Does Industry-Driven Alcohol Marketing Influence Adolescent Drinking Behaviour? A Systematic Review

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.

The relationship between the price and demand of alcohol, tobacco, unhealthy food, sugar-sweetened beverages, and gambling: an umbrella review of systematic reviews

BACKGROUND

The WHO highlight alcohol, tobacco, unhealthy food, and sugar-sweetened beverage (SSB) taxes as one of the most effective policies for preventing and reducing the burden of non-communicable diseases. This umbrella review aimed to identify and summarise evidence from systematic reviews that report the relationship between price and demand or price and disease/death for alcohol, tobacco, unhealthy food, and SSBs. Given the recent recognition as gambling as a public health problem, we also included gambling.

METHODS

The protocol for this umbrella review was pre-registered (PROSPERO CRD42023447429). Seven electronic databases were searched between 2000-2023. Eligible systematic reviews were those published in any country, including adults or children, and which quantitatively examined the relationship between alcohol, tobacco, gambling, unhealthy food, or SSB price/tax and demand (sales/consumption) or disease/death. Two researchers undertook screening, eligibility, data extraction, and risk of bias assessment using the ROBIS tool.

RESULTS

We identified 50 reviews from 5,185 records, of which 31 reported on unhealthy food or SSBs, nine reported on tobacco, nine on alcohol, and one on multiple outcomes (alcohol, tobacco, unhealthy food, and SSBs). We did not identify any reviews on gambling. Higher prices were consistently associated with lower demand, notwithstanding variation in the size of effect across commodities or populations. Reductions in demand were large enough to be considered meaningful for policy.

CONCLUSIONS

Increases in the price of alcohol, tobacco, unhealthy food, and SSBs are consistently associated with decreases in demand. Moreover, increasing taxes can be expected to increase tax revenue. There may be potential in joining up approaches to taxation across the harm-causing commodities.

Associations of recreational cannabis dispensaries' availability, storefront signage and health benefit signs with cannabis use: findings from a representative adult sample in California, United States

BACKGROUND AND AIMS

There are concerns that availability of recreational cannabis dispensaries (RCDs) and point-of-sale marketing may lead to increased cannabis use in jurisdictions where cannabis retail sale is legal. This paper examined whether the availability RCDs and the presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs were associated with cannabis use and risk perceptions.

DESIGN

Cross-sectional, secondary data analysis.

SETTING

California, USA.

PARTICIPANTS

A representative sample of 3385 adults in California who participated in the 2020 probability-based Marijuana Use and Environment Survey.

MEASUREMENTS

Binary outcomes included past-month overall cannabis use, perceiving cannabis smoking as harmful and past-month cannabis use by purpose (medical only, recreational only and dual). The objectively assessed predictors included proximity and density of RCDs and presence of storefront signage indicative of cannabis and signs promoting health benefits in RCDs.

FINDINGS

In terms of proximity, thepresence of storefront signage in the nearest RCD was associated with smaller odds of perceiving cannabis smoking as harmful [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.39, 0.99] if the RCD was located within 2 miles of home. Presence of health benefit signs in the nearest RCD was associated with greater odds of overall cannabis use (OR = 2.45, 95% CI = 1.17, 5.16) and recreational use (OR = 3.50, 95% CI = 1.027, 11.91) if the RCD was located within 2-4 miles of home. In terms of density, count of RCDs, count of RCDs with storefront signage and count of RCDs with health benefit signs within 2 miles of home were each separately associated with greater odds of overall cannabis use and cannabis use for dual purposes.

CONCLUSIONS

The availability of recreational cannabis dispensaries within 2 miles of one's home and the presence of storefront signage indicating the availability of cannabis and signs promoting health benefits of cannabis appear to be associated with increased cannabis use and reduced risk perceptions among adults in California, USA.

Prices, taxes and alcohol use: a systematic umbrella review

AIM

To measure the impact of taxes and prices on alcohol use with particular attention to the different context of rising alcohol consumption in low- and middle-income countries.

METHODS

Systematic review: we searched MEDLINE, Embase, EconLit and LILACS, grey literature, hand-searched five specialty journals and examined references of relevant studies. We considered all reviews that included studies that quantitatively examined the relationship between alcohol prices or taxes and alcohol use. At least two reviewers independently screened the articles and extracted the characteristics, methods and main results and assessed the quality of each included study. We identified 30 reviews.

