“Alcohol is the number one killer of people ages 18 to 45 in this country,” says BU public health researcher David Jernigan. He advocates for limiting the attractiveness, affordability, and availability of alcohol. Photo via Unsplash/Rilla Paris

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Do Alcohol Ads Promote Underage Drinking?

In this episode of The Brink’s podcast, BU public health researcher David Jernigan breaks down “predatory” alcohol marketing and how drinking can damage our health

You can also find this episode on Spotify, YouTube, and other podcast platforms.

Have you ever stopped to wonder how many alcoholic beverage ads you encounter in a day—online or on TV, at the movies or at a sports stadium? What about how many alcohol products can seem styled to look like their nonalcoholic counterparts? How about how much less you’d drink if you weren’t constantly bombarded with all those alcohol ads?

The tactics used by alcohol companies to sell their products—and how many of those ads might end up appealing to children—are a big focus of David Jernigan’s research. A Boston University School of Public Health professor of health law, policy, and management, his goal is to raise awareness of alcohol as a public health hazard. The way it’s advertised, sold, talked about, and idealized, he says, can lead to increased rates of car accidents, substance use disorder, and mortality—risks that are exacerbated in underage drinkers.

For the latest episode of Explain This! host Alene Bouranova sat down for a conversation with Jernigan, asking him how underregulated alcohol marketing can compromise collective safety, and what can be done to prevent further damage. 

Takeaways

• According to Jernigan, between 40 and 50 percent of alcohol consumption is by buyers the alcohol industry says it “doesn’t want,” like underage drinkers; he found that in 2016, the alcohol industry earned $17 billion off of underage consumers alone.
• The human brain is most vulnerable to alcohol in adolescence, and raising the drinking age to 21 has probably saved tens of thousands of lives. 
• Alcohol is a carcinogen and a causal factor in cancer in seven areas of the body. Roughly 15 percent of breast cancer cases in the US are caused by alcohol use.

Transcript

The Brink: You’re listening to Explain This! Our new podcast from The Brink explores big and small pictures of research done at Boston University, from microbiology to art history and everything in between. Join us as we interview on-campus experts who break down areas of study and put their work into real-world contexts.

Jernigan: The alcohol industry has succeeded in painting itself as your best friend, and I wish people would understand that it’s not your best friend, that, like tobacco, it’s an industry. Its primary responsibility is to its shareholders and to make money. In order to do that, it’s going to bend every rule it possibly can to get more people to drink more of its product. 

Bouranova: That’s David Jernigan, a professor in the Department of Health Law, Policy, and Management at the Boston University School of Public Health. David is also the assistant dean for practice and coruns the BU SPH Activist Lab, a research space that fosters projects that promote positive social change. As a researcher, David studies how our society responds to the pervasive presence of alcohol, and, as an activist, he is passionately involved in crafting policy to mitigate its effects. He’s joined us today to discuss how alcohol marketing contributes to alcohol misuse, and what we can do about it. Thanks so much, David, for being here today. 

DJ: Thanks so much for having me. 

AB: Our pleasure. Let’s get things started: Could you walk us through a little bit about your research background?

DJ: I’m trained as a sociologist at the University of California at Berkeley. And that’s partly because I’m interested in everything. And alcohol has been a really good issue for me, because alcohol touches so many parts of people’s lives, of our society. Pretty much anything I was interested in, there was an alcohol angle. 

AB: So why should the public then care about alcohol policy and alcohol marketing? 

DJ: Alcohol is the number one killer of people ages 18 to 45 in this country. It’s responsible for 140,000 deaths a year. Beyond the deaths, it is the most damaging drug we know of to others, in that drinkers affect people around them hugely. And we’re not very good at calculating that, but alcohol has big health and safety effects on people. 

AB: Absolutely. And then what are the dangers of irresponsible alcohol marketing? 

DJ: Well, the point of marketing is to sell a product, when you’re selling a product that kills 140,000 people a year, you have to be very creative. And you can’t be as direct as would be good for the public’s health. So the kinds of things the industry does, of course, they only tell one side of the story. If you watch the marketing, alcohol is the key to a happy life, to popularity. The marketing targeted at people raised male is heavily in the direction of, Drink this and you’ve got the female. And the marketing targeted at people raised female is very much “empowering, women in charge.” They’re flip sides of each other. Never look at the two of them side by side, or look at the two of them side by side and you’ll see exactly what the industry is doing: They are selling. They are not in the health business, they are in the profit business. Their market depends on people drinking heavily. In fact, most of the consumption is by the heaviest drinkers. The industry claims that they don’t want anybody to abuse their product. They claim that they don’t want underage drinkers. We did a study and estimated that the industry earned, in 2016, $17 billion off of underage drinking. And our other work has found that somewhere in the neighborhood of 40 to 50 percent of the consumption is consumption that the industry says it doesn’t want. 

