Empirically, much less is known about the effects of high levels of exposure to alcohol advertising and alcohol portrayals on actual alcohol consumption, drinking norms, and alcohol outcome expectancies. Smart (1988) reviewed the affects of alcohol advertising on overall alcohol consumption by examining: (a) advertising bans and restrictions; (b) correlational studies of exposure to advertisements; (c) econometric studies (correlations of advertising expenditures with aggregate measures of alcohol consumption); and (d) experimental studies. He noted that methodological problems severely limited the interpretability of findings, but generally concluded that there was little evidence to suggest any more than weak associations between advertising and alcohol consumption. Nonetheless, he suggested that more carefully designed econometric, experimental, and prospective studies would be useful additions to the extant literature.
Typically, researchers in the area have tacitly assumed that mere exposure to alcohol ads or portrayals (often indirectly assessed) is sufficient to elicit attitudinal and behavioral changes. Grube and Wallack (1994) suggested, in accordance with information processing theory, that advertisements may only affect attitudes and behaviors when they are attended to and remembered. To this end, they investigated relations between awareness of television beer advertising, drinking knowledge, alcohol outcome expectancies, and intentions to drink as adults among a group of lo- to 14-year-old youths. In conservative analyses, they demonstrated: (a) awareness of alcohol advertising was significantly associated with increased knowledge of brands and slogans and with positive beliefs about drinking; (b) alcohol outcome expectancies mediated the relation between alcohol advertising and intentions to drink as an adult; and (c) awareness of ads was not significantly related to negative beliefs about alcohol. These findings indicate that cognitive variables (e.g., alcohol outcome expectancies) may be an important mechanism of influence for mass media effects, and suggest prevention efforts should not ignore alcohol advertising as a potential source of social influence.
In reviewing etiological factors in alcohol use and misuse, several important issues need to be highlighted. First, alcohol is a drug that affects most of the neurotransmitter systems that have been identified as playing key roles in motivating and regulating human behavior. The neuropharmacological consequences of alcohol consumption are likely to play a key role in both alcohol-seeking behavior and determining the amount an individual consumes on a given occasion. Second, there are large individual differences in the likelihood that persons will misuse alcohol. Many of these individual differences are probably determined by genetic factors. However, the mechanisms describing how heredity exerts its effects are currently unknown. Although available research suggests that vulnerability is associated with differential sensitivity to alcohol effects, other genetically mediated mechanisms that do not rely on individual differences in ethanol sensitivity are also quite plausible (Sher, 1991). Third, at present, the strongest correlates (both cross-sectionally and prospectively) of alcohol use and misuse are psychological constructs including certain behavior patterns (especially those characterized by impulsivity) and alcohol outcome expectancies. Fourth, social influences ranging from the family, to peers, to mass media and other cultural and political variables all appear to exert important influences on alcohol use. A comprehensive understanding of the etiology of alcohol misuse will require an understanding of how these diverse factors influence alcohol consumption both independently and in combination.
The broad range of biopsychosocial determinants of alcohol consumption and problems have important implications for development of techniques for preventing and treating alcohol misuse. Although intervention in alcohol problems is discussed elsewhere in this volume (see Altman & Goodman, chap. 36), it is worth noting here that interventions have been developed that target biological, psychological, and social variables. For example, at the biological level, there appears to be therapeutic benefit to employing pharmacologic agents that reduce craving and antagonize some of the reinforcing effects of alcohol (O'Malley et al., 1992; Volpicelli et al., 1992). At the psychological level, attempts to modify individually held beliefs about the consequences of alcohol consumption (i.e., alcohol outcome expectancies), although preliminary, show promise (e.g., Darkes & Goldman, 1993; 1998). At the social level, interventions that attempt to change perceived drinking norms appear to be an important component of multi- component prevention programs (e.g., Baer, 1993; Marlatt et al., 1998) and have demonstrated efficacy in universal prevention efforts with college students (Haines & Spear, 1996). Against this background of efforts targeted at individuals, social policy interventions (e.g., increasing the drinking age, decreasing permissible blood alcohol levels for drivers, stricter enforcement and harsher penalties of drinking and driving laws) have been shown to be particularly important in reducing certain alcohol- related problems (e.g., alcohol-related motor vehicle crashes). Thus, it seems likely that the effective prevention and treatment of alcohol misuse will involve interventions at each level of biopsychosocial organization.
Preparation of this chapter was supported in part by a grant from the Alcoholic Beverage Medical Research Foundation and Grant R29 AA12241 from the National Institute on Alcohol Abuse and Alcoholism to Mark D. Wood, Grant R37 AA7231 from the National Institute on Alcohol Abuse and Alcoholism to Kenneth J. Sher and by an award from the Generalist Physician Faculty Scholars Program of the Robert Wood Johnson Foundation to Daniel C. Vinson.
We gratefully acknowledge Heather Gotham and Matt Kushner, who provided valuable comments on an earlier draft.
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