Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies

Alcohol-Induced Mortality in the USA: Trends from 1999 to 2020

This study comprehensively examined trends in alcohol-induced overdose mortality in the USA between 1999 and 2020 by age, sex, race/ethnicity, census region, and type of injury. Using the CDC WONDER database, 605,948 alcohol-induced deaths were recorded. Mortality increased by 14.1% per year (95% CI 8.2, 20.3) from 2018 to 2020, with the highest rates among males, non-Hispanic Whites, individuals aged 55-64, and the Western census region. Rising trends were observed across racial/ethnic subgroups, except for American Indians/Alaska Natives, with annual increases of 17% among non-Hispanic Blacks, 14.3% among non-Hispanic Whites, 9.5% among Asian/Pacific Islanders, and 12.6% among Hispanics. Males, females, all age groups, and census regions also experienced increasing trends. In conclusion, this study underscores worsening alcohol-induced mortality in the recent two decades and the need for research to identify its determinants. Such research can guide evidence-based public health interventions to reduce excessive alcohol use consequences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11469-023-01083-1.

Alcohol and Public Health: Failure and Opportunity

Policy Points Public health science regarding alcohol consumption and problems, alcohol's role in equity and social justice, and identification of effective policy interventions has grown steadily stronger in the past 30 years. Progress on effective alcohol policies has stalled or gone backward in the United States and much of the world. Because alcohol influences at least 14 of the 17 sustainable development goals, as well as more than 200 disease and injury conditions, reducing alcohol problems should offer a platform for collaboration across public health silos but will require that public health itself respect and follow its own science.

Effective alcohol policies and lifetime abstinence: An analysis of the International Alcohol Control policy index

INTRODUCTION

Alcohol abstinence remains common among adults globally, although low and middle-income countries are experiencing declines in abstention. The effect of alcohol policies on lifetime abstinence is poorly understood. The International Alcohol Control (IAC) policy index was developed to benchmark and monitor the uptake of effective alcohol policies and has shown strong associations with alcohol per capita consumption and drinking patterns. Uniquely, the index incorporates both policy 'stringency' and 'impact', reflecting policy implementation and enforcement, across effective policies. Here we assessed the association of the IAC policy index with lifetime abstinence in a diverse sample of jurisdictions.

METHODS

We conducted a cross-sectional analysis of the relationship between the IAC policy index score, and its components, and lifetime abstinence among adults (15+ years) in 13 high and middle-income jurisdictions. We examined the correlations for each component of the index and stringency and impact separately.

RESULTS

Overall, the total IAC policy index scores were positively correlated with lifetime abstinence (r = 0.76), as were both the stringency (r = 0.62) and impact (r = 0.82) scores. Marketing restrictions showed higher correlations with lifetime abstinence than other policy domains (r = 0.80), including restrictions on physical availability, pricing policies and drink-driving prevention.

DISCUSSION AND CONCLUSION

Our findings suggest that restricting alcohol marketing could be an important policy for the protection of alcohol abstention. The IAC policy index may be a useful tool to benchmark the performance of alcohol policy in supporting alcohol abstention in high and middle-income countries.

Adolescent brain maturation and the neuropathological effects of binge drinking: A critical review

Adolescence is a transitional stage marked by continued brain development. This period is accompanied by physical and neurochemical modifications in the shape and function of the hippocampus, prefrontal cortex, and other limbic system structures. Brain maturation during adolescence, which is typically governed by intrinsic factors, can be dramatically altered by environmental influences such as drugs and alcohol. Unlike many other addictive substances, binge drinking is very common and normative among teenagers and young adults. This repeated pattern of excessive alcohol consumption in adolescents has been shown to cause behavioral changes and neurocognitive impairments that include increased anxiety, risky decision-making, and learning deficits, which could lead to the development of alcohol use disorder (AUD). This manuscript highlights factors that lead to adolescent binge drinking, discusses maturational changes that occur in an adolescent's brain, and then evaluates the effect of adolescent alcohol consumption on brain structure, function, and neurocognitive abilities in both human studies and animal models. The impact of gender/sex and COVID-19 are briefly discussed. Understanding the factors that promote the onset of adolescent binge drinking and its undesirable consequences could serve as a catalyst for developing therapeutic agents that would decrease or eradicate the damaging effects of alcohol on an adolescent brain.

Association and dose-response relationship between exposure to alcohol advertising media and current drinking: a nationwide cross-sectional study of Japanese adolescents

BACKGROUND

Underage drinking is a public health concern. However, few studies have examined the association between alcoholic beverage advertising and underage drinking, particularly in countries with low underage drinking rates, such as Japan. Therefore, we aimed to investigate the relationship between exposure to advertising in various media and alcohol drinking among Japanese adolescents.

METHODS

We conducted a cross-sectional study involving 15,683 adolescents (51% girls) using data from a nationwide lifestyle survey in 2021 among junior and senior high schools across Japan. Media types were websites, stores, and public transportation. We defined current drinking as alcohol consumption of ≥1 day in the 30 days preceding the survey. Multivariable logistic regression was used to examine the association between exposure to alcohol advertisements and current drinking, adjusting for sex, grades, school area, lifestyle (bedtime and having fun at school), and addictive behaviors (smoking status and parents' alcohol consumption).

RESULTS

The prevalence of current drinking was 2.2% (2.3% of boys and 2.0% of girls). Students who were exposed to any alcohol advertising media had higher odds of current drinking compared with those who were not (odds ratio, 1.48; 95% confidence interval [CI], 1.18-1.87). Students who were exposed to web, in-store, and public transportation advertisements had odds ratios of 1.44 (95% CI, 1.14-1.81), 1.62 (1.28-2.05), and 1.45 (1.06-1.98) of current drinking, respectively, compared with those who were not. The association of exposure to alcohol advertising media with the prevalence of current drinking was similar among boys and girls (all p for sex interaction >0.1), except for that of exposure to web advertisements; its association with current drinking was more pronounced in girls (p for sex interaction = 0.046). Exposure to a larger cumulative number of different alcohol advertising media was independently associated with a higher prevalence of current drinking among all students, boys, and girls (p-values for trend <0.001, 0.031, and <0.001, respectively; p for sex interaction = 0.085).

CONCLUSIONS

We found an association with a dose-response relationship between exposure to alcohol advertisements and current drinking among adolescents in junior and senior high schools across Japan. Our findings highlight the need for further advertising regulations to prevent underage drinking.

Public Health Measures and Prevention of Alcohol-Associated Liver Disease

Hazardous alcohol consumption causes approximately 4% of deaths globally, constituting one of the leading risk factors for the burden of the disease worldwide. Alcohol has several health consequences, such as alcohol-associated liver disease, hepatocellular carcinoma, nonliver neoplasms, physical injury, cardiac disease, and psychiatric disorders. Alcohol misuse significantly affects workforce productivity, with elevated direct and indirect economic costs. Due to the high impact of alcohol consumption on the population, public health has led to the development of a range of strategies to reduce its harmful effects. Regulatory public health policies (PHP) for alcohol can exist at the global, regional, international, national, or subnational levels. Effective strategies incorporate a multilevel, multicomponent approach, targeting multiple determinants of drinking and alcohol-related harms. The World Health Organization categorizes the PHP into eight categories: national plan to fight the harmful consequences of alcohol, national license and production and selling control, taxes control and pricing policies, limiting drinking age, restrictions on alcohol access, driving-related alcohol policies, control over advertising and promotion, and government monitoring systems. These policies are supported by evidence from different populations, demonstrating that determinants of alcohol use depend on several factors such as socioeconomic level, age, sex, ethnicity, production, availability, marketing, and others. Although most policies have a significant individual effect, a higher number of PHP are associated with a lower burden of disease due to alcohol. The excessive consequences of alcohol constitute a call for action, and clinicians should advocate for developing and implementing a new PHP on alcohol consumption.

Analysis of related factors for adolescents' intention to use alcohol in Korea

The harmful effects of alcohol consumption by adolescents have been increasingly emphasized. Thus, it is necessary to identify individual and environmental factors that encourage drinking. This study investigated factors associated with the sustainable use of alcohol (SUA) in adolescents who consume alcohol, and the possibility of future drinking (PFD) in non-drinking adolescents. Data from "The Adolescents Awareness Survey of Alcohol Encouraging Environment" by the Ministry of Health and Welfare and the Korea Health Promotion Institute (2017) were used. The survey was completed by 1,038 participant, selected through a proportional allocation extraction method, who were aged 13-18 years and lived in five cities with a population of over 1 million. The factors associated with SUA included gender (β = 0.634, p = 0.004), grade (8th β = 1.591, p<0.001, 9th β = 1.674, p<0.001, 10th β = 1.497, p = 0.001, 11th β = 1.041, p = 0.004, 12th β = 2.610, p<0.001), drinking alone (β = -2.147, p = 0.002), liquor commercial (β = 1.644, p<0.001), ease of alcohol purchase (β = 1.541, p = 0.025), parent's recommendation for drinking (β = 1.084, p<0.001), not knowing the mother's education level (β = -0.685, p = 0.045), positive expectancy of drinking (β = 0.141, p<0.001), number of pubs (β = 0.303, p = 0.002), internet game cafes (β = 0.456, p = 0.019), and karaokes (β = -0.098, p = 0.023) in the community. The factors associated with the PFD in non-drinkers were grade (8th β = 0.531, p = 0.024, 10th β = 0.717, p = 0.035, 12th β = 1.882, p = 0.001), liquor commercial (β = -1.355, p<0.001), parent's recommendation for drinking (β = 0.783, p = 0.020), positive expectancy of drinking (β = 0.139, p<0.001), and relationship with the father (β = 0.072, p = 0.033). Multidimensional interventions, including those by individuals, parents, peers, and local communities, are needed to prevent SUA and the PFD in adolescents.

