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

Alcohol Policy in Adolescence and Subsequent Alcohol-attributable Hospitalizations and Mortality at Ages 21-54 Years: A Register-based Cohort Study

BACKGROUND

Little is known about how alcohol policies experienced in adolescence are associated with later health. We assess whether the age of exposure to stricter alcohol policies is associated with later alcohol-attributable hospitalizations and mortality. We take advantage of an alcohol advertising ban and alcohol tax increases introduced in 1975-1977 with relatively stable alcohol policies before and after.

METHODS

We used Finnish register data on birth cohorts 1950-1964 (1,175,878 individuals) to assess cohort-wise hazard ratios for the first incidence of alcohol-attributable hospitalization and mortality, and mortality due to external and other causes at ages 21-54 years.

RESULTS

Men who were aged 19-25 at the time of the restrictive reform had similar risks for alcohol-attributable hospitalization and mortality to the reference group of those aged 18-legal drinking age-at the time of reform. For those underage at the time, hospitalization and mortality rates were incrementally smaller cohort by cohort. For example, men who were 17 at the time of the reform had lower hazard ratios of alcohol-attributable hospitalization: 0.91 (95% confidence interval: 0.87, 0.95) as did those who were 13 (0.85; 95% confidence interval: 0.81, 0.89). The findings were similar for external-cause mortality, and similar yet more uncertain for women. In contrast, mortality from other causes declined continuously from cohort to cohort.

CONCLUSIONS

Our findings are consistent with the hypothesis that stricter alcohol policies in adolescence reduce harmful alcohol consumption patterns extending into adulthood and manifesting as lower alcohol-related harm to health.

'I'd be willing to take that risk for the enjoyment of the time that I have': a COM-B influenced analysis of older people's perspectives on their alcohol consumption

Methods: Semi-structured interviews were conducted with 33 Australian community-dwelling older adults (aged 65+ years) who drank alcohol at least once a month. Thematic analyses identified common themes which were then mapped onto the COM-B theoretical framework.

Results: Drinking behaviours were driven by a lack of capability in the form of poor knowledge regarding safe drinking behaviours and guidelines; high opportunity for consumption due to ease of accessing alcohol and its prominence in social routines; and high motivation to drink due to perceived benefits outweighing perceived risks.

Conclusion: Increasing older peoples' knowledge of the risks associated with consumption and safe drinking behaviours represents a key health promotion priority in order to reduce the burden of alcohol-related harms among this group.

Quantifying the portrayal of alcohol-related A&E attendances and prevention in the British medical documentary series '24 hours in A&E'

BACKGROUND

Alcohol misuse is linked to numerous health and socioeconomic harms. Edutainment and docutainment television programmes can act as health promotion tools, influencing health perceptions and behaviours. Inaccurate portrayals can engender misinformation. Limited research has assessed alcohol-related illnesses and prevention in edutainment/docutainment, with none examining British medical documentaries.

METHODS

A quantitative content analysis assessed the portrayal of alcohol-related attendances (ARAs), behaviours, and prevention in the series 24 hours in A&E. Main series episodes broadcast 2011-2022, depicting ARAs, were coded. Descriptive statistics and a Fisher's exact were then undertaken.

RESULTS

ARAs featured 38 patients in 23 episodes (8.3% episodes total). Significantly more ARA episodes were broadcast from 2011 to 2016 than 2017-2022 (P = 0.002). ARAs were mainly portrayed in males (63.2%), young adults (73.7%) and White ethnic groups (78.9%). Binge drinking and pubs/bar/nightclubs/'nights out' were the main behaviours and settings depicted. ARAs encompassed predominantly accidents/injuries (72.7%). Prevention featured infrequently (15.8% patients) and involved secondary (50.0%) or tertiary prevention (50.0%) for alcohol-use disorders (AUDs).

CONCLUSION

ARAs were under-portrayed. While prevention portrayals and demographics were largely consistent with reality, ethnic minority groups, AUDs and chronic alcohol-related illnesses were underrepresented. Binge drinking and night-time economy settings were over-portrayed. Inaccurate depictions could lead to misperceptions of alcohol-related health harms.

The Necessity of Regulating Drinking Scenes on Social Media Platforms Focusing on YouTube Sulbang Videos: Public Opinion From Surveys and YouTube Content Analysis

Background

Alcohol consumption is a major risk factor for diseases and social burdens worldwide. Despite this, depictions of alcohol use continue to rise across various social media platforms, increasing concerns about their potential impact, particularly on adolescents. While some guidelines exist to regulate alcohol portrayals in media, they remain largely advisory and lack legal enforcement. As alcohol-related content becomes more widespread on social media, the need for stronger regulatory measures is growing.

Objective

This study aimed to analyze the content of sulbang (broadcasts featuring alcohol consumption) on YouTube and to assess public opinions regarding the regulation of alcohol-related broadcasts on social media platforms such as YouTube.

Methods

To evaluate public attitudes toward appropriate regulations on alcohol depictions in web-based media, a survey was conducted with 1500 adults (aged 20-74 years) residing in South Korea. Participants were recruited through stratified multistage sampling, with a 21.8% (n=1500) response rate from 6880 invitations. The survey included Likert-scale and rank-ordered questions, with reliability assessed using Cronbach α. Additionally, a content analysis of 318 YouTube (sulbang) videos was conducted based on the Korean government's media alcohol scene guidelines. Two trained coders independently analyzed the videos, achieving high intercoder reliability (Cohen κ=0.92).

Results

This study found that exposure to sulbang content was significantly higher among individuals with higher education levels (n=33, 26.2% graduate degree holders), lower income groups (P<.001), and women. Younger individuals and heavy drinkers were also more likely to engage with such content, with heavy drinkers showing a significantly higher likelihood (P<.001). Regarding public opinion, 83.1% (n=1247) of respondents supported some form of regulation on sulbang content. However, heavy drinkers were less inclined to agree (coefficient: -0.3652; P<.001). Age was positively associated with stronger support for regulation (coefficient: 0.21984; P<.001), while women were significantly more likely than men to advocate for stricter restrictions (coefficient: 0.37827; P<.001). Exposure frequency also had the strongest correlation with support for regulation (coefficient: 1.0278; P<.001). The analysis of 318 YouTube videos revealed an average Like ratio of 97.9% (range: 32.7-100.0), indicating predominantly positive viewer responses, with a median Video Power Index of 939.6 (range: 10.4-84,821.7). Content analysis based on the Media Drinking Scene Guidelines showed that 89.0% (n=283) of the videos glorified drinking, often portraying alcohol as a stress reliever or a source of recovery. Additionally, 92.8% (n=295) of the videos depicted binge drinking or drunkenness, and 27.7% (n=88) of the videos featured celebrities or notable figures consuming alcohol. Furthermore, 42.8% (n=136) of the videos presented distorted drinking norms, such as glorifying high tolerance or linking alcohol to sexual advances. In contrast, only 0.6% (n=2) of the videos were age-restricted, and 31.1% (n=99) included any warning message.

Conclusions

Given the potential influence of alcohol-related content on drinking perceptions and behaviors, regulatory measures should be explored to mitigate possible risks. Strengthening content guidelines and increasing awareness could help address concerns about alcohol-related social media exposure.

Alcohol use in Iraq: Perceptions of interviewed students at three Iraqi universities

INTRODUCTION

Iraq has faced decades of conflict and increased exposure to alcohol use. While the majority (60%) of Iraq's population is under the age of 24, there is no research examining their views on alcohol use and related factors. This study explores how the individual, interpersonal and social contexts of university students may influence their experiences and perceptions of alcohol use.

METHODS

We undertook a qualitative study underpinned by a socio-ecological framework and the alcohol use motivational model. Forty students from 11 disciplines at three universities across Iraq were interviewed (45% female). Interviews were conducted in English (n = 3) or Arabic (n = 37). Template analysis was used to examine the data.

RESULTS

Perceptions of the prevalence of alcohol use varied among participants. Perceived motives for drinking included using alcohol to cope with grief, loss, poverty and unemployment; as well as peer pressure, thrill-seeking and social approval. Abstinence was perceived to be associated with knowledge of the adverse effects of alcohol and a commitment to faith. Students reported alcohol use as a clandestine activity. Students suggested education, open communication and employment opportunities as preventative strategies.

DISCUSSION AND CONCLUSION

This is the first study to explore young Iraqi perceptions and experiences of peers' alcohol use in the current context of conflict, political instability and globalisation. Young Iraqis are a vulnerable population who may be at risk of alcohol-related harm. Iraq should consider multidimensional preventive approaches that include evidence-based and culturally appropriate interventions that reflect young people's real-life experiences and challenges.

