Big alcohol catches up with adolescent girls

The alcoholic beverages industry has used advertising and events promotion to grant a form of equality to young women that perhaps even the women’s movement never intended. The industry knows that the alcoholic beverages market is economically mature. Individual companies can increase profits mainly by increasing their market share or by targeting young women. Unfortunately, adolescent girls are exposed to this advertising as well. Girls as young as 13 are now reported to be consuming as much alcohol and as early in life as boys.1^,2 Research has shown that exposure of adolescent girls to alcohol advertising has increased3 and that such exposure was associated with increased alcohol consumption in adolescents.4 Although it is uncertain whether the relation is causal, the fact is that adolescent girls have, on average, reached another benchmark for freedom of choice on a par with boys.

The problem with this equality is that alcohol, all drinkable forms of it, is not an equal-opportunity substance. What is at issue is not the equality of drinking choice but rather the inequality of the impact of alcohol on health. On average, women have a smaller body mass than men, with proportionately less of it composed of water, which results in a more rapid rise and higher net level of alcohol in the blood for a given quantity consumed. It is well known that excess lifetime consumption of alcohol causes various forms of cancer in the gastrointestinal and genitourinary tracts, cirrhosis, liver cancer, heart disease, addiction and dementia. Female-specific risks are already well known and include violence, unwanted sex and pregnancy, and inadvertent alcohol consumption during early pregnancy. In addition, a recent cohort study has found that girls who start using alcohol early in high school are prone to problem drinking by graduation.4

It has become apparent in the last 15 years that alcohol use is a risk factor for breast cancer. The population attributable risk of alcohol use for breast cancer has been estimated to be 4%.5 Here the news gets more concerning, because we now have evidence that the amount consumed matters a lot. Even as little as one drink a day has been shown to be associated with increased risk.6 As many girls now start consuming alcohol at earlier ages, this adverse effect is likely to become more burdensome.

The advertising industry knows very well how to secure new, lifelong clients: most current smokers began smoking before age 18. The type of alcohol advertising being directed at young women suggests that an attractive body and a successful, trendy life will be the result of using any particular product. Many of these ads also suggest that men will find them to be more desirable sex objects (a simple Internet search on “women, alcohol, advertising” should suffice to illustrate the point). Exposure to advertising on television and in magazines, and use of alcohol have also been shown to have distinctive social and emotional effects on girls compared with boys.4

Adults, both male and female, should know what they are doing. But adolescents need guidance as to what alcohol is and what it does. They need to be taught that the purpose of advertising is to create a demand where there is no need. When advertising reaches a vulnerable group, such as adolescent girls, they need to understand what it means to be duped by an adult influence that does not have their interest at heart.

Governments already know that restrictive measures have only a modest impact. We all know that we are raising a generation of bright, plugged-in and assertive daughters. Enabling informed choice by them is likely to succeed at least as well for alcohol as it appears to be doing for avoiding starting to smoke. At a minimum, informing them of the specific risks at the point of procurement — already well underway with tobacco in Canada and with tobacco and alcohol in the United States — seems only just. The government should require a proportionate health warning to accompany alcohol advertising aimed at young women as well as on the products sold.

Physicians and parents have a duty to ask and to explain about alcohol use and its effects. In addition to a teaching role, parents of adolescent girls have another powerful influence to exert. It has been said that your children are not listening much to what you say, but that they are watching carefully everything you do. Being a good role model about the healthy use of alcohol and providing choice on quantity for everyone you serve are likely to be the predominant determinants of your child’s future behaviour.