WASHINGTON — Auden C. McClure, M.D., and her colleagues noticed some time ago that children and young teens in their New Hampshire community and pediatric practice often wore T-shirts, hats, and other merchandise bearing alcohol brand names and logos.
Now, armed with research findings showing that ownership of such merchandise is associated with early-onset drinking, Dr. McClure is calling on the alcohol industry to follow the example of the tobacco industry and stop distributing the merchandise.
“The alcohol industry should institute a voluntary ban … because of the association with early drinking and because students become a walking advertisement for alcohol consumption,” Dr. McClure said at the annual meeting of the Pediatric Academic Societies.
She reported on a survey of fifth- to eighth-grade students in eight rural public schools in New Hampshire. Approximately 2,400 who said they had never used alcohol were asked by telephone 1–2 years later whether they owned an alcohol promotional item and if they had begun using alcohol.
Fourteen percent reported owning at least one alcohol promotional item (mostly clothing), and 15% reported using alcohol.
Those who owned alcohol promotional items had higher rates of alcohol use, compared with those who did not own the merchandise—approximately 25% vs. 13%, said Dr. McClure, a pediatrician at the Dartmouth-Hitchcock Medical Center in Lebanon, N.H.
Ownership of alcohol promotional items was associated with peer drinking, poor school performance, and high-risk behaviors, such as sensation seeking and rebelliousness.
Even after adjusting for these factors, Dr. McClure and her associates found that students who owned alcohol promotional items were more than 1.5 times more likely to try drinking than their peers.
Tobacco companies spent more than $2 billion in the 1990s on cigarette promotional items, but in 1999 they voluntarily gave up distribution and sale of the products after the practice was found to be associated with adolescent smoking.
Tobacco companies agreed to the ban as part of the master settlement agreement with the state attorneys general.
“Multiple studies during that time documented that tobacco promotional items are prevalent among adolescents, that ownership is associated with smoking, that it's independent of other adolescent risk factors, and also that ownership … precedes the decision to smoke,” Dr. McClure said at the meeting, sponsored by the American Pediatric Society, the Society for Pediatric Research, the Ambulatory Pediatric Association, and the American Academy of Pediatrics.
Unlike the smoking research, their study on alcohol promotional items does not prove causality, she said. The survey also did not ascertain where the items came from—whether they were purchased or received free at sporting events, for instance—and it did not ascertain alcohol brands.
The study also excluded students who, at baseline, had already begun drinking, which means “we potentially could have eliminated a higher-risk population,” Dr. McClure said.
Alcohol use was assessed in the telephone survey with the question, “Have you ever had beer, wine, or another drink of alcohol that your parents didn't know about?” The other main question was: “Do you own something that has the name of a beer or alcohol brand on it like a T-shirt, or a backpack, or a hat?”
A national sample of adolescents is being surveyed currently, she said.
Until more research is completed and action is taken, “parents and schools should help … to eliminate the ownership and display of alcohol promotional items in our schools and homes,” she said.