Children, Adolescents, Substance Abuse, and the Media

sive alcohol consumption, 7 includingthe death of 5000 people younger than21 years. 8 Drug use also representsone of many risky behaviors that occurduring adolescence: teenagers who reportthat at least half of their friendsare sexually active are 31 times morelikely to drink, 5 times more likely tosmoke, and 22 times more likely to trymarijuana than are teenagers who donot report such a high prevalence ofsexual activity among friends. 9EFFECTS OF ADVERTISINGThe power of advertising to influencechildren and adolescents (and adults,for that matter) is incontrovertible. 1,10Advertising works; otherwise, companieswould not spend billions of dollarson it. 1 Many ads use celebrity endorsers,humor, rock music, or attractiveyoung models, all of which have beenshown to be effective with childrenand adolescents. 11 Advertising makessmoking and drinking seem like normativeactivities and may function as a“superpeer” in subtly pressuring teenagersto experiment. 12 Research hasrevealed that advertising may be responsiblefor up to 30% of adolescenttobacco and alcohol use. 13,14CigarettesMore money is spent advertising tobaccothan any drug—an estimated$15 billion per year, 15 almost half ofwhat the National Institutes of Healthspends each year to study all aspectsof health (www.nih.gov/about/budget.htm). The tobacco industry (often referredto as “Big Tobacco”) has engagedin a systematic campaign toattract underage smokers for decadesand then lied to Congress about it. 16–19Given the demographics of smoking(1200 deaths per day, half of which areof middle-aged adults; 50% of smokersbegin by 13 years of age, and 90% ofsmokers begin by 19 years of age), theindustry must recruit young people assmokers. 20 Recent statistics show thatthey continue to succeed. According tothe 2009 Monitoring the Future study,nearly half of all teenagers have triedsmoking, as have 20% of all 8thgraders.21 Cigarette advertising seemsto increase teenagers’ risk of smokingby glamorizing smoking and smokers.3,20 Smokers are depicted as young,independent, rebellious, healthy, andadventurous. By contrast, the adverseconsequences of smoking are nevershown. As a result, the US SurgeonGeneral concluded in 1994 that cigaretteadvertising increases young people’srisk of smoking. 20The most heavily advertised brands ofcigarettes are also the most popular. 22Tobacco advertising may even trumpstrong parenting practices. 23 Teenmagazines have attracted an increasingnumber of cigarette ads since1965. 24–26 Numerous studies have revealedthat children or teenagers whopay closer attention to cigarette ads,who are able to recall such ads moreeasily, or who own promotional itemsare more likely to become smokersthemselves. 27–31 Joe Camel singlehandedlyincreased the market sharefor Camel cigarettes from 0.5% of adolescentsmokers to 32%. 32 A recentmeta-analysis of 51 separate studiesrevealed that exposure to tobaccomarketing and advertising more thandoubles the risk of a teenager beginningto smoke. 33AlcoholApproximately $6 billion is spent annuallyon alcohol advertising and promotion.34 Similar to tobacco ads, beercommercials are virtually custommadeto appeal to children and adolescents,using images of fun-loving, sexy,successful young people having thetime of their lives. 3,35,36 Unlike tobaccoadvertising, alcohol advertising facesfew restrictions. For example, whereasthe tobacco industry gave up televisionadvertising in the 1960s, beer, wine,and liquor ads are frequently featuredon prime-time television, and youngpeople view 1000 to 2000 alcohol adsannually. 12,37 Much of the advertising isconcentrated during teen-orientedshows and sports programming. All ofthe top-15 teen-oriented shows containalcohol ads. 38 Currently, teenagersare 400 times more likely to see analcohol ad than to see a public serviceannouncement (PSA) that discouragesunderage drinking. 39 Teen-orientedmagazines contain 48% more advertisingfor beer, 20% more advertising forhard liquor, and 92% more advertisingfor sweet alcoholic drinks than domagazines aimed at adults of legaldrinking age. 40,41According to the research, the effectsof all of this advertising are increasinglyclear. 3,42,43 A sample of 9- to 10-year-olds could identify the Budweiserfrogs nearly as frequently as theycould Bugs Bunny. 44 In a study of morethan 3500 South Dakota students, 75%of 4th-graders and nearly 90% of 9thgradersrecognized the Budweiser ferretad. 45 Many studies have revealedthat exposure to alcohol advertisingresults in more positive beliefs aboutdrinking and is predictive of drinkingduring early adolescence and youngadulthood. 46–52 The results of severallongitudinal studies have shown a similartrend, 53,54 although they havesometimes been mixed. 48Prescription DrugsNearly $4 billion is spent annually onprescription drug advertising. 55 Drugcompanies now spend more thantwice as much money on marketing asthey do on research and development,and studies have revealed that themarketing efforts pay off 56 : results of arecent survey of physicians showedthat 92% of patients had requested anadvertised drug. 57 Children and teenagersget the message that there is apill to cure all ills and a drug for every792 FROM THE AMERICAN ACADEMY OF PEDIATRICSDownloaded from pediatrics.aappublications.org by guest on December 14, 2011