Adolescents in Europe may be just as susceptible to online alcohol marketing as their counterparts elsewhere, according to a recent study in four countries that links the ads with kids' likelihood of drinking and of binge drinking.

There have been similar results from studies conducted in the U.S., Scotland and the Pacific, said lead author Avalon de Bruijn of the European Center for Monitoring Alcohol Marketing in Heerde, the Netherlands, but "it was a surprise to me that the impact of online advertising was so strong and the exposure so high among young people in these countries."

Alcohol marketing seems unavoidable on the internet, de Bruijn told Reuters Health by email.

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The researchers surveyed more than 9,000 students around age 14 at schools in Germany, Italy, the Netherlands and Poland. About 4,500 kids said they never drank alcohol and were categorized as non-drinkers; all others were categorized as drinkers. In addition, one quarter of all the participants said that they had five or more drinks at once in the past 30 days and were classified as binge drinkers.

The students answered questions about having seen promotional emails or joke emails mentioning alcohol brands and websites for alcohol brands or whose content was about drinking. They were also asked about using mobile phone or computer screensavers containing an alcohol brand name or logo and about having used a profile website on social media that contained an alcohol advertisement.

Two-thirds said they had noticed an alcohol ad online, and one third had used a profile website with an alcohol ad. One fourth received promotional emails containing alcohol advertisements and one in five looked at websites for alcohol brands. The proportion of kids who had downloaded a screensaver featuring an alcohol brand ranged from just under one in three in Italy to one in six in Poland.

In each country, higher exposure to online alcohol marketing was tied to greater odds of being a drinker and of binge drinking, according to the results in Alcohol and Alcoholism.

"Existing research suggests that exposure to alcohol marketing increases the risk of starting to drink and to increase the amount and frequency of drinking among drinkers," de Bruijn said, though the current study cannot prove that one factor causes the other.

Active engagement with online marketing materials was also found to be more closely linked to drinking behavior than passive exposure to them, the report notes.

All types of alcohol advertising have been tied in past research to higher levels of drinking, de Bruijn said. "However, the impact of online alcohol marketing is especially influential. This might be explained by the interactive and personalized character of online alcohol advertising."

Past research has also shown that price policies and restricting the number of alcohol vendors in a certain area can reduce binge drinking among youth, she said.

"Given that teens are spending considerable amount of time online, it is not surprising that advertising and marketing are influential in the online realm," 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.

But it is possible that adolescents who drink more are seeking out alcohol advertising and marketing more than adolescents who are not drinkers, Litt told Reuters Health by email.

"It may not be feasible to reduce the volume of alcohol marketing teens view online, but it is probably more realistic, at least in the short term, to work on teaching our kids how to be more savvy 'consumers' of this alcohol content by teaching media literacy skills," she said.

Most alcohol advertisers have pledged to voluntarily limit ads targeting teens but the nature of the internet makes it very hard to monitor and enforce these regulations, Litt said.

"In most EU countries the volume of online alcohol advertisements in not regulated by law and only by insufficient voluntary codes by the alcohol industry," de Bruijn said. "There is a responsibility of EU Member States and the European Union to regulate this in order to protect children and adolescents against harmful exposure to online alcohol advertisements."