Alcohol marketing to childrenBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1767 (Published 24 March 2011) Cite this as: BMJ 2011;342:d1767
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Regarding the Editorial of Hastings G and Sharon N., "Alcohol marketing to
Two important pieces of evidence came out from the last, 2007, Isle of Man
The sampling method always differed from that of UK and Denmark; the Isle
of Man results can only be used in direct comparison with nations of
similar size or where similar sampling has taken place, such as Island-
Secondly, the trend analysis shows that the Isle of Man "heavy episodic
drinking" has 'plateaud' in 15-16 years and whether it ranks slightly
before or after the UK has no meaning for the reason mentioned above.
However, what the second Isle of Man ESPAD (2007) found, which got
the attention of researchers and policy makers, were two things:-
That Portugal and France climbed up significantly in ranks in the "heavy
episodic drinking" trend, thus dispelling the Mediterranean Cafe culture
myth (or is it that Loi Evin on its own is not sufficient and its impact
would have faded away anyway after 15-20 years);
And that the distribution of Isle of Man results has departed from its
"normalised" behaviour in 2003 and shows now, in 2007 that 15-16 years
polarise now to the two extremes: either abstaining or heavy drinking.
Whilst the quantity of alcohol per capita has only gone down slightly in
the British Isles, this may indicate that those fewer heavy drinkers may
drink more than they did a few years ago. In this case the problem is not
spreading, it is becoming more of a problem for fewer.
These are only hypotheses which ESPAD only claims formulating from a
series of cross-sectional surveys carried out every 4 years; cross-
sectional surveys cannot provide the full epidemiological picture,
including an impact, of a health determinant such as alcohol.
Moreover, closer to the technical aspect as to how the empirical data are
collected via ESPAD: the Isle of Man information comes from a nearly 80%
sized sample, i.e. from a 100% selected sample of the target population;
and the CI95% for the Isle of Man estimates are also calculated with a
formula adapted for finite populations.
ESPAD has its unique and own merits in assisting with monitoring of how
European alcohol and drug policies are implemented. Considering only the
ESPAD evidence in relation to marketing, would not assist the concern
regarding alcohol and health in general or specific in the British Isles.
An introduction of a "Loi Evin", "Loi Wollaston" or "Loi Minister for
Health" in general, must be backed up in the XXIst century by other means,
individually enforced or in combination: reduction of price per unit of
alcohol, an increase in the legal age for purchasing, legislation which
would back up the 0% BAC for novice drivers, if to say at least that an
impact on injuries or fatalities is sought. All changes would also have to
be communicated to the public to at least call assisting the population
with interventional informed consent.
Keeping within use of empirical evidence by using surveys such as ESPAD
this is a series of cross-sectional surveys and has come out with a few
hypotheses which can only wait long to be tested:
- that drugs of any kind, illicit or prescribed, can be misused in all
societies with any level of unemployment, whether low or high, for
- that poly-substance use has a higher potential of being associated with
violent or delinquent behaviour
- that marketing applied unilaterally is bound to unbalance something
else, such as the law enforcement in a health system. After all, all
factors compete for the same individuals in society, so it's the one
economic area which will penetrate faster and will allow quick fixes that
will keep some going, whilst others will keep changing policies with no
- and smaller nations such as the Isle of Man, Faroe Islands, Iceland,
Malta and Cyprus (all ESPAD Small Nations) have shown that substitution
theory (substituting a substance for another) is the gateway to tackling
issues of addiction: where illegal substances are highly controlled the
prevalence use of alcohol or other substances is higher than elsewhere.
Review of the literature can also show why the evidence is not clear in
what is happening in alcohol marketing. The example of the alcopop drinks
industry is a compelling one 1.
Note: Claude Evin, an advocate by profession, was a French Minister
for Health from 1988 to 1991. The law enforced on tobacco and alcohol
since 1991 in France demonstrated two things: the political "buy-in" and
secondly, now, after 15-20 years, it may not have the same effect it had
in 2003, particularly when economic boom may have been a confounder in
2003 and 2007 (ESPAD years).
1. Metzner C and Kraus L: The impact of alcopops on adolescent drinking: a
literature review, Alcohol &Alcoholism, Advance Access published 17
Competing interests: No competing interests