Prioritising research on marketing and consumption of No and Low (NoLo) alcoholic beverages in Ireland

Advertising of zero/no and low-strength (NoLo) alcohol brands is becoming increasingly common in Ireland, but empirical research to determine their impact is lacking. Although the Public Health (Alcohol) Act (2018) prohibits advertising alcohol on or within 200 m of buses, trains, schools and playgrounds, the alcohol industry advertises NoLo products in these spaces using similar iconography and brand identifiers of parent brands. This article highlights evidence regarding the industry's roles in the frequent promotion of NoLo brands in Ireland, recommending areas for future research. While NoLo products and advertisements are becoming common in Ireland, recently, the alcohol industry invested €30 million to double NoLo's production capacity. Given the available evidence elsewhere, we argue that doubling the production capacity serves the alcohol industry's interests, not public health interests, as it misleadingly claims because it will increase alcogenic environments and exposure to more marketing campaigns and normalise alcohol consumption. We urge the Minister of Health to take responsibility for effectively interpreting and implementing the Public Health Act to ban NoLo advertising in spaces where full-strength beverage advertisements are prohibited. We conclude by recommending key areas for urgent research focusing on, but not limited to, the perceptions and consumption of NoLo among different populations, including those who drink harmfully or are in recovery and the impact of marketing and availability of NoLo on alcohol initiation and consumption among young people. This will help generate robust evidence to inform the public, improve public health, and implement policies that curtail alcohol corporations' health-damaging activities in Ireland.

How Alcohol Marketing on Social Networking Sites Influences Young Singaporeans' Binge Drinking: Application of the Prototype Willingness Model

This study used cross-sectional survey data (N = 305) to explore the relationship between alcohol marketing on social networking sites (SNS) and binge drinking among young Singaporeans. The prototype willingness model (PWM), a dual-process framework, was applied to explore how health-risk behaviors are shaped by both reasoned action and social reaction pathways. Results indicated a significant association between exposure to alcohol marketing on SNS and descriptive norms (perceived prevalence of binge drinking). Additionally, active engagement with alcohol marketing - such as liking, commenting, and sharing - was significantly associated with attitudes and both injunctive and descriptive norms. Engagement was also correlated with prototype favorability. Mediation analysis using bootstrapping further suggested that engagement with alcohol marketing was indirectly associated with binge drinking willingness through prototype favorability. These findings provide valuable insights into the direct and indirect associations between social media alcohol marketing and youth drinking behaviors, highlighting the roles of both reasoned action and social reaction pathways in relation to binge drinking.

Impact of food, beverage, and alcohol brand marketing on consumptive behaviors and health in children and adults: A systematic review and meta-analysis

Exposure to unhealthy food, beverage, and alcohol marketing can contribute to inadequate diet and excess alcohol consumption, both risk factors for diet-related non-communicable diseases including obesity and cancer. By not featuring specific products, brand-only marketing strategies circumvent restrictions that assess healthiness at the product level and restrict accordingly. Currently, there is no global or national government policy that explicitly addresses brand marketing for unhealthy products linked to diet-related non-communicable diseases. This systematic review and meta-analysis synthesizes contemporary evidence on the effects of food, beverage, and alcohol brand-marketing on diet-related cognitive outcomes (preference, choice), diet-related behavioral outcomes (purchase requests, purchase, consumption), and health-related outcomes (body weight, body mass index, obesity) in children and adults. Included studies manipulated acute marketing exposure, with at least one brand-only marketing condition. Fourteen databases were searched (including MEDLINE and PubMed) for articles published from January 2004 to February 2024. Nineteen eligible studies were identified and assessed for bias; five were included in the meta-analysis assessing effects on consumption. Findings from the review suggest brand marketing for food, beverages, and alcohol can influence preference, choice, and purchase intent. The meta-analysis found no evidence of a significant effect of brand-only marketing on consumption. Overall, evidence was limited and of mixed quality so further robust research is needed to inform regulatory action. Government policies for reducing brand-only marketing are needed to protect vulnerable populations from brand marketing promoting unhealthy consumption behaviors that increase the risk of non-communicable disease.

Characteristics and effects of cannabis advertisements with appeal to youth in California

BACKGROUND

California boasts the largest regulated cannabis market in the world, but it is increasingly exposing youth to cannabis marketing, and the state's definition of content appealing to youth is vague. We aimed to identify the specific features of California cannabis ads that increase interest in cannabis use among adolescents to inform reasonably restrictive marketing policy.

METHODS

Participants consisted of 409 youth (age 16-20 years) susceptible to using cannabis in the future and living in California. Using an online experiment, participants were randomly assigned to view cannabis ads with and without features previously shown to be appealing to adolescents, followed by questions about attitudes toward the ad and their interest in using the advertised cannabis product or service. Multivariable regressions tested associations of content features with these outcomes.

RESULTS

Several features were significantly associated with increasing youth interest in cannabis use and attitudes toward the ad following ad exposure, including illustration, clear product descriptions, food or flavor references, depictions of positive sensations, adventure, psychoactive effects, and references to heavy consumption.

CONCLUSION

California cannabis ads contain features that appeal to youth and that are not restricted in California or other U.S. states with legal cannabis retail.

Children's views on outdoor advertising of unhealthy food and beverages near schools

Children are often exposed to unhealthy outdoor food advertisements during the school commute. This exposure can have negative public health consequences given childhood weight gain has been linked to the marketing of energy-dense and nutrient-poor foods. This study aimed to explore schoolchildren's lived experiences and attitudes towards outdoor advertising surrounding their schools. Seven focus groups with children aged 10-16 years (n = 47) attending schools located in areas with high densities of unhealthy outdoor advertising were conducted in Perth, Western Australia, between July and October 2023. Study participants were aware of outdoor advertising of unhealthy food and beverages near their school, with many reporting that it impacted their food preferences and diet. Many participants felt it was unethical to advertise unhealthy food and beverages around schools and strongly supported restricting alcohol advertising within school precincts. Participants suggested a range of strategies to manage outdoor advertising of unhealthy food and beverages, including banning advertisements on public transport. These findings have the potential to impact State and local government policies affecting children's exposure to unhealthy outdoor advertising, serving as a crucial strategy in the fight against childhood obesity and the harmful effects of alcohol.

Age verification and underage accessibility of official alcohol companies' websites and brand pages on Facebook and Instagram

BACKGROUND

Digital alcohol marketing increases alcohol consumption among underage persons. The study aimed to assess the effectiveness of age verification measures on three digital sites: official alcohol company websites and their associated brand pages on Facebook and Instagram in Nigeria.

METHODS

We created three fictitious age profiles (14, 16, and 18 years) on the three digital sites. Using a smartphone and desktop computer, we assessed the presence of age verification on 15 official alcohol companies' websites, 66 alcohol brand pages on Facebook, and 72 on Instagram. We assessed whether the fictitious underage profiles could interact with content on brand pages.

FINDINGS

Only three of 15 alcohol companies' websites included age verification. Two websites required entering the date of birth, while one required clicking a yes/no box to confirm being above 18 years old. Only one website blocked multiple attempts to gain access using an underage profile. Only 24 of 66 official alcohol brand pages on Facebook activated age verification. Underage users aged 14 and 16 could interact with posts and follow 42 alcohol brand pages on Facebook. Only 22 of 72 alcohol brand pages on Instagram had age verification. Users aged 14 and 16 could interact with posts and follow 50 alcohol brand pages on Instagram.

CONCLUSION

Underage persons can access and interact with alcohol content on alcohol companies' websites and brand pages on Facebook and Instagram in Nigeria. A regulatory framework for restricting underage access to alcohol marketing on digital platforms is required in Nigeria.

Public and professional stakeholders' perceptions of alcohol advertising and availability policies: A qualitative study

INTRODUCTION

Reducing alcohol availability and restricting alcohol advertising are effective ways to reduce harm from alcohol. Implementation of public health policies involves collaboration between different stakeholders, and is influenced by public opinion. This paper explores public and professional stakeholders' perceptions of alcohol advertising and availability policies. It is the first to capture consensus and divergence in narratives of these stakeholders.

METHODS

We conducted semi-structured interviews with 14 stakeholders from third sector organisations, government, public health and alcohol licensing in Scotland. We conducted 11 online focus groups with 45 participants, living in neighbourhoods in Scotland characterised by varying levels of urbanity, deprivation and retail density change. We gave participants a list of policies and discussed their views on acceptability, feasibility and likely success.

RESULTS

Despite general consensus that regulation of alcohol advertising is an important priority, public stakeholders were concerned about the feasibility of advertising interventions and potential unintended consequences. While professional stakeholders were in favour of regulating alcohol availability, public stakeholders had misgivings about feasibility and effectiveness. When prompted to discuss specific interventions, similar views about protecting children and achieving cultural change emerged.

DISCUSSION AND CONCLUSIONS

This study highlights the importance of policy makers and other stakeholders to consider public stakeholders' opinions on alcohol policy and understanding that their views may be influenced by competing framings of alcohol problems. Attempts to increase support for alcohol control policies need to consider people's concerns about the effectiveness and potential unintended consequences of these policies, and the wider social context of alcohol consumption.

