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Data suggest a rise in drinking among underage girls in recent years, more so than boys – and a researcher believes advertising is playing a role.

A woman in a tight T-shirt holds a cup in front of her chest as she pours a beer in a TV ad. Her face is cut out of the shot. In another beer commercial, there is a closeup on a woman's torso from behind as she dances at a party. Next to a bottle of tequila, a man embraces a woman, lifting her up with a smile on his face.

These images of sexually attractive, popular women associated with alcoholic beverages are not meant for women as young as 13. But underage girls see them, and the exposure to advertising is having an adverse effect on their health. That's the argument made in an editorial published on the Canadian Medical Association Journal website on Monday by senior associate editor Dr. Ken Flegel.

To illustrate this, Dr. Flegel points to research showing that young girls – at ages as early as 13 – are drinking as much alcohol as young boys are (while suffering, in some cases, worse health effects as a result). He cites further studies that have found that adolescent girls are exposed to more alcohol advertising, and that this exposure can be associated with increased consumption.

"This is a worrying issue for both genders, but there are some extra worries for girls," Dr. Flegel said in an interview.

According to data from the Canadian Community Health Survey, risky drinking among underage girls in Canada increased 14 per cent between 2003 and 2010. That reflects an increase to 21 per cent, from 18 per cent, of underage girls who drank at least once in the past year, reporting they had consumed more than four drinks in one occasion at least once in the past month. Over the same time, risky drinking was stable, at about 30 per cent, among underage boys who drank at least once in the past year and reporting risky drinking (defined for boys as 5 drinks or more).

Brayden (The Globe agreed not to use her full name) is 15 years old, and like many typical teenage girls well below the legal drinking age, alcohol is part of her life.

"At my school, [the students] definitely support drinking. They see it as fun and cool and trendy," she said, speaking from her home in the greater Toronto area.

And while Brayden does not believe ads are enough to convince teens to drink, she says the images do have an impact on her friends.

"Definitely. You see the ads and they all look like they're having fun, and they're on a private jet and stuff," Brayden said.

The fact that young girls are approaching young boys in the amount they drink is worrisome, Dr. Flegel said. For one, women have different water mass in their bodies and tend to process alcohol differently.

Young girls are exposed regularly – and increasingly – to alcohol ads. Dr. Flegel cited a 2004 study in the journal Archives of Pediatrics & Adolescent Medicine that found "exposure of underage girls to alcohol advertising is substantial and increasing, pointing to the failure of industry self-regulation and the need for further action."

That study analyzed young girls' exposure to alcohol ads in magazines specifically. The researchers showed that girls between the ages of 12 and 20 were exposed to ads for beer, ale and liquor, as often as women aged 21 to 34. When it came to sweet-flavored "low-alcohol refreshers," such as coolers, it found that the younger girls were 95 per cent more exposed to advertising for those products than women over age 21.

"In the context of youth generally being more likely per capita than the legal-age audience to see magazine advertising for beer and ale, distilled spirits, and [low-alcohol refreshers], perhaps the most striking finding of our analysis is the level of overexposure experienced by girls," the study said.

Established research has also shown that alcohol advertising has an influence on underage drinking, researchers Jerry Grenard, Clyde and Alan Stacy said in a study published in the journal Pediatrics earlier this year.

Their study found that children in the seventh grade who were exposed to alcohol advertising and liked the images they saw, increased their alcohol use in the subsequent few years. Those kids also had more severe alcohol-related problems by grade 10. They determined this through a survey of 3,890 students in California, once per year over four years.

The results showed that "exposure to alcohol advertising and affective reactions to those advertisements on television influence underage drinking and the development of alcohol-related problems."

Other research has established that media literacy programs in schools helped to increase skepticism about ads; the researchers found that this is one strategy that should be pursued, since their findings indicated that the influence of ads on behaviour depended on the kids actually liking the ads.

However, in addition to putting the onus on parents, teachers and doctors to inform young girls about their choices, Dr. Flegel suggested that the regulations around alcohol advertising need to change. He argues that as with tobacco products, health warnings should be required on the packaging of alcoholic drinks, and included in ads as well.

The industry disagrees. Jan Westcott, president of the Association of Canadian Distillers, said the working group that produced the 2007 recommendations for a National Alcohol Strategy – which included the Canadian Centre on Substance Abuse as well as government representatives, addictions agencies, industry representatives and others – looked into the possibility of using warning labels but did not recommend their use. (It did, however, recommend reviewing and updating existing regulations around alcohol ads.)

"Our regulations in Canada are more strict than a lot of markets," he said. For one, the broadcast code enforced by Advertising Standards Canada, as well as provincial laws, prevent alcohol ads from being targeted to minors.

"It's not worth it. We'll get those people in time, as they grow up and choose or not to become our customers," Mr. Wescott said. "Trying to somehow entice people that shouldn't be our customers and won't be the type of customer we're looking for? Come on. We're not stupid."

However, outside of broadcast advertising, in digital environments where kids spend a great deal of time, regulations are not as easily enforced. That said, some provinces have begun to expand the advertising code around broadcast to apply to all media, said Advertising Standards Canada president Linda Nagle.

The use of attractive people in attractive situations is not new for any type of advertising, alcohol included, said Luke Harford, the president of the Brewers Association of Canada.

"Advertising doesn't induce people to start drinking, or drink in risky patterns … the primary drivers are parents and peers," he said. "There's a lot of other things at play here that we need to deal with – not just brewers, or distillers or vintners, but the society at large. We need to cultivate a culture of moderation."

However, Dr. Flegel said part of that culture should come from the advertising.

"I don't think corralling our kids is going to solve this problem," he said. "Informing our kids, and reminding them before they indulge is the way to go. At the point of seeing the ad, and at the point of procuring they need to be reminded."