More than half of underage people say they've seen alcohol marketing on the Internet, though few admit to engaging with brands or being a fan online, according to a new U.S. study.

Based on surveys about a year apart, researchers also found that teens who were more receptive to the marketing were more likely than others to later develop problem drinking.

The study team led by Dr. Auden McClure of the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, used data from a 2011 survey of about 2,000 youth, ages 15 to 20 years. The participants answered questions about their recollections of having seen alcohol ads online, visiting alcohol websites, recognizing images from brand home pages and being an online fan of brands like Bacardi or Jack Daniels.

Almost 60 percent said they had seen alcohol advertising online and 13 percent recognized at least one of five brand websites. Six percent said they had been to a brand website and 3 percent were online fans of an alcohol brand.

The following year, almost 1,600 of the youth completed a follow-up online survey in which they answered questions about ever drinking and binge drinking. At this point, 55 percent of participants said they had ever engaged in any kind of drinking and 27 percent said they had ever been binge drinking, which was defined as having six or more drinks on one occasion.

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Kids who reported some engagement with the alcohol advertising online in the first survey were about 80 percent more likely than others to have started binge-drinking by the second survey, according to the results in Pediatrics.

In turn, greater Internet use, sensation seeking, having family or peers who drank and past alcohol use were all linked to a greater likelihood of being receptive to Internet alcohol marketing.

The study authors did not respond to a request for comments.

Another recent study in the journal Alcohol and Alcoholism found that Twitter and Instagram accounts created for underage users, and age-gated in principle, could still view and engage with alcohol brand ads on a daily basis (see Reuters Health story of December 18, 2015, here:

A Centers for Disease Control and Prevention study released this week found that online e-cigarette ads reach about seven in 10 middle and high-school students in the U.S. (see Reuters story of January 5, 2016, here:

Decades of previous research has determined that exposure to alcohol advertising in other forms of media like magazines and television is related to alcohol consumption for teens, said Dana Litt of the Center for the Study of Health and Risk Behaviors at the University of Washington in Seattle, who was not part of the new study.

"The interactive nature of internet activity and the sheer amount of alcohol-related content online have led researchers to suggest that these forms of media can be particularly influential sources of alcohol messaging," Litt told Reuters Health by email.

"One of the fundamental concepts of interactive online marketing is engagement, where the goal is not simply to expose consumers to a particular product, but to create an environment in which they are actually interacting with the brand, 'befriending' the product, and integrating it into their personal and social relationships," she said.

It's still not clear how formal messaging, like alcohol ads on websites, and informal messaging, like seeing an alcohol-related post on a friend's Facebook page, influences teen alcohol use, Litt noted.

Though most alcohol advertisers have pledged to voluntarily self-regulate the ads online and limit targeting of teens, the nature of the Internet makes it very hard, if not impossible, to monitor and enforce these regulations, she said.

"One thing parents can do is work with their teens on media literacy techniques to help them view ads critically," Litt said. "For example, discussing who created or paid for the ad, what the ad is targeted to do, and whether the ad shows the full range of alcohol-related consequences (i.e. does it show anything bad about alcohol) may be useful topics to start a conversation and help your teen better understand that alcohol ads communicate the advertiser's point of view and learn how to challenge what an ad is saying."