status, daily TV time, parenting style, school performance and team sports participation. Interactions among gender, race, and weight status were examined.Results-In multivariate analysis, female gender, Hispanic race, overweight and obesity, sensation seeking, rebelliousness, and daily TV time were each independently associated with lower self-esteem. Teens of Black race, with higher parental responsiveness and demandingness, better school performance or involvement in team sports were less likely to report low self-esteem. Black females were at lower risk and Hispanic males were at higher risk for low esteem than peers of similar gender of other races.Conclusions-Low self-esteem was associated with a number of modifiable risk factors including obesity, television time, team sports participation, school performance and parenting style that should be discussed with teens and parents at health supervision visits. Further research examining race and gender-specific factors that serve to moderate risk for poor self-esteem in adolescents is warranted.

IMPORTANCE Alcohol is the most common drug among youth and a major contributor to morbidity and mortality worldwide. Billions of dollars are spent annually marketing alcohol. OBJECTIVE To examine the reach of television alcohol advertising and its effect on drinking among underage youth. DESIGN, SETTING, AND PARTICIPANTS Longitudinal telephone- and web-based surveys conducted in 2011 and 2013 involving 2541 US adolescents 15 to 23 years of age at baseline, with 1596 of these adolescents completing the follow-up survey. Cued recall of television advertising images for top beer and distilled spirits brands that aired nationally in 2010–2011 (n = 351). Images were digitally edited to remove branding, and the respondents were queried about 20 randomly selected images. An alcohol advertising receptivity score was derived (1 point each for having seen the ad and for liking it, and 2 points for correct brand identification). Fast-food ads that aired nationally in 2010–2011 (n = 535) were similarly queried to evaluate message specificity. MAIN OUTCOMES AND MEASURES Among the underage youth at baseline, we determined (1) the onset of drinking among those who never drank, (2) the onset of binge drinking among those who were never binge drinkers, and (3) the onset of hazardous drinking among those with an Alcohol Use Disorders Identification Test consumption subscore of less than 4. Multivariate regressions were used to predict each outcome, controlling for covariates (demographics, drinking among friends and parents, and sensation seeking), weighting to the US population, and using multiple imputation to address loss to follow-up. RESULTS Underage participants were only slightly less likely than participants of legal drinking age to have seen alcohol ads (the mean percentage of ads seen were 23.4%, 22.7%, and 25.6%, respectively, for youth 15–17, 18–20, and 21–23 years of age; P < .005). The transition to binge and hazardous drinking occurred for 29% and 18% of youth 15 to 17 years of age and for 29% and 19% of youth 18 to 20 years years of age, respectively. Among underage participants, the alcohol advertising receptivity score independently predicted the onset of drinking (adjusted odds ratio [AOR], 1.69 [95% CI, 1.17–2.44]), the onset of binge drinking (AOR, 1.38 [95% CI, 1.08–1.77]), and the onset of hazardous drinking (AOR, 1.49 [95% CI, 1.19–1.86]). Fast-food advertising receptivity was not associated with any drinking outcome. CONCLUSIONS AND RELEVANCE Receptivity to television alcohol advertising predicted the transition to multiple drinking outcomes. The findings are consistent with the idea that marketing self-regulation has failed to keep television alcohol advertising from reaching large numbers of underage persons and affecting their drinking patterns.

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