Media alcohol advertising with drinking behaviors among young adolescents in Taiwan

The potential adverse effects of minors' exposure to alcohol-related stimuli via licenced venues: A narrative review

ISSUES

Young people are particularly impressionable when it comes to forming expectations and attitudes around alcohol consumption. Any stimuli that normalise and foster positive expectations around alcohol use may increase the risk of underage alcohol consumption. Alcohol venues that market themselves as being appropriate 'family friendly' establishments for children risk exposing minors to environments that are saturated with alcohol-related stimuli. However, research examining how exposure to licenced venues affects underage people is very limited. The aim of this narrative review was to identify and synthesise relevant evidence to better understand how attending these venues might affect minors.

APPROACH

A narrative review of research published between January 2016 and November 2022 was conducted to investigate the potential effects on underage people of exposure to licenced venues and stimuli encountered in/around these venues. Examined stimuli included alcohol advertising, people consuming alcohol and alcohol outlets.

KEY FINDINGS

The reviewed literature indicates that the risk of alcohol-related harm among minors is likely to increase with greater exposure to alcohol venues due to the associated exposure to alcohol advertising, exposure to others consuming alcohol and higher outlet density. In combination, these factors are likely to normalise alcohol consumption for minors and create positive alcohol expectancies.

IMPLICATIONS AND CONCLUSION

Venues serving alcohol should be discouraged from targeting families and parents should be warned about the risks associated with taking minors to venues where alcohol is sold and consumed.

Development and validation of a Chinese Drinking Expectancies Questionnaire for young adults: A Hong Kong study

INTRODUCTION

Drinking expectancies, the perceived consequences of alcohol consumption, are noted to predict drinking behaviours. However, there is comparatively little research of drinking expectancies in non-Western populations. This study aimed to develop and validate a Chinese Drinking Expectancy Questionnaire (CDEQ-Adult) for Chinese young adults.

METHODS

Face and content validity were first assessed of items generated from literature review and previously conducted focus groups. Exploratory (EFA) and confirmatory factor analyses (CFA) were conducted with split-half samples from a random telephone survey that was conducted on Hong Kong Chinese adults between the ages of 18-34 (n = 675). The instrument's convergent validity and internal reliability were also examined.

RESULTS

The preliminary instrument items showed good content validity (Item Content Validity Index range: 0.8-1.0). The EFA yielded a 31-item, five-factor model consisting of five domains: Negative Consequences, Interpersonal Benefits, Increased Confidence, Health Benefits and Tension/Stress Reduction (variance explained 63.7%). The CFA revealed that the fit indices for the five-factor model using diagonal weighted least squares estimator were χ2 (256, N = 338) = 394.04, p < 0.001, comparative fit index 0.97, SRMR 0.07, RMSEA 0.06 (95% confidence interval 0.06, 0.08), suggesting a good fit of the model. The Cronbach's α coefficients were 0.94, 0.90, 0.86, 0.77 and 0.57, respectively for each of the five domains (n = 675). Significant associations with past month drinking behaviours and future drinking intentions give strong support for convergent validity.

DISCUSSION AND CONCLUSIONS

The CDEQ-Adult is a culturally relevant instrument for assessing drinking expectancies in Chinese young adults for use in future studies.

Drinking Expectancies among Chinese Young Adults: A Qualitative Study from Hong Kong

BACKGROUND

Alcohol expectancies, i.e., the perceived consequences of drinking, have been reported to be important factor in predicting drinking behaviors. However, studies in the Asia region were largely limited to school-based samples. This study aimed to be the first to explore drinking expectancies among urban Chinese young adults.

METHODS

In 2020, eight focus group discussions were conducted with Hong Kong Chinese young adults aged 18-34 (n = 53). The participants included heavy drinkers, light drinkers, and non-drinkers from a wide range of occupations and educational backgrounds. Thematic analysis was conducted to uncover common alcohol expectancies.

RESULTS

Six themes emerged from this study. Four themes that were commonly reported in the literature were the negative consequences of drinking, social bonding, confidence enhancement, and tension reduction. The study also uncovered two culturally relevant alcohol expectancies: health benefits and business drinking expectancies. In contrast to Western samples, Chinese young adults did not report drinking expectancies related to cognitive enhancement or increased sexual interest.

CONCLUSION

Alcohol harm reduction strategies will need to address the positive drinking expectancies uncovered in this study. Future policy discussions in this emerging alcohol market region should consider greater scrutiny of the role of alcohol marketing in the propagation of positive drinking expectancies.

Men's decrease and women's increase in harmful alcohol use from the 2014 to 2018 national surveys in Taiwan: A harbinger for an emerging national trend in East Asia?

BACKGROUND

Gender differences in alcohol use have narrowed in Western societies, but that in Asia has been less investigated. By comparing the 2014 and 2018 waves of the national survey in Taiwan, we aimed to examine the gender differences in population trends in past-month alcohol use, binge drinking, and harmful alcohol use.

METHODS

The national survey enrolled 17,837 participants in 2014 and 18,626 participants in 2018. Binge drinking was defined as having ≥5 drinks on one occasion in the past month, and harmful alcohol use as having an Alcohol Use Disorders Identification Test score of ≥8.

RESULTS

There were significant decreases from 2014 to 2018 in the population's prevalence of past-month alcohol use, binge drinking, and harmful alcohol use. However, males and females had different trends: males showed significant reductions in all three alcohol use behaviours (a decrease of 3.79%, 1.59%, and 2.60%, respectively), while females exhibited a significant rise in harmful alcohol use (from 1.32% to 1.72%), particularly among those aged 18-29 years.