The epidemiology of pediatric traumatic brain injury presenting at a referral center in Moshi, Tanzania

Background

Over 95% of childhood injury deaths occur in low- and middle-income countries (LMICs). Patients with severe traumatic brain injury (TBI) have twice the likelihood of dying in LMICs than in high-income countries (HICs). In Africa, TBI estimates are projected to increase to upwards of 14 million new cases in 2050; however, these estimates are based on sparse data, which underscores the need for robust injury surveillance systems. We aim to describe the clinical factors associated with morbidity and mortality in pediatric TBI at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania to guide future prevention efforts.

Methods

We conducted a secondary analysis of a TBI registry of all pediatric (0–18 years of age) TBI patients presenting to the KCMC emergency department (ED) between May 2013 and April 2014. The variables included demographics, acute treatment and diagnostics, Glasgow Coma Scores (GCSs, severe 3–8, moderate 9–13, and mild 14–15), morbidity at discharge as measured by the Glasgow Outcome Scale (GOS, worse functional status 1–3, better functional status 4–6), and mortality status at discharge. The analysis included descriptive statistics, bivariable analysis and multivariable logistic regression to report the predictors of mortality and morbidity. The variables used in the multivariable logistic regression were selected according to their clinical validity in predicting outcomes.

Results

Of the total 419 pediatric TBI patients, 286 (69.3%) were male with an average age of 10.12 years (SD = 5.7). Road traffic injury (RTI) accounted for most TBIs (269, 64.4%), followed by falls (82, 19.62%). Of the 23 patients (5.58%) who had alcohol-involved injuries, most were male (3.6:1). Severe TBI occurred in 54 (13.0%) patients. In total, 90 (24.9%) patients underwent TBI surgery. Of the 21 (5.8%) patients who died, 11 (55.0%) had severe TBI, 6 (30.0%) had moderate TBI (GCS 9–13) and 3 (15.0%) presented with mild TBI (GCS>13). The variables most strongly associated with worse functional status included having severe TBI (OR = 9.45) and waiting on the surgery floor before being moved to the intensive care unit (ICU) (OR = 14.37).

Conclusions

Most pediatric TBI patients were males who suffered RTIs or falls. Even among children under 18 years of age, alcohol was consumed by at least 5% of patients who suffered injuries, and more commonly among boys. Patients becoming unstable and having to be transferred from the surgery floor to the ICU could reflect poor risk identification in the ED or progression of injury severity. The next steps include designing interventions to reduce RTI, mitigate irresponsible alcohol use, and improve risk identification and stratification in the ED.

Development and validation of the Alcoholic Beverage Identification Deep Learning Algorithm version 2 for quantifying alcohol exposure in electronic images

BACKGROUND

Seeing alcohol in media has been demonstrated to increase alcohol craving, impulsive decision-making, and hazardous drinking. Due to the exponential growth of (social) media use it is important to develop algorithms to quantify alcohol exposure efficiently in electronic images. In this article, we describe the development of an improved version of the Alcoholic Beverage Identification Deep Learning Algorithm (ABIDLA), called ABIDLA2.

METHODS

ABIDLA2 was trained on 191,286 images downloaded from Google Image Search results (based on search terms) and Bing Image Search results. In Task-1, ABIDLA2 identified images as containing one of eight beverage categories (beer/cider cup, beer/cider bottle, beer/cider can, wine, champagne, cocktails, whiskey/cognac/brandy, other images). In Task-2, ABIDLA2 made a binary classification between images containing an "alcoholic beverage" or "other". An ablation study was performed to determine which techniques improved algorithm performance.

RESULTS

ABIDLA2 was most accurate in identifying Whiskey/Cognac/Brandy (88.1%) followed by Beer/Cider Can (80.5%), Beer/Cider Bottle (78.3%), and Wine (77.8%). Its overall accuracy was 77.0% (Task-1) and 87.7% (Task-2). Even the identification of the least accurate beverage category (Champagne, 64.5%) was more than five times higher than random chance (12.5% = 1/8 categories). The implementation of balanced data sampler to address class skewness and the use of self-training to make use of a large, secondary, weakly labeled dataset particularly improved overall algorithm performance.

CONCLUSION

With extended capabilities and a higher accuracy, ABIDLA2 outperforms its predecessor and enables the screening of any kind of electronic media rapidly to estimate the quantity of alcohol exposure. Quantifying alcohol exposure automatically through algorithms like ABIDLA2 is important because viewing images of alcoholic beverages in media tends to increase alcohol consumption and related harms.

The Comprehensive Alcohol Advertising Ban in Lithuania: A Case Study of Social Media

Alcohol advertising exposure is a risk factor for earlier alcohol initiation and higher alcohol consumption. Furthermore, engagement in digital alcohol marketing, such as liking or sharing an ad on social media, is associated with increased alcohol consumption and binge or hazardous drinking behavior. In light of these challenges, Lithuania has enacted a total prohibition on alcohol advertising, including social media. This study monitored the two most popular social media networks, Facebook and Instagram, to determine compliance with current legislation. In total, 64 Facebook and 51 Instagram profiles were examined. During the 60-day study period, 1442 and 749 posts on the selected Facebook and Instagram profiles, respectively, were published. There were a total of 163 distinct social media alcohol-related posts. Alcohol-related posts accounted for 5.9 percent of total Instagram posts and 8.3 percent of total Facebook posts. Alcohol advertisements accounted for 1.4 percent of all posts (infringement of the Alcohol Control Law). Influencers were responsible for nearly half (45.5 percent) of all observed alcohol-related Instagram posts. The study demonstrates high compliance with Lithuania's total alcohol advertising ban on social media and emphasizes the importance of adequately monitoring the growing prominence of influencers on social media.

The Mediating Effects of Food Content Watching Motivation on the between Watching Time and Nutrition Quotient of Adolescents in Seoul, Korea

Food-related content varies widely and is increasingly popular. Using various media, teenagers can easily access food content, which could affect they eating habits. This study was conducted to confirm the effects of watching motivation on the relationship between food content watching time and eating habits among adolescents in Seoul, Korea. Exactly 806 participants were surveyed about their food content watching status, including watching time and watching motivation. The Nutrition Quotient for adolescents (NQ-A) questionnaire was used to confirm eating habits. Exploratory factor analysis was conducted to classify watching motivation’s subfactors. A parallel multimedia model was used to analyze the effect of watching motivation on the relationship between food content watching time and eating habits. As a result of this study, following the factor analysis, watching motivation was classified into information acquisition, emotional satisfaction, and enjoyment. The influence of food content watching time on NQ-A scores through information acquisition motivation was positively significant, whereas that through emotional satisfaction motivation was negatively significant. Enjoyment motivation did not indirectly affect the relationship between food content watching time and NQ-A scores. Hence, attention should be paid to these mediating factors when analyzing the relationship between watching food-related content and eating habits. Developing and distributing content that meets viewing motivations should help improve adolescents’ eating habits.

Inequalities in children's exposure to alcohol outlets in Scotland: a GPS study

BACKGROUND

Alcohol use is a leading cause of harm in young people and increases the risk of alcohol dependence in adulthood. Alcohol use is also a key driver of rising health inequalities. Quantifying inequalities in exposure to alcohol outlets within the activity spaces of pre-adolescent children-a vulnerable, formative development stage-may help understand alcohol use in later life.

METHODS

GPS data were collected from a nationally representative sample of 10-and-11-year-old children (n = 688, 55% female). The proportion of children, and the proportion of each child's GPS, exposed to alcohol outlets was compared across area-level income-deprivation quintiles, along with the relative proportion of exposure occurring within 500 m of each child's home and school.