AB: Yeah, with that in mind, does that mean that these manufacturers have a corporate responsibility to their consumers, both actually legally and ethically? 

DJ: They have a responsibility to their shareholders, they’re in the business of making money. That’s fine; that’s our system. The problem is, when they make a lot of money, a lot of people get sick, a lot of people get injured, and a lot of people die. So even though their primary responsibility is to their shareholders, we as a society have a responsibility to set the guardrails on what they can do, on where their product can be sold, on how much it costs, and on how it can [be marketed] and, unfortunately, we are failing miserably at setting those guardrails. Which is why, for instance, this is also the killer of one in eight people of working age. It’s a major factor in our productivity as a country. Beyond the mortality, there’s the phenomenon known as presenteeism. It’s the Monday morning effects of when people have drunk a lot over the weekend and they come to work and they are simply partly not there because they’re still recovering from the heavy drinking they did on the weekend. 

AB: So Dunkin’ Spiked drinks were a bit notorious, and I know you’ve written about them. So what could have been done differently with the marketing, or was it the product itself that was the problem?

DJ: The product’s a problem. This is a product I can’t imagine that the world really needed. Also, by branding it with something that is associated with doughnuts, which are popular among children, this is an obvious no-brainer in terms of appealing to young people. And there’s a very good reason why we have a 21-year-old purchase age for alcohol. The vulnerability of the human brain to alcohol is highest during the adolescent years, when our brains are developing—our brains aren’t fully developed until age 25. Twenty-one was as high as we could put the purchase age, but we have really good research [that] 21 has saved literally tens of thousands of lives since it was put in place. It’s not particularly popular among young people, but part of our job as a society is to take steps to protect young people from what some would call the predatory actions of adults. And you could certainly look at some of the marketing of alcohol and call it predatory. 

AB: I’m curious, would the same apply to things like spiked seltzers? Because it seems like we’ve had an onslaught where every company has their own seltzer now, or they have cocktails in a can that are fruity and cutely packaged; are those problems as well?

DJ: I was waiting at a bus stop in New Hampshire recently, and there was a discarded can in the corner, for what looked like a regular, 12-ounce soda can but it was a tequila-based soda pop. Seven and a half percent alcohol content—your average beer is four to four-and-a-half percent. So this looks like a beer, it’s packaged like soda pop, and it’s significantly stronger in terms of alcohol content than either of those. This is not particularly fair to consumers. You look at all sorts of other things that we put in our bodies, and they usually have things like serving sizes, they have ingredient lists, they have calories. Alcohol is not required to have any of those. So we have a situation where we have a widely uninformed public, who is then very, very heavily marketed to. This industry spends billions of dollars in the US alone each year marketing their product; some of the brightest minds in the country are behind those marketing campaigns. And again, to me, it’s an issue of fairness. We live in a democratic society; our society is based on having access to information so we can make informed choices. We don’t have a level playing field when it comes to alcohol. All the money, all the information, all the energy is on the selling it side, and public health is a tiny voice. 

AB: So to that end, what can we do? What are some of the tools that advocates and legislators have in their arsenals?

DJ: What I talk about is the three As: We want to reduce the attractiveness of alcohol—and that’s putting guardrails around the marketing, where it can be shown, what it can show. We want to reduce its affordability—that’s the price and the tax and all that. And we want to reduce its availability—and that has to do with how many licenses there are, how many places there are where you can buy it, where you consume it, and so on. And that’s where there’s constant pressure: when we add more licenses, when we make it easier for people to get alcohol physically. So many studies, literally hundreds and hundreds of studies done in study settings all over the world, [show that] when it’s easier to get alcohol, people drink more, and when people drink more, you have worse consequences. 

AB: Yeah, and that makes me think that if you were in charge here in Massachusetts then, what changes to alcohol laws would you make? 