RESULTS

There was overwhelming evidence that higher alcohol prices and taxes were associated with lower total alcohol consumption and that price responsiveness varied by beverage type. Total own-price elasticities of alcohol demand were consistently negative and substantial enough to be policy meaningful; total own-price elasticities for beer, wine and spirits were found to be approximately -0.3, -0.6 and -0.65. Reviews generally concluded that higher taxes and prices were associated with lower heavy episodic drinking and heavy drinking, although the magnitude of these associations was generally unclear. Reviews provided no evidence that alcohol price responsiveness differed by socioeconomic status, mixed and contradictory evidence with respect to age and sex and limited evidence that price responsiveness in low- and middle-income countries was approximately the same as in high-income countries.

CONCLUSIONS

Taxes are effective in reducing alcohol use. Moreover, increasing the price of alcohol by increasing taxes can also be expected to increase tax revenue, because the demand for alcohol is most certainly inelastic.

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

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

Parent/caregiver attitudes, motivations and behaviours in relation to alcohol use among offspring aged 13-18 years: a qualitative study

BACKGROUND

Parental alcohol consumption and alcohol-related behaviour play a critical role in shaping adolescent alcohol use, but comparatively little is known about the perspectives of parents regarding adolescent alcohol use from qualitative studies in England. This study aimed to explore parental views and attitudes towards alcohol use during adolescence, among their offspring and among young people in general.

METHODS

Twenty-three parents (21 mothers, 2 fathers) of children aged 13-18 years were recruited via schools, workplaces and community settings, predominantly in the West of England (n = 19) between 2017 and 2018. Data were collected via in-depth one-to-one interviews and analysed thematically, using an inductive, constructionist approach.

RESULTS

Five major themes were identified in the data: (1) the parental alcohol environment, (2) balance and acceptance, (3) influences of the parental approach, (4) boundaries and parental monitoring, and (5) wider influences shaping young people's behaviour. Overall, parents were aware of the risks and consequences of alcohol use and the wide range of influences shaping drinking behaviour, and expressed broad disapproval of alcohol use among young people. However, adolescent alcohol use was viewed as inevitable, and set within a context of a tolerant drinking culture. Many parents therefore chose a balanced and reluctantly accepting approach. This approach was determined by weighing disapproval of drinking against consistency with wider culture and parental behaviour, support for autonomy of the child, and avoidance of social sanctions. Parents' responses were also determined by a desire to protect the parent-child relationship, maintain an open, communicative and trusting relationship, and ultimately limit risk and minimise harm. Various boundaries and strategies were employed to this end, including care around role modelling, gradual introductions to alcohol, boundaried provision, clear risk reduction messaging and parental monitoring.

CONCLUSIONS

Parents employ a range of mechanisms to reduce alcohol-related risk and to balance harms of alcohol use among their offspring against adolescent behavioural norms. A downward shift in community consumption and changing socio-cultural norms could alter the accepting context in which parents are required to navigate adolescent alcohol use.

Binge Drinking and Drunk Driving Among Current Drinkers in Thailand: Analysis of Cigarette Smoking and Alcohol Drinking Behavior Surveys From 2007 to 2017

This study aimed to evaluate the association between binge drinking and drunk driving among the Thai population. Data in 2007, 2011, and 2017 of the Thai National surveys on Tobacco and Alcohol Consumption were analyzed. The household surveys collected information from the population, aged >15 years, using a face-to-face interview. There were 89 002 current drinkers from the 3 waves of surveys. About 40% reported drunk driving in the past 12 months. Binge drinking accounted for 17.3%, 17.8%, and 42.8% of the current drinkers in 2007, 2011, and 2017, respectively. The prevalence of drunk driving also increased from 36.6% to 57.7% over the 10-year period. Both occasional binge drinkers and regular binge drinkers showed about twice the risk of drunk driving (range of odds ratios [ORs] from 1.81; 95% confidence interval [95% CI] = 1.71-1.92 to OR 2.96; 95% CI = 2.64-3.31), compared with non-binge drinkers, and these OR increased by drinking frequency.

