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Although youth exposure to television alcohol advertisements has been shown to influence youth drinking behaviors, the underlying relationship has remained uncertain. We tested the joint influence of exposure and primarily youthful content appeal (PYCA) on underage drinking, triangulating data from a content analysis, a survey of youth brand-specific consumption, and market exposure data. PYCA was positively associated with youth consumption, β = .15, p < .001, and negatively with adult consumption, β = -.15, p < .001. Within brands popular among youth, exposure was negatively associated with youth consumption, β = -.14, p < .001. Among less popular brands, exposure was positively associated with youth consumption, β = .39, p < .01, and there was an interaction effect such that PYCA strengthened the effect of exposure on consumption. The joint influence of content and exposure must be considered in order to reduce the influence of alcohol advertising on underage drinking.