RESULTS

Off-sales alcohol outlets accounted for 47% of children's exposure, which was higher than expected given their availability (31% of alcohol outlets). The proportion of children exposed to alcohol outlets did not differ by area deprivation. However, the proportion of time children were exposed showed stark inequalities. Children living in the most deprived areas were almost five times more likely to be exposed to off-sales alcohol outlets than children in the least deprived areas (OR 4.83, 3.04-7.66; P < 0.001), and almost three times more likely to be exposed to on-sales alcohol outlets (OR 2.86, 1.11-7.43; P = 0.03). Children in deprived areas experienced 31% of their exposure to off-sales outlets within 500 m of their homes compared to 7% for children from less deprived areas. Children from all areas received 22-32% of their exposure within 500 m of schools, but the proportion of this from off-sales outlets increased with area deprivation.

CONCLUSIONS

Children have little control over what they are exposed to, so policies that reduce inequities in alcohol availability should be prioritised to ensure that all children have the opportunity to lead healthy lives.

Prevalence of substance use and associated factors among secondary school adolescents in Kilimanjaro region, northern Tanzania

Background

Substance use among school-going adolescents increases the risk of developing mental disorders, addiction, and substance use disorders. These may lead to poor academic performance and reduced productivity, which affects adolescent lives. The study aimed to determine the prevalence of substance use and associated factors among secondary school adolescents in the Kilimanjaro region, northern Tanzania.

Methodology

The study used secondary data from a cross-sectional survey of adolescents aged 10–19 years from public secondary schools in the Kilimanjaro Region, northern Tanzania. Substance use was measured using the Global School Health Survey (GSHS) questionnaire. Categorical variables were summarized using frequencies and percentages, while numerical variables used mean and standard deviation. Multivariable logistic regression models were used to obtain odds ratios (OR) and 95% confidence intervals (CI) to determine risk factors associated with lifetime and current (within the past 30 days preceding the survey) substance use.

Results

The lifetime and current prevalence of substance use among 3224 adolescents was 19.7% and 12.8%, respectively, while alcohol and cigarettes were commonly used. Female adolescents had lower odds of current substance use (OR = 0.63, 95%CI 0.50–0.80). Higher odds of current substance use were among adolescents who have ever had sex (OR = 4.31, 95%CI 3.25–5.71), ever engaged in a physical fight (OR = 2.19, 95%CI 1.73–2.78), ever been bullied (OR = 1.55, 95%CI 1.16–2.05), always seen alcohol advertisements (OR = 1.87, 95%CI 1.37–2.53), and adolescents whose parent/guardians rarely understood their problems (OR = 1.38, 95% CI = 1.03–1.85). Adolescents whose classmates always showed social support had lower odds of current substance use (AOR = 0.71, 95%CI 0.53–0.97). Similar factors were associated with lifetime substance users.

Conclusion

The study reflects a high prevalence of substance use among adolescents in the Kilimanjaro region. Alcohol and cigarette are the most prevalent substances used. Regulatory measures are essential to limit alcohol advertisements that are media portrayed. Efforts are needed to reduce risk behaviors, such as physical violence and bullying, through peer support groups/clubs in school environments.

Racial/Ethnic Bullying Subtypes and Alcohol, Tobacco, and Marijuana Use Among US Adolescents

BACKGROUND

The study examines the rate of alcohol, tobacco, and marijuana use among White, African American, and Latino adolescents and whether racial/ethnic bullying subtypes (victim-only, bullies-only, and bully/victim) are related to alcohol, tobacco, and marijuana use.

METHODS

We used data from the 2009-2010 Health Behaviour in School-aged Children study (n = 9863) to examine differences in alcohol, tobacco, and marijuana use among White, African American, and Latino adolescents in the USA, and assessed whether racial/ethnic bullying involvement was associated with alcohol, tobacco, and marijuana use among these adolescents. Adolescents were categorized into four groups based on whether they had experienced racial bullying perpetration, victimization, both perpetration, and victimization, or neither perpetration nor victimization. Descriptive statistics were conducted to examine the distributions of the study variables and describe the samples. Spearman's rank-order correlation analyses were used to examine the relationships among the variables. Multinomial logistic regression was conducted to examine alcohol, tobacco, and marijuana use among the racial bully victimization, perpetration, and victimization-perpetration groups compared to the non-involved group by race/ethnicity.

RESULTS

The White victim-only group was more likely to use alcohol but less likely to use tobacco. The African American victim-only group was more likely to use alcohol, and the bully/victim group was more likely to use marijuana. The Latino victim-only group was more likely to use alcohol, whereas the bully/victim group was more likely to use tobacco.

CONCLUSION

Our findings have implications for the development and implementation of prevention and intervention programs across different racial/ethnic adolescent groups.

Time spent on social media and alcohol use among adolescents: A longitudinal study

BACKGROUND AND AIMS

Research into the association between use of social media (SoMe) and alcohol use among adolescents is still in its infancy. The aim of the current longitudinal study was to examine if time spent on SoMe was prospectively associated with alcohol use among adolescents, and whether these associations differed for boys and girls.

DESIGN

Prospective cohort study among Norwegian adolescents who completed e-questionnaires in the autumn of 2017 (t1), 2018 (t2), 2019 (t3) and 2020 (t4).

SETTING

Norway.

PARTICIPANTS

A nation-wide sample of N = 3096 adolescents (mean age at t1: 14.3 years (SD = 0.85), 43% boys).

MEASUREMENTS

Self-report data were collected on adolescents' alcohol use, time spent on SoMe, parental monitoring, sensation-seeking, and positive and negative urgency, gender, and age.

FINDINGS

Latent growth modelling adjusted for time invariant covariates (i.e., parental monitoring, sensation-seeking, and positive and negative urgency at t1) showed a positive association between time spent on SoMe and alcohol use at the start of the study; standardized b (β) = 0.17 (95% CI: 0.09, 0.26). Time spent on SoMe at t1 was a strong positive predictor of increase in alcohol use β = 0.31 (95% CI: 0.23, 0.40). There was also an association between degree of increase in alcohol use and increase in time on SoMe, β = 0.14 (95% CI: 0.05, 0.24). Subsequent multigroup analysis found little evidence for gender differences (p > 0.05).

CONCLUSION

The more time Norwegian adolescents aged 13-15 years spend on SoMe, the greater is their subsequent increase in alcohol use over time.

Do different actors submit different evidence to alcohol advertising policy consultations?

INTRODUCTION

This study examined the extent to which industry and non-industry actors draw from the same (vs. different) bodies of peer-reviewed evidence in submissions to alcohol advertising policy consultations.

METHODS

Submissions (n = 71) to two Australian public consultations about alcohol advertising policy were classified as submitted by industry or non-industry actors. Details of cited journal articles were extracted. Articles were coded according to whether: (i) cited in industry and/or non-industry actor submission/s; (ii) findings were supported or contested by the submitter; and (iii) the article was a systematic review. The most frequently cited first authors were identified.

RESULTS

In total, 126 articles were cited in 45 industry actor submissions and 159 articles were cited in 26 non-industry actor submissions. Only seven articles were cited by both groups. Authors cited most frequently by one actor group were rarely cited by the other group. The first author most cited by industry actors declared alcohol industry links in two articles. Industry actors cited three systematic reviews (and contested the findings); non-industry actors cited (and supported) seven systematic reviews.

DISCUSSION AND CONCLUSION

There was a low degree of overlap in peer-reviewed evidence cited by industry and non-industry actors in submissions to Australian alcohol advertising policy consultations. Industry actors often omitted or contested high-quality evidence. Industry actors placed greater emphasis on evidence published by one industry-linked researcher than on evidence from systematic reviews and researchers with no apparent conflicts of interest. The findings raise questions about the suitability of industry actors to participate in evidence-informed policymaking processes.

Prospective associations between attitudes toward alcohol advertisements and alcohol use behaviors among adolescent boys

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Exposure to alcohol advertisements is associated with drinking among adolescents.

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Little is known about attitudes toward advertisements and drinking.

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Positive attitudes toward advertisements affect alcohol use prospectively.

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Media literacy programs should address attitudes toward alcohol advertisements.

Objectives

Earlier initiation of alcohol use and problematic drinking among adolescents are linked with adverse health outcomes. Exposure to alcohol advertisements is associated with drinking among adolescents, but the association between the attitudes toward alcohol advertisements and drinking behaviors is understudied. We evaluated the association between attitudes towards alcohol advertisements and initiation of alcohol use among adolescent boys.

Methods

Adolescent boys from urban and Appalachian Ohio enrolled in a prospective study and reported whether they had ever consumed alcohol or been drunk at baseline (N = 1220; ages 11–16 years) and at the 24-month follow up (N = 891). Attitudes toward alcohol advertisements were measured at baseline following a brief advertisement viewing activity. Adjusted logistic regression models were used to estimate associations between attitudes toward advertisements and initiating alcohol use or drunkenness at the 24-month follow-up.

Results

Adolescent boys reporting any positive attitudes toward alcohol advertisements had higher odds of initiating alcohol use (aOR = 2.00, 95% CI [1.16, 3.44]), and attitudes were marginally associated with incident drunkenness (aOR = 2.20, 95% CI [0.94, 5.12]). Increasing age, higher household income, ever use of tobacco, and frequency of visiting alcohol retailers were also associated with greater odds of incident alcohol use and/or drunkenness.