DJ: That’s a great question. Because of our first amendment protections for commercial speech, we treat corporations like people and we grant them free speech. It’s very difficult to regulate advertising and marketing in the US. What we learned in tobacco, though, is if you could do effective countermarketing, you can shift particularly perceptions around for young people, and there’s really good research on the tobacco counter marketing campaigns. So one of the things I’d do is I’d raise the tax on alcohol significantly—about a quarter a drink would raise somewhere in the neighborhood of $200 million—and I would designate some of that money to fund a countermarketing campaign. I would also look at the hours of sale. I would look at equity rather than quantity when we come to think about the licenses. One of my favorite things Boston does is First Night, because First Night is a citywide celebration of New Year’s Eve, and it’s alcohol-free. 

AB: Speaking of teenage drinking, is teenage drinking is one of our biggest concerns right now, are there other things that we should be worried about within vulnerable populations?

DJ: We’re always concerned about underage drinking simply because of the vulnerability of the developing brain, and the studies that we have that show that kids who start drinking before age 15, compared to those who wait until they’re 21, are four times more likely to become addicted, five times more likely to get in a fight, and six or seven times more likely to be in a motor vehicle crash because of alcohol sometime later in life. We want to delay initiation as long as possible. That said, the good news about young people and drinking is—like other risky things that young people do together, and teen pregnancy is the classic example—those numbers are way down in the mobile phone era. Kids are doing far more things by themselves, and they’re relating to each other virtually, often more than they do physically. So some of those risks have changed. Youth drinking has dropped substantially; that’s good news. But we have a bubble group moving through. It’s Gen Z, the millennials, in particular. And I’ve gotten so many calls in the last, oh three, four years from, currently, female journalists who have suddenly discovered that alcohol is a carcinogen. Alcohol is a causal factor in cancer in seven areas of the body, including the female breast. Roughly 15 percent of female breast cancer cases in the US are caused by alcohol use, and a third of those happened at less than a drink and a half a day. There is no safe level of consumption when it comes to alcohol risk, in terms of cancer. Who knows this? We’ve got a warning label on alcohol—it’s a terrible label, you can barely read it. When it passed in 1991, I said in the press, Congress passed a warning label, not an eye test. It talks about heavy machinery, driving a car, and then has the five dirty words on the end of it: And may cause health problems. Those were added in the back rooms in Congress to protect the alcohol industry for product liability suits forever. There is no cancer warning. We know a lot about how to effectively warn [people], from our experience with tobacco. We don’t do any of those things with the alcohol warning label. And again, this is not in the hands of a health agency. This is not at the FDA or HHS; this is in the hands of the treasury department, and when we’ve challenged the treasury department about this, they throw up their hands and say, We can’t do it, we have no health expertise in our department. That’s simply passing the buck. The alcohol industry’s worst fear is that there’ll be a cancer label, and that they’ll start to be lumped more and more in with tobacco. And, frankly, in terms of deaths, disability, etc., they should be. 

AB: Absolutely. And my last question is less of the question and more just about opening the floor to you: What do you think listeners should know, what’s been going through your mind while we’ve been chatting? What are your final thoughts that you want to leave people with? 

DJ: The alcohol industry has succeeded in painting itself as your best friend, and I wish people would understand that it’s not your best friend, that, like tobacco, it’s an industry. Its primary responsibility is to its shareholders and to make money. In order to do that, it’s going to bend every rule it possibly can to get more people to drink more of its product. That affects all of us. And that’s only part of the story, because the other thing that the alcohol industry does to sell their product, the way they use tropes around sexism, around racism, the way that they’ve made it synonymous with sports. Pretty funny because, you know, drinking a lot is actually really bad for sports performance. And yet, it’s hard to imagine a sport in this country that’s not connected to alcohol. That was not always the case. Advertising and marketing is a process of intentional cultural change. The culture we have around alcohol is a culture that’s created and propagated by the alcoholic beverage industry. And that industry plays a terrible role in terms of oppression, plays a terrible role in terms of poor communities and communities of color. I just wish people would think about what they’re participating in. This is a beverage of misery and exploitation, and predatory marketing, a lot like tobacco. I wish we could see it that way. For decades, the primary driver behind our tobacco policy was money. And still, the primary driver behind our alcohol policy is money. I’ve spent my entire career working on this issue—I never planned that. I fell into it coincidentally. But it was so interesting, and then affected so many people: we’re talking 2.6 million deaths a year worldwide. It seems like a worthwhile thing, to spend your professional career trying to prevent 2.6 million deaths a year.

The Brink: Explain This! is a podcast produced by The Brink at Boston University. This episode was mixed by Andrew Hallock and edited by Sophie Yarin. To learn more about us go to bu.edu/brink. Stay curious out there folks! We’ll see you next time.

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