Harmful Marketing: An Overlooked Social Determinant of Health

This paper reviews evidence about the impact of marketing on ill health. We summarize evidence that marketing practices in six industries (tobacco, alcohol, pharmaceutical, processed food, firearm, and fossil fuel) are causal influences on the occurrence of injury, disease, and premature death. For each industry, we provide a brief overview on the extent of harmful marketing, efforts from each industry to obscure or otherwise conceal the impact of their marketing strategies, and efforts to counter the impact of harmful marketing in these industries. However, considering the ubiquitous belief that regulation is harmful to society, little headway has been made in reducing harmful marketing. We propose the substitution of a public health framework for the currently dominant free market ideology. Doing so would situate harmful marketing as a social determinant of health and consolidate the disparate efforts to regulate marketing of harmful products. Implications for future policy and research efforts are discussed.

The relationship between young people, social media use and alcohol use: A prospective cohort study

BACKGROUND AND AIMS

Social media use is now a significant part of modern daily life. Little is known about how social media impacts young peoples' drinking behaviours and drinking-related consequences. This cohort study aims to explore the prospective relationship between social media use and future drinking.

METHODS

1473 alcohol naïve young people, who at Wave 5 (aged 12-13 years) reported no lifetime alcohol use, were included (social media use, peer alcohol use, and covariates were also reported at Wave 5). At Wave 8 (aged 17-18 years), participants reported alcohol use outcomes, including age of drinking initiation, past month and past week risky consumption (>10 drinks/week), and problem drinking (alcohol-related troubles, injuries, and fights).

RESULTS

After controlling for factors known to be associated with alcohol use in young people and applying a conservative significance level (α =.01), results revealed that children who engaged in almost daily social media use at ages 12-13 later reported a younger age of drinking onset (β = -0.56, 95 % CI = -0.74, -0.39, p <.001) and greater problem drinking (β = 0.48, 95 % CI = 0.13, 0.83, p =.008) at ages 17-18, compared to those who never used social media at ages 12-13. Early social media use was not associated with odds of subsequent past-month alcohol use or risky alcohol consumption.

CONCLUSION

Young peoples' social media use was associated with future drinking behaviours, prompting the need for preventative measures to acknowledge the salient impacts of social media.

Exploring links-exposure to alcohol adverts on social media in relation to alcohol use among university students in Uganda

AIM

This study assessed the association between exposure to alcohol adverts on social media and alcohol use among university students in Uganda since alcohol consumption has severe effects, especially in countries with weak regulations for alcohol marketing.

METHODS

In total, 996 undergraduate students at Makerere University responded to a questionnaire assessing exposure to alcohol advertising on social media (independent variable) and alcohol use (dependent variable). Adjusted multinomial logistic regression was used to analyse data.

RESULTS

One in ten students reported hazardous drinking, while three in ten students were low-risk drinkers. Most students (70.1%) reported low exposure to alcohol adverts on social media, followed by high exposure (12.1%), and 17.8% reported no exposure. A key finding was that exposure to alcohol adverts on social media was significantly associated with alcohol use, especially the high exposure and hazardous drinking (odds ratio = 12.62, 95% confidence interval: 4.43-35.96). Students reporting high exposure to alcohol adverts on social media also had higher odds of low-risk drinking (odds ratio = 3.70, 95% confidence interval: 1.88-7.27) than those with low exposure (odds ratio = 1.77, 95% confidence interval: 1.09-2.87), in reference to no exposure.

CONCLUSION

Among Ugandan university students, exposure to alcohol adverts on social media is common and associated with alcohol use, in a dose-response manner. These findings suggest a need for a design and implementation of alcohol interventions for students using social media.

Educating adolescents on preventing substance use: The role of 24-h movement behaviors ─ data from 2021 Youth Risk Behavior Surveillance

BACKGROUND

Little is known about how adhering to the health guidelines for physical activity (PA), screen time (ST), and sleep duration (SD) relates to substance use in adolescents. Thus, this study aims to explore the potential association between adherence to the 24-h movement behavior (24-h MB) guidelines and substance use among adolescents.

METHODS

Data from the 2019 Youth Risk Behavior Surveillance was analyzed. Participants reported their weekly PA, ST, SD, and substance use (alcohol and smoking) over the past 30 days. The mean age in the total participants was 15.56, and 48.03 % of the participants were females. Logistic regression was used in this study to explore the potential association between 24-h MB and substance use. Odds ratios (ORs) were reported alongside a 95 % confidence interval to enhance understanding of the observed association.

RESULTS

Only 2.22 % participants adhered to all three 24-h MB guidelines, while 47.99 % did not follow any guidelines. Notably, there was no significant difference in the odds of cigarette smoking between participants who followed none of the guidelines and those who followed some or all of them. Nevertheless, adherence to one or more guidelines was found to be associated with higher odds of abstaining from alcohol consumption compared to non-adherence (one guidelines: OR = 1.17 [1.08, 1.28], two guidelines: OR = 1.28 [1.13, 1.44]).

CONCLUSIONS

Adhering to 24-h MB guidelines may reduce adolescents' alcohol consumption, but the adherence was not significantly associated with smoking. Longitudinal studies are needed to confirm these findings. These results can inform adolescent health policies and interventions aimed at reducing substance use from the perspective of healthy time-use behaviors, which can be used for researchers and educator.

Impact of Concurrent Media Exposure on Professional Identity: Cross-Sectional Study of 1087 Medical Students During Long COVID

BACKGROUND

Long COVID has widened the health gap across society and highlighted the vulnerabilities and risks faced by health care systems. For instance, the global trend of medical workers resigning has become a prominent topic on social media. In response to this severe social problem in global public health within the digital society, it is urgent to investigate how the professional identity of medical students, who are digital natives and the future workforce of medical practitioners, is affected by the media environment.

OBJECTIVE

This study aims to examine how media exposure relates to medical students' perceptions of informational and emotional support, and how these perceptions further influence the development of their professional identity.

METHODS

Building on the Stimulus-Organism-Response (SOR) framework, this study develops a theoretical model to illustrate how media exposure affects medical students' professional identity through the mediation of social support. Specifically, media exposure was assessed through online news media and social media exposure; social support was evaluated in terms of informational and emotional support; and professional identity was measured through medical students' sense of belonging and professional commitment. A survey was conducted at a medical school in China, yielding 1087 valid responses that were analyzed using SmartPLS 4.0.

RESULTS

Consistent with our expectations, online news media exposure was positively associated with both informational support (β=.163; P<.001) and emotional support (β=.084; P=.007). Similarly, social media exposure showed positive associations with informational support (β=.122; P<.001) and emotional support (β=.235; P<.001). Thereafter, informational support (β=.228; P<.001) and emotional support (β=.344; P<.001) were positively associated with students' sense of belonging. Meanwhile, both informational support (β=.245; P<.001) and emotional support (β=.412; P<.001) positively impacted medical students' professional commitment. In addition, a mediation test was conducted. The results confirmed that informational support and emotional support partially mediated the effect of online news media, while fully mediating the effect of social media on medical students' sense of belonging and professional commitment.

CONCLUSIONS

This study finds that exposure to online news media and social media can enhance medical students' sense of belonging and professional commitment through the formation of informational and emotional support. It expands the discussion on the role of media in providing social support and facilitating the development of medical students' professional identity. This is a valuable contribution to addressing complex public health crises through effective media governance in the network era.

Assessing the implementation of evidence-based alcohol policies on Atlantic Canadian post-secondary campuses: A comparative analysis

OBJECTIVE

This study assessed the quality of campus alcohol policies against best practice to assist campus decision-makers in strengthening their campus alcohol policies and reducing student alcohol use and harm.

METHODS

Drawing on empirical literature and expert opinion, we developed an evidence-based scoring rubric to assess the quality of campus alcohol policies across 10 alcohol policy domains. Campus alcohol policy data were collected from 12 Atlantic Canadian universities. All extracted data were verified by the institutions and then scored.

RESULTS

On average, post-secondary institutions are implementing only a third of the evidence-based alcohol policies captured by the 10 domains assessed. The average campus policy score was 33% (range 15‒49%). Of the 10 domains examined, only enforcement achieved an average score above 50%, followed closely by leadership and surveillance at 48%. The two heaviest-weighted domains-availability and access, and advertising and sponsorship-had average scores of 27% and 24%, respectively. However, if post-secondary campuses adopted the highest scoring policies from across all 12 campuses, they could achieve a score of 74%, indicating improvement is possible.

CONCLUSION

Atlantic Canadian universities are collectively achieving less than half their potential to reduce student alcohol-related harm. However, this study identifies opportunities where policies can be enhanced or modified. The fact that most policies are present at one or more campuses highlights that policy recommendations are an achievable goal for campuses. Campuses are encouraged to look to each other as models for improving their own policies.