Conclusions

Attitudes toward alcohol advertisements at baseline were associated with alcohol drinking behaviors 24-months later among adolescent boys. Results highlight the importance of media literacy interventions targeted to adolescents.

Typology of Adolescents Exposed to Non-medical Cannabis Marketing and Associations with Consumption Patterns

Latent class analysis (LCA) identified subtypes of cannabis marketing exposure among adolescents and assessed whether the classes were associated with three cannabis use outcomes: past 28-day use, poly-cannabis use, and symptoms of cannabis use disorder (CUD). Survey data were from 471 adolescents (aged 15-19 years) who lived in four states with legal non-medical cannabis in 2018. Measures included social media engagement and cannabis outcomes. LCA with robust maximum likelihood estimation identified latent classes. Chi-squared tests assessed whether empirically derived classes differed across demographics, and logistic regression tested associations with cannabis use outcomes. Three classes were identified: digitally engaged (35.5%), digitally unengaged (36.5%), and traditional (28.0%). Both digitally engaged and unengaged classes were exposed to marketing on social media platforms, but youth in the engaged class interacted with posts and brands. Class membership differed by age (χ² = 14.89, p < 0.001) and school type, with the digitally engaged group older and not in school or in non-traditional schools (χ² = 16.22, p=0.01). As compared to the traditional class, youth in the digitally engaged class had 10.63 times the odds of past 28-day cannabis use (95% CI: 5.25, 21.51), 7.84 times the odds of poly-cannabis use (95% CI: 3.54, 17.33), and 13.85 times the odds of symptoms of CUD (95% CI: 3.96, 48.48). Youth in the digitally engaged class had higher odds of all cannabis use behaviors than the traditional class. These findings point to the possible use of algorithmic marketing to adolescents and suggest a need for monitoring and possible restrictions on digital cannabis marketing.

Potential financial impact on television networks of a ban on alcohol advertising during sports broadcasts in Australia

OBJECTIVE

This study aimed to assess the potential financial impacts on Australian television networks of a ban on alcohol advertising during sports broadcasts.

METHODS

We analysed television advertising data from Nielsen, a commercial market research company. The data included details of all advertisements (ads) for the 10 highest-spending alcohol brands on free-to-air television networks in the five largest capital cities in Australia over a 12-month period (November 2018-October 2019). We estimated alcohol advertising spend during sports broadcasts. Financial value per network was estimated using ad duration and total spend per channel.

RESULTS

There were 10,660 alcohol ads (average of 75 minutes per week) shown during sports broadcasts, amounting to A$14.4 million in revenue to television networks. Forty-five per cent of these ads were at children's viewing times. Channel Seven received the largest amount of alcohol advertising revenue (A$20.8 million), of which A$10.8 million (52.0%) was during sports broadcasts (0.5% of its total advertising revenue).

CONCLUSIONS

Alcohol advertising during sports broadcasts is pervasive but contributes a relatively small proportion of revenue for television networks. Implications for public health: A ban on alcohol advertising during sport broadcasts is unlikely to have major financial impacts on broadcasters, whilst the health and social benefits are potentially substantial.

Accessibility and availability of alcohol outlets around schools: An ecological study in the city of Madrid, Spain, according to socioeconomic area-level

Neighborhood accessibility and availability of alcohol products has been associated with increased alcohol consumption and harms among adolescents. This availability has been shown to be higher in neighborhoods with lower socio-economic status (SES). The aim of this study was to examine inequalities in alcohol outlet density and proximity around schools by area-level SES in Madrid, Spain. Data on schools, SES, alcohol outlets and population density at census tract level were obtained through public databases from the local government of Madrid. We examined (1) density as the number of alcohol outlets around schools within 3 buffers (i.e. 200 m, 400 m and 800 m) and (2) proximity as the distance from schools to their nearest alcohol outlet. We performed multilevel analyses to examine the associations between alcohol outlet density and proximity and SES, adjusted by population density. Secondary schools (n = 576) located in less deprived areas had lower densities of alcohol outlets at walking distances of 200 and 400 m (50% and 37% lower, respectively p < 0.05). No significant differences were found for the proximity measures. The socioeconomic level of the area in which adolescents go to school is a determinant of their exposure to alcohol, where those who study in high SES areas have lower exposure to alcohol outlets. This study highlights the need to prioritize equity in the design and implementation of policies to limit alcohol accessibility among adolescents, including establishing minimum distances between schools and alcohol outlets or limiting the number of outlets per inhabitant in neighborhoods.

The high frequency of alcohol advertising during televised English Premier League football games shown in Ethiopia

Background

Excessive alcohol consumption is an important risk factor for increased morbidity, mortality and other social harms globally. Televised sport allows the promotion of alcoholic drinks to a large and often young audience, and thus can be used to develop new markets for alcohol in low- and middle-income countries. This study aimed to analyse the alcohol advertising displayed during televised English Premier League (EPL) games, which is widely viewed in Ethiopia, and are particularly popular among young people.

Methods

Nineteen live televised EPL football matches broadcast in Ethiopia on the SuperSport channels over 4 weeks of the 2018/19 season were digitally recorded from the digital satellite television. Exposure to alcohol advertising was measured by calculating the total elapsed time duration with the alcohol content from the pre-match to the end of the post-game period of the broadcast.

Results

Data were available for a total of 2451 min broadcast time. Alcohol advertising accounted for 205.2 min (8.4%) with a mean duration of 10.8 min per match (range 5.5 to 22.6). The dominant format of alcohol advertisement was the display of logos associated with an alcoholic drink on the television (TV) screen, which accounted for approximately 43% of the total alcohol advertising time. This was followed by pitch side virtual display (17.7%) and a glass of alcohol drink on the TV screen (17.6%). Over three quarters of alcoholic drink advertising (77.7%) was during active football playing time. None of the advertisements on the televised football games showed cigarettes.

Conclusion

There is a high frequency of exposure to alcohol advertising during televised EPL matches in Ethiopia. It is important to ensure that the newly introduced domestic ban on alcohol advertising is also applied to foreign satellite broadcasters. This is likely to have relevance to other sub-Saharan African countries in promoting public health strategies to reduce harm from alcohol consumption.

Comparisons of Culturally Targeted Food and Beverage Advertisements in Caribbean-American Neighborhood and Non-Latinx White Neighborhood in New York City

Purpose:

This descriptive study aimed to (1) compare the number of food and beverage advertisements (ads) located in a Caribbean-American neighborhood and non-Latinx white neighborhood in New York City (NYC), and (2) qualitatively assess and compare the culturally targeted marketing themes of the food and beverage advertisements in both neighborhoods.

Methods:

Three research assistants photographed all outdoor food and beverage advertisements (n=361) across a 1.6 kilometer distance on a high-retail street in a Caribbean-American neighborhood and a non-Latinx white neighborhood. We used content analysis to evaluate advertising themes, and sorted food into nutritional categories (e.g., fast food and alcohol). We identified two neighborhoods with similar income levels in Queens, NYC, USA—South Ozone Park residents are predominantly non-white Caribbean Americans based on data from the NYC Department of City Planning, whereas residents of Steinway are predominantly non-Latinx white.

Results:

We identified a significantly higher proportion of fast-food advertisements in the Caribbean-American neighborhood (19.78%, n=36) compared with the non-Latinx white neighborhood (5.03%, n=9; p<0.001). Among beverage advertisements, 30.77% (n=56) featured alcohol brands in the Caribbean-American neighborhood, whereas 22.91% (n=41) featured alcohol brands in the non-Latinx white neighborhood. In the Caribbean-American neighborhood, 24.18% (n=44) of food and beverage advertisements referenced Caribbean culture.

Conclusions:

The Caribbean-American neighborhood in this study had more fast-food advertisements relative to non-Latinx white neighborhoods. More research is needed to understand the effects of culturally targeted ads on Caribbean-American communities.

NZ-RugbyHealth Study: Self-reported Injury Experience and Current Health of Former Rugby Union and Non-contact Sport Players

Background

There is limited research on associations between playing rugby union and player health post-retirement.

Objective

This study investigated differences in self-reported sport injury history and current self-reported health characteristics between former New Zealand rugby and non-contact sport players with a view to identifying issues to be further investigated with stronger epidemiological research designs.

Methods

Using a cross-sectional design, the NZ-RugbyHealth study surveyed 470 former rugby and non-contact sport players (43.8 ± 8.1 years; 127 elite rugby, 271 community rugby, 72 non-contact sport) recruited from October 2012 to April 2014. Demographic information, engagement in sport, sport injuries, medical conditions, mood, alcohol and substance use and ratings of current health status were obtained from a self-report 58-item general health e-questionnaire. We highlighted standardised differences in means of > 0.6 and differences in relative percentages of > 1.43 for variables between groups as representing at least moderate effect sizes, and of being worthy of follow-up studies.

