Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents

Nandi Siegfried; David C Pienaar; John E Ataguba; Jimmy Volmink; Tamara Kredo; Mlenga Jere; Charles DH Parry

doi:10.1002/14651858.CD010704.pub2

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Figure 1

Flow diagram of screening and eligibility of records of electronic databases: PubMed, EMBASE, The Cochrane Library (CENTRAL and UK National Health Service Economic Evaluations Database) and PsychINFO

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Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies (N = 4).

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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study (N = 4).

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Analysis 1.1

Comparison 1 Low‐alcohol content movies versus high‐alcohol content movies, Outcome 1 Total alcohol consumption in number of glasses.

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Analysis 2.1

Comparison 2 Non‐alcohol commercials versus alcohol commercials, Outcome 1 Total alcohol consumption in number of glasses.

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Analysis 3.1

Comparison 3 High‐alcohol content movies versus low‐alcohol content movies adjusted for clustering effects, Outcome 1 Total alcohol consumption.

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Analysis 4.1

Comparison 4 Alcohol commercials versus non‐alcohol commercials adjusted for clustering effects, Outcome 1 Total alcohol consumption.

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Analysis 5.1

Comparison 5 Total advertising ban versus Partial advertising ban Abrupt permanent model, Outcome 1 Volume of alcohol (beer, wine and spirits) sales in kilolitres.

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Analysis 5.2

Comparison 5 Total advertising ban versus Partial advertising ban Abrupt permanent model, Outcome 2 Volume of beer sales in kilolitres.

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Analysis 5.3

Comparison 5 Total advertising ban versus Partial advertising ban Abrupt permanent model, Outcome 3 Volume of wine sales in kilolitres.

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Analysis 5.4

Comparison 5 Total advertising ban versus Partial advertising ban Abrupt permanent model, Outcome 4 Volume of spirits sales in kilolitres.

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Analysis 6.1

Comparison 6 Total advertising ban versus Partial advertising ban Gradual permanent model, Outcome 1 Volume of alcohol (beer, wine and spirits) sales in kilolitres.

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Analysis 6.2

Comparison 6 Total advertising ban versus Partial advertising ban Gradual permanent model, Outcome 2 Volume of beer sales in kilolitres.

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Analysis 6.3

Comparison 6 Total advertising ban versus Partial advertising ban Gradual permanent model, Outcome 3 Volume of wine sales in kilolitres.

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Analysis 6.4

Comparison 6 Total advertising ban versus Partial advertising ban Gradual permanent model, Outcome 4 Volume of spirits sales in kilolitres.

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Analysis 7.1

Comparison 7 Alcohol ban versus no ban, Outcome 1 % Change in beer consumption.

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Summary of findings for the main comparison. Non‐alcohol commercials compared to alcohol commercials for reduction of alcohol consumption

Non‐alcohol commercials compared to alcohol commercials for reduction of alcohol consumption
Patient or population: General population Settings: General population Intervention: Non‐alcohol commercials Comparison: Alcohol commercials
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Alcohol commercials	Non‐alcohol commercials
Total alcohol consumption in number of glasses Follow up: mean 1.5 hours		The mean total alcohol consumption in number of glasses in the intervention groups was 0.73 less (1.3 to 0.16 less)		80 (1 study)	⊕⊝⊝⊝ very low^1,2,3
Delayed age of initiation of alcohol use ‐ not measured			Not estimable	‐		This outcome was not applicable in this trial
Reduction in rate of reported risk behaviour ‐ not measured			Not estimable	‐
Reduction in alcohol‐related injuries or accidents ‐ not measured			Not estimable	‐
Reduction in individual spending on alcohol ‐ not measured			Not estimable	‐
Loss of revenue from alcohol industry ‐ not measured			Not estimable	‐		This outcome was not applicable in this trial
Loss of advertising revenue ‐ not measured			Not estimable	‐		This outcome was not applicable in this trial
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval;
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Risk of bias: rated as serious. In the Engels 2009 trial, randomisation was inadequate (the groups differed on the baseline prognostic factor prior drinking levels), allocation concealment was unclear and the researchers were not blinded to group allocation so detection bias may be present. ² Indirectness: rated as serious. The trial is specific to young men from a university setting in a high‐income country and may not be generalisable to other settings. ³ Imprecision: rated as serious: The 95% CI is wide and the sample size small.