Associations between traumatic dental injuries due to violence and various drinking behaviors in Korea: A cross-sectional study

BACKGROUND AND AIM

Various patterns of alcohol consumption are associated with trauma and violence. The aim of this study was to assess the association between traumatic dental injuries (TDI) due to violence and different patterns of alcohol consumption in Korean adults.

MATERIALS AND METHODS

A cross-sectional study was conducted with representative sample of Korean adults. Among the total participants, 11.8% (6489/58,999) experienced TDI, and 0.9% (520/58,999) experienced TDI due to violence. The associations between various types of alcohol consumption (frequency of drinking, frequency of binge drinking, age of first drinking) and TDI due to violence were assessed using logistic regression analyses. We confirmed differences in the prevalence experience of TDI due to violence with various types of alcohol consumption by confounders (socioeconomic status).

RESULTS

All types of drinking (frequency of drinking, frequency of binge drinking, age of first drinking) were strongly associated with TDI due to violence. After adjusting for confounders, those who started drinking at the age of 18 or younger and drank 4 or more days a week (OR: 2.86, 95% CI: 1.68-4.88), those who started drinking at the age of 18 or younger and drank 3 days or less a week (OR: 2.37, 95% CI: 1.40-4.02), and those who started drinking at the age of 18 or younger and binge drinking at least once a week (OR: 3.18, 95% CI: 1.79-5.65) had higher prevalence of TDI due to violence compared to those with no alcohol drinking.

CONCLUSIONS

This study presents evidence of an association between various types of alcohol consumption and TDI due to violence in Korean adults. These findings suggest the necessity for policies aimed at reducing alcohol consumption, frequency of drinking, and access to drinking especially in adolescent to reduce the prevalence experience of TDI due to violence.

Ecological Momentary Assessment of Alcohol Marketing Exposure, Alcohol Use, and Purchases Among University Students: Prospective Cohort Study

BACKGROUND

The relationships between alcohol marketing exposure, alcohol use, and purchase have been widely studied. However, prospective studies examining the causal relationships in real-world settings using mobile health tools are limited.

OBJECTIVE

We used ecological momentary assessment (EMA) to examine both the within-person- and between-person-level effects of alcohol marketing exposure on any alcohol use, amount of alcohol use, any alcohol purchase, and frequency of alcohol purchase among university students.

METHODS

From January to June 2020, we conducted a prospective cohort study via EMA among university students in Hong Kong who reported current drinking. Over 14 consecutive days, each participant completed 5 fixed-interval, signal-contingent EMAs daily via a smartphone app. Each EMA asked about the number and types of alcohol marketing exposures, the amount and types of alcohol used, and whether any alcohol was purchased, all within the past 3 hours. We used 2-part models, including multilevel logistic regressions and multilevel gamma regressions, to examine if the number of alcohol marketing exposure was associated with subsequent alcohol use and alcohol purchase.

RESULTS

A total of 49 students participated, with 33% (16/49) being male. The mean age was 22.6 (SD 2.6) years. They completed 2360 EMAs (completion rate: 2360/3430, 68.8%). Participants reported exposure to alcohol marketing in 5.9% (140/2360), alcohol use in 6.1% (145/2360), and alcohol purchase in 2.4% (56/2360) of all the EMAs. At the between-person level, exposure to more alcohol marketing predicted a higher likelihood of alcohol use (adjusted odd ratio [AOR]=3.51, 95% CI 1.29-9.54) and a higher likelihood of alcohol purchase (AOR=4.59, 95% CI 1.46-14.49) the following day. Exposure to more alcohol marketing did not increase the amount of alcohol use or frequency of alcohol purchases the following day in participants who used or purchased alcohol. At the within-person level, exposure to more alcohol marketing was not associated with a higher likelihood of alcohol use, amount of alcohol use, higher likelihood of alcohol purchase, or frequency of alcohol purchases the following day (all Ps>.05). Each additional exposure to alcohol marketing within 1 week predicted an increase of 0.85 alcoholic drinks consumed in the following week (adjusted B=0.85, 95% CI 0.09-1.61). On days of reporting alcohol use, the 3 measures for alcohol marketing receptivity were not associated with more alcohol use or purchase (all Ps>.05).

CONCLUSIONS

By using EMA, we provided the first evidence for the effect of alcohol marketing exposure on initiating alcohol use and purchase in current-drinking university students. Our findings provide evidence of the regulation of alcohol marketing for the reduction of alcohol use and purchase among young adults.

The impacts of alcohol marketing and advertising, and the alcohol industry's views on marketing regulations: Systematic reviews of systematic reviews

ISSUES

Advertising and marketing affect alcohol use; however, no single systematic review has covered all aspects of how they affect alcohol use, and how the alcohol industry views alcohol marketing restrictions.

APPROACH

Two systematic reviews of reviews were performed according to the Preferred Reporting Items on 2 February 2023. Results were analysed using a narrative synthesis approach.

KEY FINDINGS

Twenty-three reviews were included in the systematic reviews. The first systematic review examined youth and adolescents (11 reviews), digital or internet marketing (3 reviews), alcohol marketing's impact on cognition (3 reviews), and alcohol marketing and policy options (2 reviews). The second systematic review focused on alcohol industry (i.e., importers, producers, distributors, retailers and advertising firms) response to advertising restrictions (four reviews). The reviews indicated that there is evidence that alcohol marketing (including digital marketing) is associated with increased intentions to drink, levels of consumption and harmful drinking among youth and young adults. Studies on cognition indicate that advertisements focusing on appealing contexts and outcomes may be more readily accepted by adolescents, and may be less easily extinguished in this population. The review of the alcohol industry found a strong desire to self-regulate alcohol advertising.

IMPLICATIONS

We found alcohol advertising and marketing is associated with increased drinking intentions, consumption and harmful drinking. Thus, policies which restrict advertising may be an effective way to reduce alcohol use.

CONCLUSION

More research is needed to assess all aspects of the observed associations, especially as to how marketing policies impact women and people with alcohol dependence.

Digital alcohol marketing and gender: A narrative synthesis

ISSUES

Alcohol marketing on social media platforms is pervasive and effective, reaching wide audiences and allowing interaction with users. We know little about the gendered nature of digital alcohol marketing, including how women and men are portrayed, how different genders respond and implications for gender relations. This review aimed to identify how males, females and other genders are targeted and represented in digital alcohol marketing, and how they are encouraged to engage with digital alcohol marketing content.

APPROACH

A narrative synthesis approach was employed. Academic literature and research reports were searched for studies on digital alcohol marketing published within the previous 10 years with a range of methods and designs. We reviewed the studies, extracted data relevant to gender and synthesised findings thematically.

KEY FINDINGS

The review included 17 articles and 7 reports with a range of designs and methods, including content analyses of digital material, interviews, focus groups and surveys. Our analysis identified three conceptual themes that captured many of the gendered results, namely: (i) leveraging a diversity of idealised femininities; (ii) amplifying hegemonic masculinity; and (iii) infiltrating everyday gendered life.

IMPLICATIONS AND CONCLUSION

Alcohol marketing on social media is highly gendered and is designed to embed itself into everyday life in agile ways that reinforce traditional and evolving gendered stereotypes, activities, lifestyles and roles. Gendered engagement strategies are widely used to link alcohol to everyday gendered activities and identities to encourage alcohol purchase and consumption. This marketing normalises alcohol consumption and reproduces harmful gender norms and stereotypes.

Cross-substance Effects of Adolescent Exposure to Alcohol Content in Popular Movies on Cannabis Initiation

Objective

Alcohol is the most frequently depicted substance in the media, and adolescent exposure to alcohol in the media predicts alcohol use. There is relatively little research on exposure to cannabis in the media, but exposure to alcohol content may exert cross-substance effects on cannabis use. Given the social and health risks associated with early cannabis use, the present study aims to assess the cross-substance effects of exposure to alcohol media content on age of cannabis initiation.

Method

A sample of 830 middle school students (53% female) reported on movie alcohol exposure and cannabis initiation longitudinally until high school completion. Discrete-time survival models examined whether movie alcohol exposure predicted subsequent initiation among students who were cannabis-naïve at baseline, controlling for demographic, social, and behavioral covariates. The interaction between sex and movie alcohol exposure was also explored.

Results

One third (33%) of participants reported cannabis initiation with a mean of 5.57 estimated hours (SD = 4.29) of movie alcohol exposure. A 1-hour increase in movie exposure predicted a significant 16% increased probability of cannabis initiation in models adjusted for demographic variables and a significant 14% increase in models adjusted for demographic, behavioral, and social variables. No differences were observed across sex.