Results

Higher percentages of the elite rugby player group had sustained injuries of a given body-site type (e.g. neck sprain/strain, thigh bruising, hamstring strain) combination than the non-contact sports players. Higher percentages of the rugby groups reported having sustained concussion (94% for elite, 82% for community, 26% for non-contact), injuries requiring hospitalisation (73%, 46%, 25%), injuries that stopped participation in sport permanently (28%, 28%, 11%) and sport-related surgery (72%, 46%, 32%) during their playing career. Both rugby groups had a higher prevalence of osteoarthritis (37%, 18%, 6%) than non-contact athletes and community rugby players had higher levels of hazardous alcohol consumption (38%, 40%, 25%) in retirement than non-contact athletes. There was little difference between rugby players and non-contact sports athletes in self-reported mood, substance use and current physical or psychological health ratings.

Conclusions

Former rugby player groups were at higher risk than the non-contact player group for most injuries during their playing careers, and in retirement had greater prevalence of osteoarthritis and hazardous alcohol consumption. The relative youth of the groups (43.8 years on average) means that health issues that typically do not emerge until later life may not have yet manifested.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-021-01630-7.

Exposure to Media Messages Portraying Effects of Alcohol Use in a Young Adult Sample

Background: Young adults are prolific media users and tend to use substances, such as alcohol, more than people of other ages. Despite much research on young adults' exposure to alcohol advertisements and portrayals of alcohol use in the media, much is still unknown about the nuances of young adults' exposure to and engagement with alcohol-related media content. The present paper examined how college students' media exposure differed for messages portraying positive and negative alcohol effects, how exposure to alcohol-related content differed across media sources, which themes of alcoholrelated content were seen most, and whether exposure to alcohol-related content was associated with hazardous/harmful drinking. Method: Participants (N=500) were two- and four-year college students (Mage=20.90, SDage=1.70, 63.2% female) recruited for a longitudinal study examining the efficacy of a mobile app intervention for high-risk drinking college students. The data used here comes from the baseline survey. Results: Participants reported the greatest exposure to alcohol-related messages in movies/TV/on-demand streaming shows followed by in social media, and they reported greater exposure to messages portraying positive than negative effects of alcohol. Findings from linear regressions indicated that exposure to messages portraying positive or negative effects of alcohol generally did not predict hazardous/harmful drinking. Conclusion: This sample of high-risk college student drinkers reported seeing alcohol-related content through a variety of media sources, with most content portraying alcohol in a positive light. Future research should assess the effects that messages of different types and from different sources have on use, expectancies, norms, and other outcomes.

Exposure to Alcohol Marketing and Alcohol-Related Consequences in Young Adults

Exposure to alcohol marketing is positively associated with alcohol consumption. However, few research studies have tested alcohol marketing's effect on other alcohol-related outcomes. Consequently, the current study sought to identify associations between exposure to alcohol marketing and alcohol-related consequences in young adults. Methods: A secondary analysis of the 2020 Rhode Island Young Adult Survey was conducted. Participants were lifetime drinkers (n = 390) who were 18 to 25 years old and lived in Rhode Island for at least part of 2020. Past 30 day exposure to 6 forms of alcohol marketing was assessed. Alcohol consequences were measured using 8 items from the Brief Young Adult Alcohol Consequences Questionnaire. Logistic regression models were adjusted for AUDIT score, age, race/ethnicity, gender, sexual orientation, employment status, and enrollment in school. Results: 92.3% of participants reported past 30 days exposure to any form of alcohol marketing. 43.6% of participants reported experiencing any alcohol-related consequence. Exposure to any form of alcohol marketing was positively associated with experiencing alcohol-related consequences (OR[95% CI] = 3.35 [1.19, 9.44]). After disaggregation by marketing type, only television exposure remained significantly associated with alcohol-related consequences (OR[95% CI] = 1.85 [1.06, 3.24]). Conclusions: Exposure to alcohol advertising on television may be positively associated with experiencing negative alcohol consequences in young adults. If confirmed, the findings may renew interest in strengthening alcohol marketing guidelines and regulations.

Evaluation of monitoring youth exposure to alcohol advertising on cable television, United States 2016-19

BACKGROUND AND AIMS

Exposure to alcohol advertising is associated with underage drinking, which contributes to adolescent morbidity and mortality. Alcohol advertisements are regulated by the alcohol industry. Our research team has published reports monitoring alcohol advertisers' compliance with industry guidelines. In this study, we estimated: (1) changes in youth and adult exposure to alcohol advertisements on cable television from 2016-19 and (2) changes in youth exposure to types of non-compliant advertising highlighted in monitoring reports over the same period.

DESIGN

Interrupted time-series analysis using data from Nielsen US national television audience estimates, 2012-19.

MEASURES AND METHODS

Outcome was advertising impressions (the total number of times an alcohol advertisement was viewed by youth or adults) by month. Non-compliant exposure was impressions from advertisements that did not meet guidelines. Covariates were advertising spending in multiple media categories. Seasonal autoregressive integrated moving average models estimated trends in exposure before the publication of monitoring reports (2012-15 reference period) and during the monitoring period (2016-19). We compared the modeled exposure trend during the monitoring period to the reference period projected trend.

SETTING

United States.

PARTICIPANTS

A total of 57 000 Nielsen panel households FINDINGS: Non-compliant exposure declined 6158 [95% confidence interval (CI) = -11 406 to -911] million impressions, or -77.3% during the monitoring period compared with the reference period trend. Total youth exposure declined by 20 995 (CI = -34 701 to -7288) million impressions (27.0%). Non-compliant exposure on programs, network dayparts and brands highlighted in monitoring reports declined by -82.4, -79.0 and -82.2%-more than other programs (-52.7%), network dayparts (-71.0%) or brands (143%). Adult exposure declined by 9.3%.

CONCLUSIONS

Publication of alcohol advertising monitoring reports appears to have been associated with a 27.0% decline in US youth exposure to alcohol advertising on cable television and a 77.3% decline in US youth exposure to non-compliant alcohol advertising.

Exploring the Association between Alcohol Drinking and Physical Activity in Adolescence; Two-Year Prospective Study in Younger Adolescents from Bosnia and Herzegovina

Insufficient physical activity and alcohol consumption (AC) are important health-threatening behaviors in adolescence, but there are controversial findings regarding the association that may exist between AC and physical activity levels (PALs) at this age. This study aimed to prospectively examine the relationship that may exist between AC and PAL in younger adolescence, considering the potential confounding effect of sports participation. The participants (n = 669, 337 females) were adolescents from Bosnia and Herzegovina who were tested on two occasions, at baseline (14 years of age) and again at follow-up (16 years of age). The variables included AC (as indicated by the AUDIT questionnaire), sports participation, age, gender (predictors), and PAL (obtained by the PAQ-A questionnaire) criterion. The results indicated that PAL at baseline was higher in those adolescents (boys) with a higher AUDIT score, but this association was partially confounded by sports participation. Multinomial regression indicated a higher risk of a decline in PAL over the study course in adolescents with a higher AUDIT score at baseline (OR = 1.32, 95%CI: 1.11-1.54 for being in the high-risk group for a decline in PAL). The most probable explanation is likely found in the high drop-out from sports in the studied period and earlier initiation of AC in adolescents involved in sports. Public health and sports authorities should urgently act preventively and develop educational programs against alcohol drinking in youth athletes.

Intervening alcohol marketing to reduce harmful alcohol use and lessons learned from the theory of changes: Case studies in Thailand

Objectives

Study design

Methods

Results

Conclusions

•

Theory of change and causal-loop diagram are practical tools for approaching the complex harmful alcohol use reduction.

•

Intervening alcohol marketing needs a systematic approach in shifting the social norms.

•

Community-based actions/campaigns associated with the decline of alcohol-related injuries in Thailand.

Prevalence and comparisons of alcohol, candy, energy drink, snack, soda, and restaurant brand and product marketing on Twitch, Facebook Gaming and YouTube Gaming

Objective:

To compare and evaluate the prevalence of food and beverage marketing on the livestreaming platforms Twitch, Facebook Gaming and YouTube Gaming, as well as examine growth of food and beverage marketing on these platforms over a 17-month period of data collection.

Design:

Cross-sectional data were analysed across three livestreaming platforms and six food and beverage categories: alcohol, candy, energy drinks, snacks, sodas and restaurants.

Setting:

Stream titles of livestreamed events as well as corresponding hours watched on Twitch, Facebook Gaming and YouTube Gaming.

Participants:

None.

Results:

There were significant differences between the use of food and beverage brand mentions in stream titles across all three studied platforms (P < 0·05), as well as hours watched across platforms (P < 0·05). Energy drinks dominated food and beverage brand mentions across platforms, followed by restaurants, soda and snacks. All platforms demonstrated growth over the 17-month data collection period. Post-hoc analyses revealed that the COVID-19 pandemic impacted both immediate and sustained growth across all platforms, with the greatest impact observed on the Twitch platform.