CONCLUSION

There was gender convergence in alcohol use in Taiwan, mainly due to men's decrease and women's increase in harmful alcohol use. Our findings have important implications for the intervention and prevention of the problematic use of alcohol in East Asia.

Adolescents' Perceived Drinking Norms Toward Alcohol Misuse: An Integrative Review

The purpose of this integrative review is to synthesize prior research on the relationship between adolescents' perceived subjective and descriptive drinking norms and their drinking intention and behaviors. Four databases (CINAHL, PubMed, Cochrane, and Sociological Abstracts) were searched to identify relevant articles. Thirty-one peer-reviewed articles published from 2010 to 2020 were reviewed. The results highlight that adolescents' perceived drinking norms derived from their parents and peers, such as approving or disapproving attitudes, significantly influence adolescents' drinking intention and behaviors. Moreover, pro-drinking messages, advertisements, and postings from electronic media (i.e., TV, movies, and the Internet) and online social networks (e.g., Facebook, Instagram, and Twitter) shape adolescents' drinking intention and encourage adolescents to initiate alcohol consumption early and/or escalate their drinking. Thus, future interventions should focus on subjective drinking norms that stem from interpersonal relationships in combination with perceived descriptive drinking norms derived from various media exposure.

Psychological Processes Underlying Effects of Alcohol Marketing on Youth Drinking

OBJECTIVE

Evidence increasingly suggests that alcohol marketing plays a significant role in facilitating underage drinking. This article presents a review of empirical studies and relevant theoretical models proposing plausible psychological mechanisms or processes responsible for associations between alcohol-related marketing and youth drinking.

METHOD

We review key psychological processes pertaining to cognitive mechanisms and social cognitive models that operate at the individual or intrapersonal level (attitude formation, expectancies) and the social or interpersonal level (personal identity, social identity, social norms). We use dominant psychological and media theories to support our statements of putative causal inferences, including the Message Interpretation Processing Model, Prototype Willingness Model, and Reinforcing Spirals Model.

RESULTS

Based on the evidence, we propose an integrated conceptual model that depicts relevant psychological processes as they work together in a complex chain of influence, and we highlight those constructs that have received the greatest support in the literature.

CONCLUSIONS

The evidence to date suggests that perceptions of others' behaviors and attitudes in relation to alcohol (social norms) may be a more potent driver of youth drinking than evaluations of drinking outcomes (expectancies). Considerably more research--especially experimental research--is needed to understand the extent to which theoretically relevant psychological processes have unique effects on adolescent and young adult drinking behavior, with the ultimate goal of identifying modifiable intervention targets to produce reductions in the initiation and maintenance of underage alcohol use.

Leisure activity participation in relation to alcohol purchasing and consumption in adolescence

BACKGROUND

Building upon the socioecological perspective, this study examines prospective associations linking leisure activity participation with alcohol purchasing and consumption in early adolescence.

METHODS

A total of 1763 seventh graders (age 12-13 years) were recruited from middle schools in urban Taiwan via multi-stage sampling and followed-up 1.5 years later during ninth grade. Information about leisure activities, covariates (i.e., gender, puberty development, family structure, parental educational attainment, monthly allowance, peer drinking, and childhood alcohol experience), and two outcome variables (i.e., alcohol purchasing and drinking behaviors) was gathered via web-based self-administered questionnaires. Data concerning alcohol outlets and recreational resource for each community district were retrieved from official statistics and commercial sources. Two-level hierarchical generalized linear models were used to evaluate association estimates.

FINDINGS

Five percent of ninth graders ever purchased alcohol and nearly one in seven drank alcohol on three or more occasions (i.e., occasional drinking) in the past year. Sports, unstructured, and organized leisure activities were not linked with illegal alcohol purchasing when community contexts were statistically adjusted; a higher community on-premised alcohol outlet density increased alcohol purchasing by 94% (95% CI = 1.24-3.06). In contrast, unstructured leisure activity participation at 7th grade predicted occasional drinking (adjusted Odds Ratio [aOR] = 5.52; 95% CI = 3.13-9.74). Sports participation was associated with reduced risk of occasional drinking in the communities with high unregulated alcohol outlets (aOR for interaction = 0.58; P < .001).

CONCLUSION

Our research provides insights to differential roles of leisure activity participation in shaping adolescents' commercial alcohol access and occasional drinking. Macro-social contexts should be considered in the efforts to reduce underage drinking problems through leisure activities.

Alcohol drinking and problems in young populations: the challenge in Asia

PURPOSE OF REVIEW

The current article reviews recent research (from 2016 onward) on drinking behaviors and alcohol-related problems among young people in Asia with an emphasis on population-based evidence.

RECENT FINDINGS

Recent evidence concerning underage drinking in Asia was limited to certain countries and societies with most data derived from cross-sectional surveys. Measures of alcohol drinking or problems were less sophisticated. The prevalence of recent alcohol drinking varies widely with the highest estimates reported in Hong Kong and Korea (∼21%). Certain emotional, behavioral, and cognitive characteristics have been linked with increased drinking behaviors, including internalizing or externalizing problems. Parents (or family) are the most studied predictors within the domain of socioenvironmental characteristics, whereas little attention has been paid to the macro environments (e.g., media, alcohol advertisement, and alcohol control policy/regulations).

SUMMARY

Research on underage drinking behaviors in Asia is urgently needed, particularly in some emerging markets. Follow-up studies with longitudinal measurements and large diverse samples will provide a better understanding of developmental stage-dependent and ever-changing macroenvironmental factors, as well as possible mechanisms.