Conclusions

Greater adolescent exposure to alcohol content in the media was associated with earlier cannabis initiation above and beyond other etiologically relevant demographic, behavioral, and social variables. The influence of cross-substance media exposures warrants further exploration and should be taken into consideration in the development of preventive interventions for youth substance use.

A missed opportunity for public health: How impact assessment shaped EU rules on the marketing of unhealthy commodities to children

Background

The 2015-2018 revision of the European Union's Audiovisual Media Services Directive, which governs the marketing of alcohol and unhealthy food to minors, failed to align with international best practice. Previous research has explained this 'missed opportunity' with reference to deficient political will, difficulties advocating for health, and industry pressure. We explore another explanation: the role of the impact assessment (IA) process in shaping decision-making.

Methods

We first conducted an in-depth comparison of three versions of the IA report, employing qualitative content and framing analyses to establish what changed in the substantive content, framing, and evidence cited. Second, we used process-tracing, a qualitative method drawing on multiple data sources, to explore causal mechanisms, to assess why these changes occurred. Data sources include policy documents published proactively and obtained through access-to-document requests.

Findings

Previously unpublished versions of the IA report show that stronger rules on advertising were preferred early in the policy process but later abandoned, and that concern for 'balancing' consumer protection and competitiveness shifted to focus on the latter. Following review by the Regulatory Scrutiny Board, a revised IA report narrowed the policy options, removing a requirement for member states to prevent childrens' exposure to alcohol advertising. Consequently, decision-makers were provided with an IA that did not offer adequate information on available measures to protect children.

Interpretation

Changes made during the IA process, which determines the policy options presented to decision-makers, side-lined health concerns. We argue that engaging with the institutional structures which shape decision-making is crucial for those working to further public health.

Content analysis of food and beverage marketing in global esports: sponsorships of the premier events, leagues, teams and players

Background

Food marketing has been implicated as a driving force of the obesity epidemic. Electronic sports, or 'esports', garners billions of viewership hours and is a consolidation of two major marketing outlets, online social media and sporting events, making it a focal point for food marketers and policy-makers.

Methods

The top 10 esports events and leagues were identified using data scraped between 1 January 2021 and 15 December 2021. The 10 teams within each league (90 total teams) and up to 10 players from each team (451 total players) were identified. Of the top 10 events and leagues, 6 events and 2 leagues were held or located outside the USA, reflecting the global popularity of esports. Food and beverage brands associated with each event, league, team or player were systematically identified and extracted via official websites and social media accounts. The number of sponsorships was totalled for each brand. Brands were then categorised based on product type into the following categories: energy drinks, sugar-sweetened beverages, alcohol, candy/snacks, restaurants, food delivery and stores, and supplements. The total number of brand sponsorships was then calculated for each product category.

Results

90 unique food and beverage brands were identified. Across all brands, a total of 497 food brand sponsorships were identified. For product categories, energy drink brands had the most sponsorships (181 sponsorships, 36.4%), followed by restaurants (86 sponsorships, 17.3%) and candy/snacks (64 sponsorships, 12.8%). The individual brand with the most sponsorships was Monster Energy (47 sponsorships, 9.4%), followed by Jack Links (44 sponsorships, 8.8%) and Red Bull (42 sponsorships, 8.4%).

Conclusion

Despite its nascent character, the esports industry is already heavily saturated by food and beverage marketing. There is a need to consider policies to appropriately regulate food and beverage marketing within esports communities to safeguard the health of viewers.

A rapid literature review of the effect of alcohol marketing on people with, or at increased risk of, an alcohol problem

AIMS

To explore the effect or potential effect of alcohol marketing in people with an alcohol use disorder, in recovery from an alcohol use disorder, and hazardous and harmful drinkers.

METHODS

Relevant literature was identified by searching Medline (OVID), EMBASE (OVID), and PsycINFO (OVID) and relevant websites. Both quantitative and qualitative studies were eligible for inclusion. A narrative approach was used to synthesize the findings.

RESULTS

The review included 10 studies. Two quantitative and three qualitative studies focused on participants recovering from an alcohol use disorder and five quantitative studies on those with hazardous or harmful consumption levels of alcohol. The effect of alcohol advertising on alcohol use was only assessed in one study, a small experimental study of young adult heavy drinkers, which found no significant association. Studies looking at other outcomes found that people with or at risk of alcohol problems were likely to notice alcohol advertisements and find them appealing, and that advertisements may have an effect on positive alcohol-related emotions and cognitions. Among people in recovery from an alcohol use disorder, findings suggested that there could be an effect on craving, and that alcohol marketing may be perceived to trigger a desire to drink.

CONCLUSIONS

Alcohol marketing is likely to have an effect on alcohol consumption in people with, or at increased risk of, an alcohol problem. Studies have also found that alcohol marketing is perceived to act as a trigger by people in recovery from alcohol problems.

SUMMARY

A rapid review explored the effect of alcohol marketing in people with an alcohol use disorder, in recovery from an alcohol use disorder, and hazardous and harmful drinkers. The findings of the 10 included studies suggest that an effect of alcohol marketing in these populations is likely.

Restricting alcohol marketing to reduce alcohol consumption: A systematic review of the empirical evidence for one of the 'best buys'

BACKGROUND AND AIMS

Even though a ban of alcohol marketing has been declared a 'best buy' of alcohol control policy, comprehensive systematic reviews on its effectiveness to reduce consumption are lacking. The aim of this paper was to systematically review the evidence for effects of total and partial bans of alcohol marketing on alcohol consumption.

METHODS

This descriptive systematic review sought to include all empirical studies that explored how changes in the regulation of alcohol marketing impact on alcohol consumption. The search was conducted between October and December 2022 considering various scientific databases (Web of Science, PsycINFO, MEDLINE, Embase) as well as Google and Google Scholar. The titles and abstracts of a total of 2572 records were screened. Of the 26 studies included in the full text screening, 11 studies were finally included in this review. Changes in consumption in relation to marketing bans were determined based on significance testing in primary studies. Four risk of bias domains (confounding, selection bias, information bias and reporting bias) were assessed.

RESULTS

Seven studies examined changes in marketing restrictions in one location (New Zealand, Thailand, Canadian provinces, Spain, Norway). In the remaining studies, between 17 and 45 locations were studied (mostly high-income countries from Europe and North America). Of the 11 studies identified, six studies reported null findings. Studies reporting lower alcohol consumption following marketing restrictions were of moderate, serious and critical risk of bias. Two studies with low and moderate risk of bias found increasing alcohol consumption post marketing bans. Overall, there was insufficient evidence to conclude that alcohol marketing bans reduce alcohol consumption.

CONCLUSIONS

The available empirical evidence does not support the claim of alcohol marketing bans constituting a best buy for reducing alcohol consumption.

Alcohol industry-sponsored music festivals, alcohol marketing and drinking practices among young Nigerians: Implications for policy

INTRODUCTION

The global alcohol industry sponsors social/music events targeting young people; however, existing literature focuses on Westernised contexts. Given the decline in young people's drinking in many Western countries, it appears that multinational alcohol companies are importing the strategies they have used in high-income countries to the Global South countries like Nigeria to recoup profits. This study aims to examine the Guinness Show- a free one-month annual music festival, alcohol marketing at the festival and the extent to which the event encourages diverse drinking practices among its attendees.

METHODS

We observed the music festival before collecting data through 53 interviews and 3 focus groups (N = 26). Data were analysed to generate themes with the aid of NVivo 12 software.

FINDINGS

Over 6000 participants attend the Guinness Show daily, and participants gave detailed descriptions of the music festival, alcohol marketing activities that occur in it and the drinking practices of attendees, indicating that they were highly knowledgeable of the event. The Guinness Show attracts famous music artistes and other entertainers. Therefore, young people attend to see them perform free of charge. However, diverse alcohol promotions (e.g., quantity deals, low prices, giveaways) that happen daily, the strategic use of young women as 'beer promoters', and the pleasure the event induces by fusing music/entertainment into alcogenic environments, encourage drinking and drunkenness. All the attendees drank alcohol, and some engaged in impulse buying, while many consumed excessively due to promotions (e.g., buy-two-get-one free), which facilitated intoxication and the loss of control.

CONCLUSIONS

Guinness Nigeria organises the event for strategic brand communication, generating brand capital, and encouraging alcohol purchases and consumption among young people. Policymakers should reconsider self-regulation and implement national alcohol control policies and other public health interventions to restrain the alcohol industry from sponsoring such events.