Conclusions:

Food and beverage marketing as measured through stream titles is widely prevalent across the three most popular livestreaming platforms, particularly for energy drinks. Food marketing on these platforms experienced growth over the past 17 months which was accelerated substantially by the COVID-19 pandemic. Future work should assess the sustained impact this growth may have on marketing practices and eating behaviour.

Adolescent health series - Alcohol, tobacco, and other drug use among adolescents in sub-Saharan Africa: A narrative review

Alcohol, tobacco, and other drug (ATOD) use by adolescents are major contributors to death and disability in sub-Saharan Africa (SSA). This paper reviews the extent of adolescents' ATOD use, risk and protective factors, and studies evaluating prevention interventions for adolescents in SSA. It also describes the harms associated with adolescents' ATOD use in SSA, which mainly include interpersonal violence, sexual risk behaviours, and negative academic outcomes. We use the socio-ecological model as our framework for understanding ATOD use risk and protective factors at individual, interpersonal, peer/school, and societal/structural levels. We used two strategies to find literature evaluating ATOD interventions for adolescents in SSA: (a) we sought systematic reviews of adolescent ATOD interventions in SSA covering the period 2000-2020; and (b) we used a comprehensive evidence review strategy and searched for studies that had evaluated ATOD interventions in all SSA countries between 2000 and 2020. Only two community interventions (a brief intervention and an HIV prevention intervention), out of four that were identified, were partially effective in reducing adolescent ATOD. Furthermore, only one school-based intervention (HealthWise), out of six that we uncovered, had any effect on ATOD use among adolescents. Possible reasons why many interventions were not effective include methodological limitations, involvement of non-evidence-based education-only approaches in some studies, and shortcomings in adaptations of evidence-based interventions. The scale of ATOD and related problems is disproportionate to the number of evaluated interventions to address them in SSA. More ATOD interventions need to be developed and evaluated in well-powered and well-designed studies.

Awareness of alcohol marketing one year after initial implementation of Ireland's Public Health (Alcohol) Act and during the COVID-19 pandemic

BACKGROUND

The Republic of Ireland is introducing new controls on alcohol marketing, starting in November 2019 with restrictions on some outdoor and cinema advertising, and a ban on public transport advertising. We examined changes in marketing awareness one year after initial implementation and during the COVID-19 pandemic.

METHODS

Repeat online cross-sectional surveys with adults in Ireland conducted October 2019 (n = 1,007) and October 2020 (n = 1,020). Participants self-reported past-month awareness of alcohol marketing and completed the Alcohol Use Disorders Identification Test-Concise (AUDIT-C). Current drinkers were categorised as those reporting heavy episodic drinking at least monthly and higher-risk drinkers (≥5 AUDIT-C).

RESULTS

In both waves, most participants recalled some marketing awareness (94.1% vs. 93.8%). For 9/13 activities measured in both waves, there were decreases in the proportion reporting any awareness and frequency of awareness, including for the newly restricted activities. For example, any awareness of public transport advertising decreased between waves (ORAdj = 0.66, 95%CI: 0.53-0.81). In both waves, higher past-month awareness was associated with at least monthly heavy episodic drinking and higher-risk consumption.

CONCLUSION

We recommend a precautionary interpretation. It is plausible that both Ireland's initial controls and COVID-19 restrictions contributed to decreases in awareness, but longer-term evaluation is required to determine relative contribution.

Tobacco and alcohol content in soap operas broadcast on UK television: a content analysis and population exposure

BACKGROUND

Exposure to tobacco and alcohol content in media is a risk factor for smoking and alcohol use in young people. Our previous research suggested that tobacco and alcohol imagery is common in soap operas. We now report an analysis of tobacco and alcohol content in a sample of soap operas broadcast in the UK.

METHODS

We used 1-minute interval coding to quantify tobacco and alcohol content in all episodes (including advertisement breaks) of six soap operas broadcast on UK television during three separate weeks in November and December 2018 and January 2019.

RESULTS

We coded 2222 intervals from 87 episodes and 360 intervals from 77 advertisement breaks. Tobacco content was rare, occurring in 4% of all intervals across 30% of episodes, the only tobacco appearances in adverts appeared in anti-smoking advertising. Alcohol occurred in 24% of intervals across 95% of episodes and in 13% of advertisement intervals. The programmes delivered ~381.28 million tobacco and 2.1 billion alcohol gross impressions to the UK population, including 18.91 million tobacco and 113 million alcohol gross impressions to children.

CONCLUSION

Whilst tobacco was rare, alcohol content was common, resulting in billions of viewer impressions. Soap operas represent a potential driver of alcohol consumption in young people.

Oral Health Implications of Risky Behaviors in Adolescence

Adolescence is a time for new discoveries, which may lead teens to engage in impulsive behaviors. Although social media and the Internet have brought great benefits to the world, they can also have a negative influence on adolescents, facilitating their engagement in risky behaviors. Positive parenting and healthy friendships in adolescence have a protective effect against sensation-seeking behaviors. Dental practitioners also have a significant role in steering young patients toward healthy behaviors. They play an essential role in the early recognition, initiation of appropriate interventions, and referrals for treatment of youth at risk.

Exploring the potential of citizen science for public health through an alcohol advertising case study

Citizen science connects academic researchers with the public through combined efforts in scientific inquiry. The importance of involving impacted populations in health research is well established. However, how to achieve meaningful participation and the methodological impact of citizen science needs further examination. We examined the feasibility of using citizen science to understand the impact of alcohol advertising on Australian women through a breast cancer prevention project. Two hundred and eighty-two ('participants') citizen scientists completed demographic and behavioural questions via an online survey. The research participants moved into the role of citizen scientists by completing the data collection tasks of capturing and classifying images of alcohol advertising they saw online. Interrater reliability tests found high levels of agreement between citizen scientists and academic researchers with the classification of alcohol advertising brand (Kappa = 0.964, p < 0.001) and image type (Kappa = 0.936, p < 0.000). The citizen scientists were women aged 18 and over, with 62% between 35 and 55 years old. The majority were from major cities (78%), had attained a bachelor's degree or higher-level education (62%) and were recruited via email or Facebook (86%). The use of citizen science provided methodological gains through the creation of a unique dataset with higher levels of validity than the existing literature, which employed traditional investigator-driven research methodologies. Citizen science enriched the dataset and provided a powerful methodological vehicle to understand an environmental determinant of health. The study illuminates how public participation benefitted the research process, the challenges and the potential for citizen science to improve public health.

Mechanisms Underlying Associations between Media Alcohol Exposure, Parenting, and Early Adolescent Drinking: A Moderated Sequential Mediation Model

Exposure to alcohol content in the media, especially in movies, is a demonstrated risk factor for adolescent alcohol use. This paper examines processes underlying this association and whether parenting mitigates such harms. A mediational model of parental restriction of mature media (W1), alcohol content exposure (W2), alcohol expectancies, peer norms (W3), and alcohol outcomes (W4) was tested using annual assessments from a study of adolescent drinking (N = 879; 52% female; 21% Non-White; 12% Hispanic). When restrictions are not in place, adolescents report greater exposure to alcohol content, leading to higher perceived peer drinking. Parental monitoring did not buffer the link between exposure and peer norms. Parental media restriction and perceptions about peers comprise mechanisms by which alcohol-saturated media influences youth drinking.

A Content Analysis and Population Exposure Estimate Of Guinness Branded Alcohol Marketing During the 2019 Guinness Six Nations

AIMS

To quantify Guinness-related branding in the 2019 Guinness Six Nations Championship.

METHODS

Content analysis of Guinness-related branding ('Guinness' and the alibi brand 'Greatness') was shown during active play throughout all 15 games of the 2019 Guinness Six Nations Championship. The duration of each appearance was timed to the nearest second to provide information on the amount of time that Guinness-related branding was shown on screen. Census data and viewing figures were used to estimate gross and per capita alcohol impressions.

RESULTS

Our coding identified a total of 3719 appearances of two logos of which 3415 (92%) were for 'Guinness' and 304 (8%) were for 'Greatness'. 'Guinness' imagery was present for 13,640 s (227.3 min or 3.8 h, 16% of total active play time), 'Greatness' was present for 944 s (15.7 min, 1% of total active play time), with a combined total of 14,584 s across all games (243 min or 4.05 h, 17% of active play time). The 15 games delivered an estimated 122.4 billion Guinness-related branded impressions to the UK population, including 758 million to children aged under 16.

CONCLUSIONS

Alcohol marketing was highly prevalent during the 2019 Guinness Six Nations Championship and was a significant source of exposure to alcohol marketing and advertising for children, likely influencing youth alcohol experimentation and uptake.