Community-based health promotion about alcohol and other drugs in a multicultural Australia-what works? A review of evidence

Refugee and migrant communities from culturally and linguistically diverse backgrounds in Australia experience dependency, stigma, isolation, mental health issues, family issues and other problems associated with alcohol and other drugs. Yet, refugee and migrant communities also face major linguistic, cultural and technological barriers to health promotion about drug-related problems. The aim of this review is to identify effective techniques and approaches for health promotion that reduces the risk of problems with drugs in culturally and linguistically inclusive ways. To identify what is effective, the Medline/PubMed database was systematically searched for health promotion literature published between 2008 and 2018. Grey literature from relevant agencies was also searched. The review considered both quantitative and qualitative outcome measures, and assessed studies using the Critical Appraisal Skills Programme quality assessment tool. Three studies met inclusion criteria, with weak evaluations. The studies demonstrated effective community engagement, but do not provide conclusive evidence of what is effective drug-related health promotion. The review's findings point to an important knowledge gap. More rigorous research and evaluation are required to identify effective health promotion for reducing drug-related issues with a larger, more diverse range of refugee and migrant communities.

Qualitative exploration of the intersection between social influences and cultural norms in relation to the development of alcohol use behaviour during adolescence

OBJECTIVES

Few contemporary studies have examined peer and social drivers of alcohol use during mid-adolescence. We sought to explore young people's perspectives on socio-cultural influences relating to alcohol use behaviour during this period.

DESIGN

Qualitative research study.

METHODS

Semi-structured one-to-one (n=25), paired (n=4) or triad (n=1) interviews and one focus group (n=6) were conducted with 30 young people aged 14 to 15 (13 males, 17 females) recruited from 4 schools, and 12 participants (aged 14 to 18, 8 males, 4 females) recruited from two youth groups in an urban centre in the West of England. Nineteen participants abstained from alcohol use, 9 were occasional or moderate drinkers and 14 drank alcohol more regularly. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo V.10, through a lens of social influence and social norms theories.

RESULTS

Alcohol consumption was associated with being cool, mature and popular, while enabling escape from reality and boosting confidence and enjoyment. Positive expectancies, alongside opportunity, contributed to motivating initiation, but social influences were paramount, with participants describing a need to 'fit in' with friends to avoid social exclusion. Such influences positioned drinking at parties as a normative social practice, providing opportunities for social learning and the strengthening of peer norms. Social media presented young people with positive alcohol-associated depictions of social status, enjoyment and maturity. This intersection of influences and norms generated a pressurised environment and a sense of unease around resisting pressures, which could elicit stigmatising insults.

CONCLUSIONS

Cultural norms, social influences and social media intersect to create a pressurised environment around alcohol use during mid-adolescence, driving the escalation in the prevalence of excessive consumption at this stage. New interventions need to address normative influences to enable the prevention of excessive alcohol use during adolescence.

Socio-Ecological Influences on Adolescent (Aged 10-17) Alcohol Use and Unhealthy Eating Behaviours: A Systematic Review and Synthesis of Qualitative Studies

Excess body weight and risky alcohol consumption are two of the greatest contributors to global disease. Alcohol use contributes directly and indirectly to weight gain. Health behaviours cluster in adolescence and track to adulthood. This review identified and synthesised qualitative research to provide insight into common underlying factors influencing alcohol use and unhealthy eating behaviours amongst young people aged 10–17. Sixty two studies met inclusion criteria. Twenty eight studies focused on alcohol; 34 focused on eating behaviours. Informed by principles of thematic analysis and meta-ethnography, analysis yielded five themes: (1) use of alcohol and unhealthy food to overcome personal problems; (2) unhealthy eating and alcohol use as fun experiences; (3) food, but not alcohol, choices are based on taste; (4) control and restraint; and (5) demonstrating identity through alcohol and food choices. Young people faced pressure, reinforced by industry, to eat and drink in very specific ways, with clear social consequences if their attitudes or behaviour were deemed unacceptable. No qualitative studies were identified with an explicit and concurrent focus on adolescent eating behaviours and alcohol consumption. Further exploratory work is needed to examine the links between food and alcohol in young people’s emotional, social and cultural lives.