Lifestyle Behaviors of Childhood and Adolescence: Contributing Factors, Health Consequences, and Potential Interventions

In this narrative review, we summarized evidence from peer-reviewed articles, published before February 2024, that investigated lifestyle behaviors among children (≤12 years) and adolescents (13-18 years) representing different geographic descents. These behaviors included dietary patterns, screen time, physical activity, smoking, alcohol consumption, oral hygiene, unsafe sex, and sleep duration and quality. We documented the significant impacts of parental, school, and sociodemographic factors on the adoption of numerous lifestyle behaviors in this age category. Several health consequences could be attributed to unhealthy lifestyle behaviors during childhood and adolescence. For example, poor dietary habits can lead to a higher risk of obesity and cardiovascular disease. Physical inactivity contributes to the development of musculoskeletal and psychological disorders. Excessive screen time is associated with visual acuity problems, poor sleep, and psychological and behavioral problems. Tobacco use poses a significant risk for severe respiratory and cardiovascular diseases. Risky sexual behaviors are related to sexually transmitted infections and exposure to violence. Short sleep duration is associated with a lack of physical fitness and poor cognitive function. However, potential interventions, such as school-based health programs, community outreach initiatives, and national health policies and regulations, can improve lifestyle behaviors among children and adolescents.

Drug Abuse Educational Program for Saudi University Students: A Pre-test and Post-test Design

Background and objective Designing a consistent preventive drug abuse program and evaluating the educational needs of diverse target groups, school curricula, and new instructional materials customized to a country's socioeconomic and cultural characteristics should be used. This research aims to assess the influence of an educational program on university students' awareness of drug abuse. Methodology A cross-sectional study using a pre-test questionnaire with predetermined questions was conducted with 102 participants. The educational program about drug abuse prevention measures was subsequently implemented. After the program was completed, a post-test was administered to the students, and the results were compared to the pre-test results. The data were collected from male and female Saudi students at a university in the western area of Saudi Arabia. Results The pre-test findings indicate that the students had already received some information on drug use and abuse, but the post-test results show that their awareness rose as a result of the drug abuse educational program. Conclusion Drug abuse is a major problem all across the world, including in Saudi Arabia. However, educational programs will help to increase knowledge and awareness of this issue.

Children, young people and the Commercial Determinants of Health

The commercial determinants of health (CDoH) have a significant impact on the health and well-being of children and young people (subsequently referred to as young people). While most research has focused on the influence of harmful industry marketing on young people, more recent CDoH frameworks have emphasized that a range of commercial systems and practices may influence health and well-being. Focusing on the impact of traditional and digital media, contemporary marketing strategies and corporate production and consumption processes, the following article outlines the impact of the CDoH on the health and wellbeing of young people. The article also provides evidence about how young people conceptualize the impact of corporate actors on health, and their involvement in advocacy strategies to respond. The article recommends that when collaborating with young people to understand the impacts of and responses to the CDoH, we should seek to diversify investigations towards the impact of a range of corporate tactics, systems and structures, rather than simply focusing on the impacts of advertising. This should include considering areas and priorities that young people identify as areas for action and understanding why some young people are more vulnerable to commercial tactics than others. Youth are powerful allies in responding to the CDoH. Public health and health promotion stakeholders could do more to champion the voices of young people and allow them to be active participants in the decisions that are made about harmful commercial practices and health.

Analysis of social media compliance with cannabis advertising regulations: evidence from recreational dispensaries in Illinois 1-year post-legalization

BACKGROUND

In the USA, an increasing number of states have legalized commercial recreational cannabis markets, allowing a private industry to sell cannabis to those 21 and older at retail locations known as dispensaries. Research on tobacco and alcohol suggests this new industry will use aggressive marketing tactics to attract new users and promote greater intensity of use. Of concern is that cannabis company advertising campaigns may be appealing to youth, promote false or misleading health claims, and disproportionately target low-income and minority communities. In this study, we evaluated recreational cannabis dispensary compliance with advertising regulations on social media in the state of Illinois.

METHODS

Primary data were collected from a census of recreational dispensary Facebook and Twitter business pages during the first year of recreational sales in 2020. A quantitative content analysis was conducted to systematically analyze the data; a codebook that detailed a protocol for classifying posts was developed prior to the analysis using advertising regulations outlined in the Illinois Cannabis Regulation and Tax Act. Violations of advertising regulations were organized into three categories: advertisements that may be appealing to youth (< 21 years old), advertisements that make health claims, and other advertising violations. The data were analyzed cross-sectionally and longitudinally. Additionally, differences in compliance were assessed by dispensary and neighborhood characteristics.

RESULTS

The results of the analysis revealed substantial and persistent non-compliance throughout the entire study period. Overall, nearly one third of posts had at least one violation and approximately one in ten posts met the criteria for appealing to youth or contained health claims. The majority of posts with health claims included health claims that were not qualifying conditions for medical cannabis access in the state of Illinois. No differences in compliance by neighborhood and dispensary characteristics were found.

CONCLUSIONS

The findings from this study suggest that systematic monitoring and enforcement is needed to ensure compliance with advertising regulations.

Do you 'like' problems? The linkage between college students' interactions with alcohol-related content on social media and their alcohol-related problems

INTRODUCTION

Alcohol-related content (ARC) on social media and drinking motives impact college students' drinking. Most studies have examined peer-generated ARC on drinking outcomes but have yet to extend this relationship to other sources of influence. The current study explores the link between drinking motives, alcohol company ARC, celebrity ARC, and alcohol-related problems among college students.

METHODS

Students (N = 454) from two US universities completed a cross-sectional online survey assessing demographics; drinking motives (Drinking Motives Questionnaire-Revised; Cooper, Psychol Assess. 1994;6:117-28); following/awareness of alcohol company ARC; engagement with celebrity ARC; peak drinks (most drinks consumed on one occasion); and alcohol-related problems (e.g., passed out).

RESULTS

Greater celebrity ARC was linked to coping, enhancement, and conformity motives, and peak drinks. Frequent engagement with celebrity ARC was associated with higher problems. Positive indirect effects were observed from celebrity ARC to problems through coping and conformity motives, and peak drinks. After having adjusted for the influence of celebrity ARC, no significant pathways were found between alcohol company ARC and any of the drinking motives, peak drinks or problems, nor were there any indirect effects between alcohol company ARC and problems.

DISCUSSION AND CONCLUSIONS

Results revealed that a possible explanation for why students who engaged with celebrity ARC experience problems was due to coping and conformity motives as well as peak drinks. Interventions targeting alcohol cognitions might assess engagement with and exposure to different sources of ARC given their potential to influence problems.

Exposure to media with alcohol-related content across young adulthood: Associations with risky drinking and consequences among high-risk 2- and 4-year college students

INTRODUCTION

Exposure to media with alcohol-related content is a known risk for alcohol use and related harms among young people. The present study used longitudinal self-report data on exposure to media with alcohol-related content to examine age trajectories across young adulthood and to estimate associations with heavy episodic drinking (HED) and negative consequences.

METHOD

Participants were 201 high-risk young adults enrolled in 2- and 4-year colleges (ages 18-25 at screening; 63.7% female). Repeated assessments occurred at four timepoints across a 12-month period.

RESULTS

Self-reported exposure to both positively and negatively portrayed alcohol-related media content decreased with age. Between-persons, controlling for alcohol use frequency, exposure to positive alcohol-related media content was positively associated with HED, and exposure to negative alcohol-related media content was inversely associated with HED; no within-person effects on HED were significant. For negative consequences, controlling for alcohol quantity, exposure to positive media content was associated with more negative consequences both between- and within-persons. Unexpectedly, exposure to negatively portrayed media content was positively associated with negative consequences at the within-person level.

DISCUSSION AND CONCLUSIONS

Trajectories in exposure to media with alcohol-related content showed that relatively younger participants reported greater exposure, highlighting the need for policy and prevention efforts to protect this vulnerable demographic. Findings generally indicated that positive portrayals of alcohol use increase alcohol-related risks. Moreover, increased exposure to negative portrayals in a given assessment was associated with more negative consequences-potentially by normalising or glorifying high-risk drinking and consequences, though mechanistic/causal research is needed.

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.

A systematic review and meta-analysis of the relationship between youth drinking, self-posting of alcohol use and other social media engagement (2012-21)

BACKGROUND AND AIM

Social networking sites (SNS) are interactive internet-based social platforms that facilitate information sharing. A growing body of literature on exposure to, and self-posting of, alcohol-related content on SNS has examined the relationship between SNS use and alcohol consumption in young people. This study aims to synthesise the literature exploring the relationship between exposure (i.e. viewing or listening of alcohol-related media) and self-posting (i.e. uploading images or text of alcohol content) of alcohol-related media on SNS on alcohol consumption.

METHODS

A pre-registered systematic review was conducted in June 2022 within PubMed, Scopus, PsycINFO and Web of Science. Original prospective and cross-sectional studies assessing youth and young adults (≤ 24 years of age) that measured exposure to alcohol-related media or posting of alcohol-related content on SNS and self-reported alcohol consumption outcomes were included. Meta-analyses were conducted on comparable methodologies.