'We're in this together': A content analysis of marketing by alcohol brands on Facebook and Instagram during the first UK Lockdown, 2020

BACKGROUND

The closure of on-licence premises and the restrictions placed on citizen's movements and leisure to address the COVID-19 pandemic in 2020, created an unprecedented situation for the alcohol industry. With the availability and supply of alcohol being restricted, and the social context of alcohol use transformed, alcohol corporations were required to adapt their marketing materials and actions in response.

METHODS

A content analysis of alcohol marketing by 18 alcohol brands on Facebook and Instagram during the first UK national lockdown (from 17th March- 4th July 2020) was conducted. Comments left by social media followers on posts advertising what could be defined as brand COVID-19 Corporate Social Responsibility (CSR) initiatives (i.e. monetary donations, production of hand sanitiser) were thematically analysed.

FINDINGS

Alcohol brands quickly adapted to the changing social, economic and health context of the global pandemic. Changes to the availability and sale of alcohol were evident, with brands encouraging the stockpiling of alcohol as an essential item through predominantly online sales and delivery services. Brands also adapted to the changing social and physical context of alcohol use and intensified encouragement of home drinking. Messages of togetherness underpinned the promotion of virtual interactions, for which alcohol use was presented as a key component. Consumers were encouraged to contribute to pandemic responses by 'staying at home', and consuming alcohol. Importantly, COVID-19 provided a useful marketing opportunity for alcohol producers to present themselves as private partners to a primarily public sector response, through innovative CSR initiatives such as philanthropic donations to help prevent the transmission of COVID-19. An inductive thematic analysis of online comments on CSR posts found that such activities were interpreted by consumers as ethical actions, and that they reinforced positive brand image and loyalty amongst existing and new consumers.

CONCLUSION

Alcohol corporations are highly resilient in times of crises and the brands analysed were able to quickly adapt their marketing to the COVID-19 pandemic. Future research is required to examine whether these profitable strategies are maintained post pandemic.

Correlates of alcohol experimentation and drunkenness episodes among secondary-school students in Nigeria

Background: Alcohol is the most used substance among adolescents in Nigeria. While risk factors for alcohol use among adolescents are well documented in Europe and the US, they have received less attention in the literature on African countries. This study aimed to investigate the factors associated with alcohol experimentation and drunkenness episodes in a national sample of Nigerian adolescents. Methods: A total sample of 4,078 secondary-school students participated in the survey during the school year 2015-2016. The survey involved 32 secondary schools of six geopolitical zones (South-South, South-West, South-East, North-Center, North-West, and North-East) and two metropolitan cities (Abuja and Lagos) of Nigeria. Sociodemographic characteristics, parental alcohol use and permissiveness, friends' alcohol use, risk perceptions and beliefs were investigated as correlates of alcohol experimentation and drunkenness episodes through multilevel, mixed-effect logistic regression models. Results: The prevalence of alcohol experimentation was 34.0%, while the prevalence of drunkenness episodes was 13.4%. Results showed that male gender, family structure different from both parents' families, parental and friends' alcohol use, parental permissiveness to drink, low risk perceptions on drinking alcohol, and positive beliefs on consequences of alcohol use were associated with an increased probability of alcohol experimentation and drunkenness episodes. Family affluence and one-parent family structure were related to an increased probability of alcohol experimentation but not of drunkenness episodes. Conclusions: The majority of risk factors analyzed in this study generalize across drinking-behavior outcomes. Since the young population is dominant in Nigeria, alcohol use could become a big public health problem in the near future. High investment in adolescents' well-being by addressing the factors that contribute to drinking behavior might help to reduce the burden of the problem. Evidence-based prevention curriculum addressing knowledge, risk perceptions, beliefs on consequences of alcohol use, and parental behaviors should be implemented as widely and early as possible.

Compliance With Cannabis Act Regulations Regarding Online Promotion Among Canadian Commercial Cannabis-Licensed Firms

IMPORTANCE

As global jurisdictions shift toward cannabis legalization, 2 areas of public health importance relate to exposure to youth and to truthful promotion. Although Canada's Cannabis Act specifies many prohibitions related to cannabis promotion, no systematic monitoring or enforcement among licensed firms exists. Compliance with marketing regulations has effects beyond Canadian citizens because of the global outreach of websites and social media.

OBJECTIVES

To evaluate compliance among licensed firms with the Cannabis Act and analyze trends among violations regarding promotional material.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study evaluated cannabis-licensed firms after cannabis legalization. Data were extracted from online public platforms, including company websites, Facebook, Instagram, and Twitter, from October 1, 2019, to March 31, 2020. Descriptive statistics, Poisson regression, and logistic regression were used to analyze the associations of covariates with promotion violations.

MAIN OUTCOMES AND MEASURES

The primary outcome was characterization of type and prevalence of promotion violations. Secondary outcomes were the role of various covariates (namely, licensed firm characteristics and online platforms) in the frequency and probability of violations. Hypotheses were formulated before data collection.

RESULTS

Among 261 licensed firms, 211 (80.8%) had an online platform, including 204 (96.7%) with websites, 128 (60.7%) with Facebook, 123 (58.3%) with Instagram, and 123 (58.3%) with Twitter. Of all licensed firms with an online platform, 182 (86.3%) had at least 1 violation. Compared with websites, the risk of violations was significantly higher on Facebook (rate ratio [RR], 1.24; 95% CI, 1.11-1.39) and Instagram (RR, 1.19; 95% CI, 1.05-1.34). The most common violations included lack of age restrictions, brand glamorization, and omission of risk information. With websites as the reference group, lack of age restrictions was approximately 15 times more likely to occur on Facebook (odds ratio [OR], 14.76; 95% CI, 8.06-27.05); the odds of an age restriction violation were also higher on Instagram (OR, 2.48; 95% CI, 1.43-4.32) and Twitter (OR, 4.03; 95% CI, 2.29-7.09). For unsubstantiated claims, the odds of violations were significantly decreased on Facebook (OR, 0.23; 95% CI, 0.11-0.48) and Instagram (OR, 0.28; 95% CI, 0.14-0.57). The odds of glamorization were associated with an increase on Instagram (OR, 2.90; 95% CI, 1.72-4.88).

CONCLUSIONS AND RELEVANCE

In this cross-sectional study, widespread violations were observed in online Canadian cannabis promotion. To protect public health and safety amid legalization, decision-makers should make explicit federal regulation and enforcement regarding promotional activities of cannabis retailers. These results suggest that policy and enforcement of cannabis promotion in Canada would have an international impact, from ease of access to online media and downstream consequences of unregulated promotion.

A content analysis of tobacco and alcohol audio-visual content in a sample of UK reality TV programmes

Background

Exposure to tobacco and alcohol content in audio-visual media is a risk factor for smoking and alcohol use in young people. We report an analysis of tobacco and alcohol content, and estimates of population exposure to this content, in a sample of reality television programmes broadcast in the UK.

Methods

We used 1-minute interval coding to quantify tobacco and alcohol content in all episodes of five reality TV programmes aired between January and August 2018 (Celebrity Big Brother; Made in Chelsea; The Only Way is Essex; Geordie Shore and Love Island), and estimated population exposure using viewing data and UK population estimates.

Results

We coded 5219 intervals from 112 episodes. Tobacco content appeared in 110 (2%) intervals in 20 (18%) episodes, and alcohol in 2212 (42%) intervals and in all episodes. The programmes delivered approximately 214 million tobacco gross impressions to the UK population, including 47.37 million to children; and for alcohol, 4.9 billion and 580 million respectively.

Conclusion

Tobacco, and especially alcohol, content is common in reality TV. The popularity of these programmes with young people, and consequent exposure to tobacco and alcohol imagery, represents a potentially major driver of smoking and alcohol consumption.

Neighborhood Structural Factors and Proximal Risk for Youth Substance Use

This study examined associations of neighborhood structural factors (census-based measures, socioeconomic disadvantage, and residential stability); self-reported measures of general and substance use-specific risk factors across neighborhood, school, peer, and family domains; and sociodemographic factors with substance use among 9th grade students. Data drawn from the Seattle Social Development Project, a theory-driven longitudinal study originating in Seattle, WA, were used to estimate associations between risk factors and past month cigarette smoking, binge drinking, marijuana use, and polysubstance use among students (N = 766). Results of logistic regression models adjusting for neighborhood clustering and including all domains of risk factors simultaneously indicated that neighborhood socioeconomic disadvantage was associated with a significantly higher likelihood of cigarette smoking, binge drinking, and polysubstance use, but not marijuana use. In fully controlled models, substance use-specific risk factors across neighborhood, school, peer, and family domains were also associated with increased likelihood of substance use and results differed by the outcome considered. Results highlight substance-specific risk factors as an intervention target for reducing youth substance use and suggest that further research is needed examining mechanisms linking neighborhood socioeconomic disadvantage and youth substance use.

Australia in 2030: what is our path to health for all?