The influence of alcohol outlet density and advertising on youth drinking in urban Tanzania

Despite the detrimental effects of alcohol on adolescent health, high rates of alcohol use are reported among Tanzanian youth. We conducted systematic community mapping and participatory group activities with 177 adolescents in Dar es Salaam to explore how alcohol outlet density and advertising may contribute to adolescent drinking in urban Tanzania. Findings revealed a high density of alcohol-selling outlets and outdoor advertisements. The abundance of alcohol-related cues, including their close proximity to places where youth congregate, may facilitate and increase adolescent alcohol use in Tanzania. Participants recommended several changes to the alcohol environment to reduce adolescent drinking. Structural interventions that reduce adolescents' access and exposure to alcohol are needed in Tanzania.

Young Thai People's Exposure to Alcohol Portrayals in Society and the Media: A Qualitative Study for Policy Implications

BACKGROUND

Although previous quantitative studies have documented the association between exposure to alcohol portrayals and drinking attitudes in Western countries, few qualitative studies have explored this matter in Thailand. A better understanding of the association in young Thais is required for a more efficient alcohol policy development. This study aims to explore the information young Thais have learnt from exposure to alcohol portrayals in society and the media, examine how this exposure shapes their drinking attitudes, and investigate the alignment of policy-makers' views on drinking with those of young people.

METHODS

Two qualitative research methods were employed. Seventy-two university students (38 men, 34 women) aged 20-24 participated in focus groups conducted on campus. Semi-structured interviews were conducted with academia, civil society and representatives from government who were involved in alcohol policy. Recorded data were transcribed verbatim, systematically coded and analysed using content analysis.

RESULTS

Young Thais were regularly exposed to alcohol portrayals, particularly on social media and in their social environment. Being increasingly exposed to alcohol portrayals, particularly on social media, and the role of the alcohol industry emerged as concerning matters to the academia and civil society sectors. In response to the concerns, the government social media monitoring and alcohol censorship had become more challenging.

CONCLUSIONS

This study reflects the growing concerns from academia and civil society sectors of the impacts of increased alcohol exposure and the role that the industry may have on young people's drinking attitudes. It highlights the need for response to significant policy challenges to reduce these impacts.

Treating alcohol-related liver disease from a public health perspective

Herein, we describe the evolving landscape of alcohol-related liver disease (ALD) including the current global burden of disease and cost to working-aged people in terms of death and disability, in addition to the larger spectrum of alcohol-related heath complications and its wider impact on society. We further review the most effective and cost-effective public health policies at both a population and individual level. Currently, abstinence is the only effective treatment for ALD, and yet because the majority of ALD remains undetected in the community abstinence is initiated too late to prevent premature death in the majority of cases. We therefore hope that this review will help inform clinicians of the "public health treatment options" for ALD to encourage engagement with policy makers and promote community-based hepatology as a speciality, expanding our patient cohort to allow early detection, and thereby a reduction in the enormous morbidity and mortality associated with this disease.

Viewing images of alcohol use in PG-13-rated movies and alcohol initiation in Mexican-heritage youth

Mexican American adolescents report high rates of alcohol consumption as well as media use. Viewing alcohol images in the media is associated with increased alcohol consumption; however, to date, this association has not been examined across different ethnic groups in the United States. To bridge this gap, we examined the association between viewing alcohol use images in PG-13-rated movies and alcohol initiation in Mexican-heritage adolescents. A cohort of 1,154 Mexican-heritage youth, average age 14 years, was followed for 2 years; in 2008-2009, participants reported alcohol use in the past 30 days and again in 2010-2011. Exposure to alcohol use images in PG-13-rated movies was estimated from 50 movies randomly selected from a pool of 250 of the top box office hits in the United States using previously validated methods. A series of generalized linear models, adjusting for age, gender, peer and family alcohol use, family functioning, anxiety, sensation-seeking tendency, and acculturation were completed. Multiple imputation was utilized to address missing data. Overall, N = 652 participants reported no alcohol use in 2008-2009; by 2010-2011, 33.6% (n = 219) had initiated alcohol use. Adjusted models indicated an independent association between exposure to alcohol use images in PG-13-rated movies and alcohol initiation (comparing quartiles 3 to 1: RR =1.53; 95% CI [1.11, 2.10]). The findings emphasize that the relationship between viewing alcohol use scenes in American films and alcohol initiation holds among Mexican-heritage adolescents and underscore the need to limit adolescents' exposure to such powerful images in PG-13-rated movies.

