A Neurobiological Model of Alcohol Marketing Effects on Underage Drinking

Abstract

Objective: Although an association between exposure to alcohol advertising and underage drinking is well documented, the underlying neurobiological contributions to this association remain largely unexplored. From an epidemiological perspective, identifying the neurobiological plausibility of this exposure–outcome association is a crucial step toward establishing marketing as a contributor to youth drinking and informing public policy interventions to decrease this influence. Method: We conducted a critical review of the literature on neurobiological risk factors and adolescent brain development, social influences on drinking, and neural contributions to reward sensitization and risk taking. By drawing from these separate areas of research, we propose a unified, neurobiological model of alcohol marketing effects on underage drinking. Results: We discuss and extend the literature to suggest that responses in prefrontal–reward circuitry help establish alcohol advertisements as reward-predictive cues that may reinforce consumption upon exposure. We focus on adolescence as a sensitive window of development during which youth are particularly susceptible to social and reward cues, which are defining characteristics of many alcohol advertisements. As a result, alcohol marketing may promote positive associations early in life that motivate social drinking, and corresponding neurobiological changes may contribute to later patterns of alcohol abuse. Conclusions: The neurobiological model proposed here, which considers neurodevelopmental risk factors, social influences, and reward sensitization to alcohol cues, suggests that exposure to alcohol marketing could plausibly influence underage drinking by sensitizing prefrontal–reward circuitry.

The Relationship Between Exposure to Alcohol Marketing and Underage Drinking Is Causal

“…Causality is most convincingly demonstrated by randomized clinical trials, and there are some examples in the alcohol marketing literature of the use of this “gold-standard” research design to evaluate short-term relationships at the psychological, neurobiological, and behavioral levels of analysis (e.g., Jackson & Bartholow, 2020 ; Courtney et al, 2020 ; Noel et al, 2020 ). However, most of the Bradford Hill criteria apply to results from multiple observational studies, especially when randomized clinical trials are difficult to conduct for practical or ethical reasons (e.g., it would be unethical to assign persons to smoke cigarettes as a test of the smoking–lung cancer association).…”

“…One deficiency with this method of summarizing the literature, which the present supplement was designed to correct, is that the research literature had never been organized to address multiple causal criteria in a way that would satisfy both the scientist and the policy maker. The articles in this supplement go beyond the evidence from prior reviews of the alcohol marketing literature and attempt at integration (e.g., Babor et al, 2017 ) by critically evaluating a variety of observational and experimental research of putative mechanisms that covers laboratory-based neurobiological studies ( Courtney et al, 2020 ), psychological studies ( Jackson & Bartholow, 2020 ), and econometric studies ( Saffer, 2020 ).…”

Alcohol Marketing and Youth Drinking: Is There a Causal Relationship, and Why Does It Matter?

“…There are many observational studies that address alcohol marketing, its thematic content, and its association with underage drinking. There have also been experimental studies that have investigated different aspects of alcohol marketing exposures, primarily in terms of psychological and neurobiological responses to alcohol-related stimuli or cues ( Courtney et al, 2020 ; Finan et al, 2020 ; Jackson & Bartholow, 2020 ). Our approach to summarizing this literature is organized around the Bradford Hill criteria for causality.…”

“…Hill suggested that an exposure–disease association must be plausible; that is, there has to be some hypothesized mechanism of action through which an agent embedded in the exposure exerts a biological influence that results in disease. In this supplement there are three contributions that address plausibility ( Courtney, et al, 2020 ; Henehan et al, 2020 ; Jackson & Bartholow, 2020 ). Psychologists develop, measure, and test psychological models in which exposures affect thoughts and cognitions or attitudes, thereby changing the likelihood that an individual will engage in a behavior.…”

“…Biological plausibility is an area where functional magnetic resonance imaging and other neurobiological methods are now being used to test how young persons respond to alcohol marketing compared to other marketing inputs, and whether those responses relate to their own real-world drinking. The supplement article by Courtney et al (2020) provides a narrative summary of the available scientific evidence to support the notion that brain responses to alcohol advertising relate to underage drinking behavior.…”