CHAPTER 1: HOW AUSTRALIA IMPROVED HEALTH EQUITY THROUGH ACTION ON THE SOCIAL DETERMINANTS OF HEALTH: Do not think that the social determinants of health equity are old hat. In reality, Australia is very far away from addressing the societal level drivers of health inequity. There is little progressive policy that touches on the conditions of daily life that matter for health, and action to redress inequities in power, money and resources is almost non-existent. In this chapter we ask you to pause this reality and come on a fantastic journey where we envisage how COVID-19 was a great disruptor and accelerator of positive progressive action. We offer glimmers of what life could be like if there was committed and real policy action on the social determinants of health equity. It is vital that the health sector assists in convening the multisectoral stakeholders necessary to turn this fantasy into reality. CHAPTER 2: ABORIGINAL AND TORRES STRAIT ISLANDER CONNECTION TO CULTURE: BUILDING STRONGER INDIVIDUAL AND COLLECTIVE WELLBEING: Aboriginal and Torres Strait Islander peoples have long maintained that culture (ie, practising, maintaining and reclaiming it) is vital to good health and wellbeing. However, this knowledge and understanding has been dismissed or described as anecdotal or intangible by Western research methods and science. As a result, Aboriginal and Torres Strait Islander culture is a poorly acknowledged determinant of health and wellbeing, despite its significant role in shaping individuals, communities and societies. By extension, the cultural determinants of health have been poorly defined until recently. However, an increasing amount of scientific evidence supports what Aboriginal and Torres Strait Islander people have always said - that strong culture plays a significant and positive role in improved health and wellbeing. Owing to known gaps in knowledge, we aim to define the cultural determinants of health and describe their relationship with the social determinants of health, to provide a full understanding of Aboriginal and Torres Strait Islander wellbeing. We provide examples of evidence on cultural determinants of health and links to improved Aboriginal and Torres Strait Islander health and wellbeing. We also discuss future research directions that will enable a deeper understanding of the cultural determinants of health for Aboriginal and Torres Strait Islander people. CHAPTER 3: PHYSICAL DETERMINANTS OF HEALTH: HEALTHY, LIVEABLE AND SUSTAINABLE COMMUNITIES: Good city planning is essential for protecting and improving human and planetary health. Until recently, however, collaboration between city planners and the public health sector has languished. We review the evidence on the health benefits of good city planning and propose an agenda for public health advocacy relating to health-promoting city planning for all by 2030. Over the next 10 years, there is an urgent need for public health leaders to collaborate with city planners - to advocate for evidence-informed policy, and to evaluate the health effects of city planning efforts. Importantly, we need integrated planning across and between all levels of government and sectors, to create healthy, liveable and sustainable cities for all. CHAPTER 4: HEALTH PROMOTION IN THE ANTHROPOCENE: THE ECOLOGICAL DETERMINANTS OF HEALTH: Human health is inextricably linked to the health of the natural environment. In this chapter, we focus on ecological determinants of health, including the urgent and critical threats to the natural environment, and opportunities for health promotion arising from the human health co-benefits of actions to protect the health of the planet. We characterise ecological determinants in the Anthropocene and provide a sobering snapshot of planetary health science, particularly the momentous climate change health impacts in Australia. We highlight Australia's position as a major fossil fuel producer and exporter, and a country lacking cohesive and timely emissions reduction policy. We offer a roadmap for action, with four priority directions, and point to a scaffold of guiding approaches - planetary health, Indigenous people's knowledge systems, ecological economics, health co-benefits and climate-resilient development. Our situation requires a paradigm shift, and this demands a recalibration of health promotion education, research and practice in Australia over the coming decade. CHAPTER 5: DISRUPTING THE COMMERCIAL DETERMINANTS OF HEALTH: Our vision for 2030 is an Australian economy that promotes optimal human and planetary health for current and future generations. To achieve this, current patterns of corporate practice and consumption of harmful commodities and services need to change. In this chapter, we suggest ways forward for Australia, focusing on pragmatic actions that can be taken now to redress the power imbalances between corporations and Australian governments and citizens. We begin by exploring how the terms of health policy making must change to protect it from conflicted commercial interests. We also examine how marketing unhealthy products and services can be more effectively regulated, and how healthier business practices can be incentivised. Finally, we make recommendations on how various public health stakeholders can hold corporations to account, to ensure that people come before profits in a healthy and prosperous future Australia. CHAPTER 6: DIGITAL DETERMINANTS OF HEALTH: THE DIGITAL TRANSFORMATION: We live in an age of rapid and exponential technological change. Extraordinary digital advancements and the fusion of technologies, such as artificial intelligence, robotics, the Internet of Things and quantum computing constitute what is often referred to as the digital revolution or the Fourth Industrial Revolution (Industry 4.0). Reflections on the future of public health and health promotion require thorough consideration of the role of digital technologies and the systems they influence. Just how the digital revolution will unfold is unknown, but it is clear that advancements and integrations of technologies will fundamentally influence our health and wellbeing in the future. The public health response must be proactive, involving many stakeholders, and thoughtfully considered to ensure equitable and ethical applications and use. CHAPTER 7: GOVERNANCE FOR HEALTH AND EQUITY: A VISION FOR OUR FUTURE: Coronavirus disease 2019 has caused many people and communities to take stock on Australia's direction in relation to health, community, jobs, environmental sustainability, income and wealth. A desire for change is in the air. This chapter imagines how changes in the way we govern our lives and what we value as a society could solve many of the issues Australia is facing - most pressingly, the climate crisis and growing economic and health inequities. We present an imagined future for 2030 where governance structures are designed to ensure transparent and fair behaviour from those in power and to increase the involvement of citizens in these decisions, including a constitutional voice for Indigenous peoples. We imagine that these changes were made by measuring social progress in new ways, ensuring taxation for public good, enshrining human rights (including to health) in legislation, and protecting and encouraging an independent media. Measures to overcome the climate crisis were adopted and democratic processes introduced in the provision of housing, education and community development.

Emergent gambling advertising; a rapid review of marketing content, delivery and structural features

BACKGROUND

Gambling advertising is well-funded and has become increasingly sophisticated in recent years. As the presence and pervasiveness of gambling advertising increases, there is a corresponding need for empirical understanding of the characteristics and trends associated with emergent gambling advertisements and marketing. However, there is limited data on this rapidly evolving phenomenon.

METHODS

A rapid review was undertaken of the empirical research (2015-2020) that focused upon the content, delivery and structural features incorporated within emerging gambling advertising.

RESULTS

Twenty-five studies were included in the review. The majority of these studies were conducted in either the UK or Australia; two jurisdictions that have unique and particularly liberal gambling environments. The literature suggests that emergent gambling advertising content is targeted, positively framed and in some instances, may overrepresent riskier bets. The sporting and social media spheres are densely populated with such advertisements that involve both direct and indirect marketing strategies. In relation to the online environment, there is evidence to suggest the emergence of more interactive advertisements that prompt user engagement. In addition, financial incentivisation has diversified and is often subject to strict and esoteric conditions. Despite these emergent trends, little provision is devoted to adequately displaying harm reductive or responsible gambling content within gambling advertising.

CONCLUSIONS

Overall, there is a paucity of research and lack of methodological diversity concerning the characteristics of advertising within the literature. The barriers to investigating emerging gambling advertising are discussed alongside future research priorities. It is important for this research area to expand in order to appropriately inform ethical industry marketing and effective harm-reduction strategies. [Pre-registered online via Prospero: CRD42020184349].

Understanding the Broader Impacts Of Alcohol Marketing: Time For a Research Agenda Which Includes Adults

Most research on alcohol marketing involves young people. Consequently, gaps remain in our understanding of how alcohol marketing reaches, engages and influences adults, who are the legitimate and primary targets for marketing communications. Responding to these lacunae in knowledge is necessary to help inform and evaluate population-level controls on alcohol marketing.

24-h Movement Guidelines and Substance Use among Adolescents: A School-Based Cross-Sectional Study

Children and youth are recommended to achieve at least 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and a sleep duration of 9–11 h/night for 11–13-year-olds or 8–10 h/night for 14–17-year-olds. Meeting the physical activity, screen time, and sleep duration recommendations have previously been associated with substance use among adolescents. However, previous research has mainly examined these factors individually rather than looking at how these indicators could concurrently relate to substance use in this age group. Therefore, this study examined the associations between meeting the 24-h movement guidelines for screen time, sleep duration, and physical activity (independent variables) with substance use outcomes including alcohol consumption, cannabis use, and cigarette smoking (dependent variables) among adolescents. Self-reported data from a cross-sectional and representative sample of 10,236 students (mean age = 15.1 years) in Ontario, Canada were analyzed. Logistic regression models stratified by gender were adjusted for potential confounders. Combinations of 24-h movement guidelines was differentially associated with substance use in boys and girls. Overall, findings showed that meeting 24-h movement guidelines is associated with lower odds of alcohol consumption, cannabis use, and cigarette smoking differentially with type of recommendation met and gender. Given that the associations between 24-h movement guidelines and substance use differ between boys and girls, future efforts should take this into consideration.