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Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents

Siegfried N et al (2014)

Cochrane Database of Systematic Reviews - https://doi.org/10.1002/14651858.CD010704.pub2

Evidence Categories

  • Care setting: College/University Setting
  • Population group: Adults
  • Population group: Children & Young adults
  • Intervention: Changing attitudes and social norms around alcohol
  • Outcome: Changes to frequency/amount of alcohol use

Type of Evidence

Systematic Review

Aims

Alcohol is estimated to be the fifth leading risk factor for global disability‐adjusted life years. Restricting or banning alcohol advertising may reduce exposure to the risk posed by alcohol at the individual and general population level. To date, no systematic review has evaluated the effectiveness, possible harms and cost‐effectiveness of this intervention.

Findings

The RCT found that young men exposed to movies with a low‐alcohol content drank less than men exposed to movies with a high‐alcohol content (mean difference (MD) ‐0.65 drinks; 95% CI ‐1.2, ‐0.07; p value = 0.03, very‐low‐quality evidence). Young men exposed to commercials with a neutral content compared with those exposed to commercials for alcohol drank less (MD ‐0.73 drinks; 95% CI ‐1.30, ‐0.16; p value = 0.01, very‐low‐quality evidence). Outcomes were assessed immediately after the end of the intervention (lasting 1.5 hours), so no follow‐up data were available. Using the Grading of Recommendations Assessment, Development and Evaluation approach, the quality of the evidence was rated as very low due to a serious risk of bias, serious indirectness of the included population and serious level of imprecision.

Two of the ITS studies evaluated the implementation of an advertising ban and one study evaluated the lifting of such a ban. Each of the three ITS studies evaluated a different type of ban (partial or full) compared with different degrees of restrictions or no restrictions during the control period. The results from the three ITS studies were inconsistent. A meta‐analysis of the two studies that evaluated the implementation of a ban showed an overall mean non‐significant increase in beer consumption in the general population of 1.10% following the ban (95% CI ‐5.26, 7.47; p value = 0.43; I2 = 83%, very‐low‐quality evidence). This finding is consistent with an increase, no difference, or a decrease in alcohol consumption. In the study evaluating the lifting of a total ban on all forms of alcohol advertising to a partial ban on spirits advertising only, which utilised an Abrupt Auto‐regressive Integrated Moving Average model, the volume of all forms of alcohol sales decreased by 11.11 kilolitres (95% CI ‐27.56, 5.34; p value = 0.19) per month after the ban was lifted. In this model, beer and wine sales increased per month by 14.89 kilolitres (95% CI 0.39, 29.39; p value = 0.04) and 1.15 kilolitres (95% CI ‐0.91, 3.21; p value = 0.27), respectively, and spirits sales decreased statistically significantly by 22.49 kilolitres (95% CI ‐36.83, ‐8.15; p value = 0.002). Using the GRADE approach, the evidence from the ITS studies was rated as very low due to a high risk of bias arising from a lack of randomisation and imprecision in the results.

Conclusions

There is a lack of robust evidence for or against recommending the implementation of alcohol advertising restrictions. Advertising restrictions should be implemented within a high‐quality, well‐monitored research programme to ensure the evaluation over time of all relevant outcomes in order to build the evidence base.