PASCH ET AL. 587 Received: August 21, 2006. Revision: February 20, 2007. *This research was supported by National Institute on Alcohol Abuse and Alcoholism grant R01-AA13458 to Kelli A. Komro. † Correspondence may be sent to Keryn E. Pasch at the above address or via email at: pasc0074@umn.edu. Kelli A. Komro is also with the Depart- ment of Epidemiology and Health Policy Research and Institute for Child Health Policy, University of Florida, College of Medicine, Gainesville, FL. Cheryl L. Perry is with the Michael and Susan Dell Center for the Advance- ment of Healthy Living, University of Texas School of Public Health, Aus- tin Regional Campus, Austin, TX. 587 Outdoor Alcohol Advertising Near Schools: What Does It Advertise and How Is It Related to Intentions and Use of Alcohol Among Young Adolescents?* KERYN E. PASCH, M.P.H., PH.D., † KELLI A. KOMRO, M.P.H., PH.D., † CHERYL L. PERRY, PH.D., † MARY O. HEARST, M.P.H., PH.D., AND KIAN FARBAKHSH, M.A. Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455 ABSTRACT. Objective: The objectives of this study were to (1) docu- ment and describe all outdoor alcohol advertisements surrounding schools and (2) examine the association between exposure to alcohol advertising in sixth grade and youth alcohol use, intentions, norms, and attitudes in eighth grade. Method: All outdoor alcohol advertisements within 1,500 feet of 63 Chicago school sites were documented and coded for content and theme. Longitudinal mixed-effects regression analysis was used to determine the association between number of alcohol ad- vertisements around a school in sixth grade and student alcohol behav- iors, intentions, norms, and attitudes at the end of eighth grade, 2 years later. Participants included 2,586 sixth-grade students in the 2002-2003 school year. The sample was 37% black, 33% Hispanic, and 15% white. Gender was evenly distributed, and the average age was 12.2 at the end of sixth grade. Results: A total of 931 alcohol advertisements were found within 1,500 feet of the 63 school sites. Exposure to alcohol ad- vertising around schools at the end of sixth grade was found to predict alcohol intentions at the end of eighth grade. This finding held true even for those students who were nonusers of alcohol in sixth grade. Con- clusions: Exposure to outdoor alcohol advertising around schools is as- sociated with subsequent youth intentions to use alcohol. The association between exposure to alcohol advertising and youth alcohol-use inten- tions was found even among sixth-grade nonusers of alcohol, suggest- ing that even those who have not used alcohol are still influenced by alcohol advertising. These findings suggest that restrictions in alcohol advertising near schools may be warranted. (J. Stud. Alcohol Drugs 68: 587-596, 2007) A LCOHOL USE BEGINS EARLY, with 33.9% of ninth graders in the United States reporting alcohol use be- fore the age of 13 (Eaton et al., 2006). Alcohol use has been correlated with many negative outcomes during ado- lescence and in later life (O’Malley et al., 1998; Wilson et al., 2002). Youth who drink before age 15 are estimated to be four times more likely to develop alcohol dependence than those who begin drinking at age 18 or older (Grant and Dawson, 1997; Substance Abuse and Mental Health Services Administration, 2004). Therefore, it is important to investigate the causes of the high prevalence of the early onset of alcohol use to inform preventive efforts. Social Cognitive Theory suggests that behavior results from a continuous reciprocal interaction between three lev- els of influence: personal, behavioral, and environmental (Bandura, 1977, 1986). Personal or cognitive factors refer to the factors that are found within a person and include such factors as beliefs and attitudes (Perry, 1999a). Per- sonal factors influence youth alcohol use because the be- liefs an adolescent has about the outcomes of alcohol use, such as “drinking alcohol will make me more popular,” and perceptions of the normative use of alcohol by peers and adults may influence that adolescent’s behavior (Perry et al., 1996). If the adolescent has positive beliefs and norms about alcohol use, then he or she may be more likely to use alcohol (Baranowski et al., 2002; Komro et al., 2001; Perry et al., 1996). Environmental influences are related to youth alcohol use because the environment can facilitate or prohibit alcohol use through access, exposure, and modeling (Perry and Jessor, 1985). Alcohol advertising is an environmental factor that has been found to shape adolescents’ beliefs, atti- tudes, and alcohol behaviors (Ellickson et al., 2004; Fleming et al., 2004; Grube and Waiters, 2005; Grube and Wallack, 1994; Mazis, 1995; Snyder et al., 2006; Stacy et al., 2004). Exposure to alcohol advertising leads children to have higher brand recall and hold more positive beliefs about social and ritual uses of beer (Committee on Substance Abuse, 2001). Alcohol advertisements also shape knowl- edge, attitudes, and perceptions about alcohol use, which in turn are predictive of positive expectancies and intentions to drink (Fleming et al., 2004; Grube and Wallack, 1994). Advertising research has shown that, over time, repetitive