Summary of findings for the main comparison. Non‐alcohol commercials compared to alcohol commercials for reduction of alcohol consumption

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Summary of findings 2. Alcohol ban compared to no ban for the general population

Alcohol ban compared to no ban for the general population
Patient or population: General population Settings: General population Intervention: Alcohol ban Comparison: No ban
Outcomes	*Illustrative comparative risks (95% CI)**		Relative effect (95% CI)	No. of pParticipants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	No ban	Alcohol ban
Alcohol consumption: % change in beer consumption Follow up: 1.2 to 3 years		The mean % change in beer consumption in the intervention groups was 1.1 more (5.26 less to 7.47 more)		2 ITS studies	⊕⊝⊝⊝ very low^1,2	Results for consumption of other types of alcoholic beverages and total consumption were inconsistent in the three ITS studies
Reduction in rate of reported risk behaviour ‐ not reported	See comment	See comment	Not estimable	‐	See comment	None of the studies measured this outcome
Delayed age of initiation of alcohol use ‐ not reported	See comment	See comment	Not estimable	‐	See comment	None of the studies measured this outcome
Reduction in alcohol‐related injuries or accidents ‐ not reported	See comment	See comment	Not estimable	‐	See comment	None of the studies measured this outcome
Reduction in individual spending on alcohol ‐ not reported	See comment	See comment	Not estimable	‐	See comment	None of the studies measured this outcome
Loss of revenue from alcohol industry ‐ not reported	See comment	See comment	Not estimable	‐	See comment	None of the studies measured this outcome
Loss of advertising revenue ‐ not reported	See comment	See comment	Not estimable	‐	See comment	None of the studies measured this outcome
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; ITS: interrupted time series
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.
¹ Risk of bias: rated as serious: the risk of a dilution effect is present in both studies (Ogborne 1980 and Smart 1976) and seasonality may not be adequately addressed in the analyses. The studies were not further downgraded for limitations in causal inference due to a lack of randomisation, as the initial GRADE rating commenced at low quality. ² Inconsistency: rated as serious. The results from the Smart 1976 study indicate a reduction in beer consumption after implementing a ban on advertising and Ogborne 1980 shows an increase in beer consumption.

Summary of findings 2. Alcohol ban compared to no ban for the general population

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Comparison 1. Low‐alcohol content movies versus high‐alcohol content movies

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total alcohol consumption in number of glasses Show forest plot	1	80	Mean Difference (IV, Fixed, 95% CI)	‐0.65 [‐1.23, ‐0.07]

Comparison 1. Low‐alcohol content movies versus high‐alcohol content movies

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Comparison 2. Non‐alcohol commercials versus alcohol commercials

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total alcohol consumption in number of glasses Show forest plot	1	80	Mean Difference (IV, Fixed, 95% CI)	‐0.73 [‐1.30, ‐0.16]

Comparison 2. Non‐alcohol commercials versus alcohol commercials

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Comparison 3. High‐alcohol content movies versus low‐alcohol content movies adjusted for clustering effects

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total alcohol consumption Show forest plot	1		Coefficient (Fixed, 95% CI)	0.74 [0.05, 1.43]

Comparison 3. High‐alcohol content movies versus low‐alcohol content movies adjusted for clustering effects

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Comparison 4. Alcohol commercials versus non‐alcohol commercials adjusted for clustering effects

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Total alcohol consumption Show forest plot	1		Coefficient (Fixed, 95% CI)	0.83 [0.14, 1.52]

Comparison 4. Alcohol commercials versus non‐alcohol commercials adjusted for clustering effects

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Comparison 5. Total advertising ban versus Partial advertising ban Abrupt permanent model

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Volume of alcohol (beer, wine and spirits) sales in kilolitres Show forest plot	1		Mean Difference (Fixed, 95% CI)	‐11.11 [‐27.56, 5.34]

2 Volume of beer sales in kilolitres Show forest plot	1		Mean Difference (Fixed, 95% CI)	14.89 [0.39, 29.39]

3 Volume of wine sales in kilolitres Show forest plot	1		Mean Difference (Fixed, 95% CI)	1.15 [‐0.91, 3.21]

4 Volume of spirits sales in kilolitres Show forest plot	1		Mean Difference (Fixed, 95% CI)	‐22.49 [‐36.83, ‐8.15]

Comparison 5. Total advertising ban versus Partial advertising ban Abrupt permanent model

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Comparison 6. Total advertising ban versus Partial advertising ban Gradual permanent model

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Volume of alcohol (beer, wine and spirits) sales in kilolitres Show forest plot	1		Mean Difference (Fixed, 95% CI)	‐11.96 [‐55.42, 31.50]

2 Volume of beer sales in kilolitres Show forest plot	1		Mean Difference (Fixed, 95% CI)	‐0.54 [‐1.57, 0.49]

3 Volume of wine sales in kilolitres Show forest plot	1		Mean Difference (Fixed, 95% CI)	‐0.00 [‐0.04, 0.04]

4 Volume of spirits sales in kilolitres Show forest plot	1		Mean Difference (Fixed, 95% CI)	‐27.8 [‐59.34, 3.74]

Comparison 6. Total advertising ban versus Partial advertising ban Gradual permanent model

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Comparison 7. Alcohol ban versus no ban

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 % Change in beer consumption Show forest plot	2		Mean % change (Random, 95% CI)	1.10 [‐5.26, 7.47]

Comparison 7. Alcohol ban versus no ban

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