RESULTS

Thirty studies were included (n = 19,386). Meta-analyses of cross-sectional studies showed both greater exposure (five studies; pooled β = 0.34, 95% confidence interval [CI] = 0.23, 0.44, i2 = 27.7%) and self-posting of alcohol-related content (six studies; pooled β = 0.57, 95%CI = 0.25,0.88, i2 = 97.8%) was associated with greater alcohol consumption. Meta-analyses of three prospective studies also identified that greater exposure predicted greater future alcohol consumption (three studies; pooled β = 0.13, 95%CI = 0.11,0.15, i2 = 0.0%). Narrative analyses of studies that could not be meta-analysed due to incompatible methodologies were also conducted. Most studies (all four prospective, one of two cross-sectional) identified positive associations between exposure to alcohol-related content and greater average consumption. Most studies (three of four prospective, four of six cross-sectional) reported a positive association between of alcohol-related self-posting and greater average alcohol consumption.

CONCLUSIONS

Both exposure to, and self-posting of, alcohol-related content on social networking sites are positively associated with current average consumption, problem drinking, and drinking frequency.

The estimated health impact of alcohol interventions in New Zealand: A modelling study

AIMS

To estimate the health impacts of key modelled alcohol interventions among Māori (indigenous peoples) and non-Māori in New Zealand (NZ).

DESIGN

Multi-stage life-table intervention modelling study. We modelled two scenarios: (1) business-as-usual (BAU); and (2) an intervention package scenario that included a 50% alcohol tax increase, outlet density reduction from 63 to five outlets per 100 000 people, outlet hours reduction from 112 to 50 per week and a complete ban on all forms of alcohol marketing.

SETTING AND PARTICIPANTS

The model's population replicates the 2018 NZ population by ethnicity (Māori/non-Māori), age and sex.

MEASUREMENTS

Alcohol consumption was estimated using nationally representative survey data combined with sales data and corrected for tourist and unrecorded consumption. Disease incidence, prevalence and mortality were calculated using Ministry of Health data. We used dose-response relationships between alcohol and illness from the 2016 Global Burden of Disease study and calculated disability rates for each illness. Changes in consumption were based on the following effect sizes: total intervention package [-30.3%, standard deviation (SD) = 0.02); tax (-7.60%, SD = 0.01); outlet density (-8.64%, SD = 0.01); outlet hours (-9.24%, SD = 0.01); and marketing (-8.98%, SD = 0.02). We measured health gain using health-adjusted life years (HALYs) and life expectancy.

FINDINGS

Compared with the BAU scenario, the total alcohol intervention package resulted in 726 000 [95% uncertainty interval (UI) = 492 000-913 000] HALYs gained during the life-time of the modelled population. Māori experienced greater HALY gains compared with non-Māori (0.21, 95% UI = 0.14-0.26 and 0.16, 95% UI = 0.11-0.20, respectively). When modelled individually, each alcohol intervention within the intervention package produced similar health gains (~200 000 HALYs per intervention) owing to the similar effect sizes.

CONCLUSIONS

Modelled interventions for increased alcohol tax, reduced availability of alcohol and a ban on alcohol marketing among Māori and non-Māori in New Zealand (NZ) suggest substantial population-wide health gains and reduced health inequities between Māori and non-Māori.

Have yourself a 'merry' little Christmas: Alcohol adverts and alcohol content within adverts in the run-up to Christmas

Exposure to alcohol adverts or other audio-visual content (AVC) in the media is associated with alcohol initiation and subsequent use by adolescents and adults, especially those with or at risk of an alcohol use disorder. The Christmas period is characterised by increased alcohol consumption and there may be an increase in alcohol advertisements during this period. The current study explored the number of alcohol advertisements shown on UK television in a sample of days in the run-up to Christmas 2022 and found that alcohol advertisements were commonly shown but alcohol was also seen in advertisements for other things such as supermarkets. The amount of alcohol shown is likely to encourage drinking and make Christmas a difficult time for people with alcohol use disorders or who are in recovery.

News media framing of food poverty and insecurity in high-income countries: a rapid review

Food poverty and insecurity have become a public health emergency in many high-income countries. News media coverage can shape public and political views towards such issues. This rapid review synthesizes the evidence on how food poverty and insecurity are represented in the news media. Peer-reviewed publications were accessed through three electronic databases, with reference lists of all included studies screened. Primary research studies conducted in high-income countries and published in English since 1995 were included, with no restrictions on study methods. A combination of deductive coding to Entman's framing theory and inductive analysis was used. Ten studies, mostly rated as low quality, were included in the review. Newspapers were the only type of news media examined. The findings showed a largely absent nuanced understanding of food poverty and insecurity, with the problem often defined by food bank use and the consequences mainly focused on physical health. The causes were mostly attributed to structural factors, with the solutions largely focused on charitable food aid. The discourse of recipient (un)deservingness of food aid was evident. Articles often contained views from government officials and charities, with individuals' experiences of food poverty and insecurity largely absent. The findings of this review highlight that a major shift in print media discourse on food poverty and insecurity is required. More balanced and critical news reporting is required to present a more realistic picture of food poverty and insecurity, including its multi-dimensional nature, limitations of food charity and the need for structural solutions to this important issue.

The nature and extent of outdoor alcohol marketing in Wellington, New Zealand: a longitudinal audit and spatio-temporal analysis of outdoor alcohol marketing

AIM

exposure to alcohol marketing is associated with increased consumption. We aimed to (i) measure the nature and extent of outdoor alcohol marketing within a high-density urban neighbourhood and (ii) examine temporal and spatial trends in alcohol marketing.

METHODS

this study used a longitudinal design to monitor paid advertising in public spaces over two 10-week periods in Wellington, New Zealand (Nov-Jan 2020-2021, Nov-Jan 2021-2022). The data were collected on-foot following an established route once a week using a phone camera, which also recorded gps data of ad locations. Temporal and spatial trends in alcohol ad prevalence were assessed.

RESULTS

over the study period, 13% (n = 1619) of all ads (n = 12,472) were for alcohol. Alcohol ads were predominately for spirits (29%), ready-to-drink (27%) and beer (23%). Almost half of all alcohol ads (49%) did not contain a responsible consumption message, while those with a message were de-emphasized relative to promotional features. A temporal trend was observed in 2020, whereby alcohol marketing decreased over the summer, but this trend was not reflected in 2021. Alcohol ads were more likely than non-alcohol ads to be placed in premium positions on roads of high pedestrian and motor vehicle traffic.

CONCLUSION

alcohol marketing is common in urban centres. Local and central government policy could substantially reduce the levels of alcohol marketing exposure via outdoor marketing.

Alcohol outlet density and marketing in Abeokuta, Nigeria

AIM

The physical availability of alcohol is a modifiable determinant of alcohol consumption and related harm. However, Nigeria currently does not have national regulations restricting the physical availability of alcohol. The study measured alcohol outlet density and marketing in Abeokuta, Nigeria.

METHODS

A descriptive community design was employed. Seven wards in Abeokuta South local government were surveyed street by street for functional alcohol outlets and nearby public institutions (schools and worship centres). Outlet characteristics were documented, and the location of outlets and public institutions was geocoded using a global positioning system app. The density and proximity of outlets and public institutions were analysed using QGIS 3.22.

RESULTS

Four hundred and seventy-six alcohol outlets and 194 public institutions (82 schools, 87 churches, and 25 mosques) were sampled across the 7 wards. The most common type of alcohol premises and outlets was on/off-premises and liquor/non-alcoholic drinks stores. Alcohol banners on liquor store lintels were the most prevalent marketing item. Alcohol outlet density ranged from 8.06 to 200 per km2. The smallest average distance between alcohol outlets was 28 m in Sodeke, while Ago Egun/Ijesa had the highest number of outlets and on/off premises. The shortest distance from an outlet to a school was 18.77 m in Ijaiye and 44 (14.7%) schools were located within ≤100 m of an outlet.

CONCLUSIONS

Findings indicate high alcohol density, resulting in short distances between alcohol outlets and public institutions in Abeokuta South local government area. These results underscore the importance of implementing evidence-based alcohol availability policies in Nigeria.

Unpacking assertions made by the alcohol industry and how they make them: An analysis of submissions into Australia's National Alcohol Strategy

INTRODUCTION

Alcohol is a leading cause of morbidity and mortality globally. One significant barrier to the implementation of evidence-based alcohol policy is alcohol industry opposition. Making submissions to national policy processes is one way in which the industry exert influence. The aim of this study was to analyse alcohol industry submissions into Australia's National Alcohol Strategy to determine key assertions made by the alcohol industry and the ways in which they use evidence and refute the effectiveness of public health policies to make their claims.

METHODS

Submissions made by alcohol industry actors (n = 12) were analysed using content analysis to determine key industry assertions. A pre-existing framework on alcohol industry use of evidence was then applied to analyse the evidentiary practices used to make these assertions.

RESULTS

Five common industry assertions were identified: 'Drinking alcohol in moderation has health benefits'; 'Alcohol isn't the cause of violence'; 'Targeted initiatives, not population level alcohol policies, are needed'; 'Strong alcohol advertising regulations are not necessary'; and 'Minimum unit price and pricing and taxation policies more broadly are not needed'. The industry systematically manipulated, misused and ignored evidence throughout their submissions.

DISCUSSION AND CONCLUSIONS

The alcohol industry is misusing evidence in their submissions to government consultations to make their assertions about alcohol policy. It is therefore essential that industry submissions are scrutinised and not accepted on face value. Additionally, it is suggested that the alcohol industry requires a distinct model of governance similarly to that which regulates the tobacco industry to prevent their attempts to undermine evidence-based public health policy.

Prevalence and correlates of alcohol use and risky drinking among undergraduate students in Johannesburg, South Africa: a cross-sectional study

BACKGROUND

Alcohol use and risky drinking are significant public health problem globally. Young people, including university students, are among the most affected populations. We conducted the study to determine the prevalence and correlates of alcohol use and risky drinking among undergraduate students in the Faculty of Health Sciences at the University of the Witwatersrand, South Africa.

METHODS

We conducted a cross-sectional study using an anonymous, self-administered online survey in REDCap. The survey questionnaire consisted of socio demographic, and alcohol use questions using the risky drinking identification screening tool (AUDIT-C). We performed descriptive statistics, bivariate and multivariable logistic regression to determine factors associated with alcohol use and risky drinking. The p-value of < 0.05 was considered statistically significant.

RESULTS

The response rate was 15.7%. Most participants were female (69.6%) and majority of the participants were White (38.1%). The prevalence of lifetime use of alcohol was 79.1%, and among the lifetime users; 70.2% reported alcohol use in the last 12-months, 37.1% reported alcohol use in the last 30 days. The prevalence of risky drinking was 54.8% among lifetime drinkers. Factors significantly associated with current alcohol use were siblings alcohol use (aOR = 1.79, 95% CI: 1.02-3.15) and parents alcohol use (aOR = 2.58, 95% CI: 1.39-4.80), white race (aOR = 5.70, 95% CI: 3.12-10.41), and always or daily exposure to alcohol marketing in the media (aOR = 3.31, 95% CI: 1.07-10.24). Factors associated with risky drinking were: Indian/Asian race (aOR = 2.82, 95% CI: 1.09-7.31), White race (aOR = 2.15, 95% CI: 1.14-4.04), and exposure to alcohol marketing in the media as follows, most of the time (aOR = 3.42, 95% CI: 1.29-9.04) and Always/daily exposure (aOR = 3.31, 95% CI: 1.07-10.24).

CONCLUSION

The reported alcohol use and risky drinking were common amongst undergraduate students at Wits university. There is an urgent need to design, pilot and adapt targeted interventions for this population group.

Cannabis retailer marketing strategies and regulatory compliance: A surveillance study of retailers in 5 US cities

As cannabis retail expands in the US, its surveillance is crucial to inform regulations and protect consumers. This study addresses this need by conducting point-of-sale audits examining regulatory compliance (e.g., age verification, signage), advertising/promotional strategies, products, and pricing among 150 randomly-selected cannabis retailers in 5 US cities (30/city: Denver, Colorado; Seattle, Washington; Portland, Oregon; Las Vegas, Nevada; Los Angeles, California) in Summer 2022. Descriptive and bivariate analyses characterized the retailers overall and across cities. Age verification rates were high (>90%). The majority of retailers had signage indicating restricted access (e.g., no minors; 87.3%), onsite consumption (73.3%), and distribution to minors (53.3%). Retailers were likely to post warnings regarding use during pregnancy/breastfeeding (72.0%), followed by health risks (38.0%), impacts on children/youth (18.7%), and DUI (14.0%). Overall, 28.7% posted health claims, 20.7% posted youth-oriented signage, and 18.0% had youth-oriented packaging. Price promotions were prevalent, particularly price specials (75.3%), daily/weekly/monthly specials (66.7%), and membership programs (39.3%). One-fourth had signs/promotions indicating curbside delivery/pick-up (28.0%) and/or online ordering (25.3%); 64.7% promoted their website or social media page. The most potent cannabis products were most often e-liquids (38.0%) or oils (24.7%); the least potent were often edibles (53.0%). The most expensive product was often bud/flower (58.0%); the least was joints (54.0%). The vast majority (≥81%) sold vaporizers, wrapping papers, and hookah/waterpipes/bongs, and 22.6% sold CBD products. Marketing strategies differed across cities, reflecting differences in state-specific regulations and/or gaps in compliance/enforcement. Findings underscore the need for ongoing cannabis retail surveillance to inform future regulatory and enforcement efforts.

Exposure to alcohol advertising and alcohol consumption among children and early teenagers in South Africa

BACKGROUND

There is a paucity of information on alcohol adverts on alcohol consumption among early teenagers. The study aimed to examine the association between exposure to alcohol adverts and alcohol consumption.

METHODS

A sample of 3833 early teenagers aged 12-14 years were extracted from the South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey (SABSSM) 2017. Participants answered questions related to their exposure to alcohol adverts across television, Poster/billboard, events, and social media. Alcohol consumption was assessed on ever consumed alcohol and in the previous 12 months. Information on demographic characteristics was collected. Descriptive and inferential statistics were used to process the data.

RESULT

Exposure to alcohol adverts increases from 5.2% for Events to 77.0% on television. All alcohol media of adverts were associated with alcohol consumption by age. The results mirror studies that demonstrated that exposure to alcohol advertisements was associated with alcohol consumption.

CONCLUSION

The association between alcohol consumption, exposure to alcohol adverts, and demographic characteristics need the urgent attention of policymakers and interventionists. The focus of action should be on protecting these early teenagers from exposure to media of adverts and risk background factors.

Outdoor Medical Cannabis Advertising in Oklahoma: Examining Regulatory Compliance and Social Meanings in Billboard Content

Background: Medical cannabis currently dominates the U.S. cannabis advertising landscape. The public is increasingly exposed to outdoor cannabis advertising, which increases positive attitudes about and intentions to use cannabis. Research is lacking regarding outdoor cannabis advertising content. This article characterizes the content of outdoor cannabis advertising in Oklahoma, one of the fastest growing U.S. medical cannabis markets. Methods: We conducted a content analysis of cannabis advertising billboard images (n = 73) from Oklahoma City and Tulsa, photographed May 2019-November 2020. We followed a primarily inductive, iterative team approach to thematically analyze billboard content in NVIVO. We reviewed all images, identified a broad coding taxonomy, and then incorporated emergent codes and those related to advertising regulation (e.g. youth/children). We totaled frequencies of code application across billboards and reexamined billboards for final themes. Results: Major themes were social meanings related to cannabis subculture, formal medical systems, and nature, and the presence of company contact information. Minor themes related to convenience, price promotions, store proximity, U.S. affiliation, product quality, and spirituality. State advertising regulation violations were rare, with the exception of content that may promote curative or therapeutic effects (4%) and misrepresentation of product state of origin (1.4%). Conclusion: Outdoor medical cannabis advertising in Oklahoma blurs boundaries between formal medical discourses and cannabis subculture that is suspicious of messaging from authorities and regards cannabis as harmless and natural. Increased monitoring of advertising regulation compliance and greater understanding of social discourses within emerging markets is needed to promote public health within the context of cannabis advertising.

Exposure to tobacco, alcohol and 'Junk food' content in reality TV programmes broadcast in the UK between August 2019-2020

BACKGROUND

Exposure to alcohol, tobacco and foods high in fat, sugar or salt (HFSS) content in media is a risk factor for smoking, alcohol use and HFSS consumption in young people. We report an analysis of tobacco, alcohol and HFSS content in a sample of reality TV programmes broadcast on TV and video-on-demand services throughout a 1-year period.

METHODS

We used 1-min interval coding to quantify content in all episodes of 20 different reality TV programmes between August 2019 and August 2020 and estimated population exposure to a sample of these programmes using viewing data and UK population estimates.

RESULTS

We coded 13 244 intervals from 264 episodes. Tobacco content appeared in 227 intervals (2%) across 43 episodes (2%), alcohol in 5167 intervals (39%) across 258 episodes (98%) and HFSS in 1752 intervals (13%) across 234 episodes (88%). A sample of 15 series delivered ~157.4 million tobacco, 3.5 billion alcohol and 1.9 billion HFSS gross impressions to the UK population, including 24 000, 12.6 million and 21.4 million, to children, respectively.

CONCLUSION

Tobacco, alcohol and HFSS content are common in reality TV programmes. These programmes deliver exposure to tobacco, alcohol and HFSS imagery, which are a potential driver of tobacco use, alcohol use and HFSS consumption in young people.