Impact of exposure to alcohol marketing and subsequent drinking patterns among youth and young adults

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the impact of exposure to any form of alcohol marketing, compared to less exposure or no exposure, on alcohol consumption patterns among youth and young adults up to and including the age of 25 years (we want to be able to look at potential dose response relationships at different levels of exposure).

Is popular radio a source of exposure to alcohol references in mid to later life? A content analysis

Background

There is concern around alcohol consumption in mid to later life yet little understanding about what influences this behaviour. No previous research has explored the extent to which adults in mid to later life may be exposed to alcohol references in the media. This project aimed to determine the frequency of alcohol references on radio stations with a high proportion of listeners in mid to later life.

Methods

Content analysis of alcohol references on four popular UK music-based radio stations with a high proportion of listeners aged 55-64 years over three time points.

Results

Alcohol references occur frequently, but vary by time of year and type of radio station. When alcohol is mentioned its consumption is portrayed as the norm, without negative consequences. On three commercial stations, the majority of mentions came from advertising, whereas on BBC Radio 2 nearly all references were talk-based. All adverts for direct promotion of alcohol were by supermarkets. Alcohol was frequently associated with celebrations, socializing or something to consume for its own sake.

Conclusions

Adults in the age group 55-64 may be exposed to references to alcohol that could serve to reinforce norms of consumption of alcohol and promote purchases of cheap alcohol.

Media/Marketing Influences on Adolescent and Young Adult Substance Abuse

PURPOSE OF REVIEW

We describe the state of research on substance use portrayals in marketing and media, considering exposure to tobacco, alcohol, e-cigarette, and marijuana content. Putative mechanisms are offered, and recommendations made for effective prevention strategies for mitigating the influence of these portrayals.

RECENT FINDINGS

There is consistent evidence that adolescents and young adults are highly exposed to substance use portrayals and that these portrayals are associated with subsequent substance use. Exposure via new media (social networking sites, brand websites) has risen rapidly. Social norms and cognitions appear to at least partially account for the effects of portrayals on youth substance use.

SUMMARY

Digital media has surpassed traditional marketing, which is concerning because youth have on-demand access to content and are active consumers of digital media. Developmentally appropriate media literacy interventions that include a parenting component and target multiple substances and media domains are recommended.

Media/Marketing Influences on Adolescent and Young Adult Substance Abuse

PURPOSE OF REVIEW

We describe the state of research on substance use portrayals in marketing and media, considering exposure to tobacco, alcohol, e-cigarette, and marijuana content. Putative mechanisms are offered, and recommendations made for effective prevention strategies for mitigating the influence of these portrayals.

RECENT FINDINGS

There is consistent evidence that adolescents and young adults are highly exposed to substance use portrayals and that these portrayals are associated with subsequent substance use. Exposure via new media (social networking sites, brand websites) has risen rapidly. Social norms and cognitions appear to at least partially account for the effects of portrayals on youth substance use.

SUMMARY

Digital media has surpassed traditional marketing, which is concerning because youth have on-demand access to content and are active consumers of digital media. Developmentally appropriate media literacy interventions that include a parenting component and target multiple substances and media domains are recommended.

Patterns and perception of alcohol drinking among the Lahu people, Northern Thailand

Purpose

The purpose of this paper is to understand the pattern and perception of alcohol drinking among the Lahu people in northern Thailand.

Design/methodology/approach

A qualitative method was used to elicit information on the patterns and perceptions of alcohol drinking amongst the Lahu tribespeople. Question guidelines had been developed from literature reviews and approved by three experts in the field of public health and alcohol studies. A total of 21 participants of different ages and sexes from 3 separate Lahu villages were invited to provide information. All interviews were taped and transcribed before analysis. A content analysis was used.

Findings

Lahu people begin alcohol consumption at an average of 12 years, with males usually beginning before females of the same age. Consuming alcohol is perceived to be a sign of adulthood and is also used as a means of gaining social acceptance from others in the community. Alcohol is consumed throughout the year with young and old, male and females, describing varied reasons for drinking. Income, parental behavior, and peer pressure contributes to the onset of alcohol drinking among young Lahu people. Several factors contributed to the use of alcohol among the Lahu people such as sex, age, occupation and income, peer pressure, taste and price as well as cultural adaptations amongst the farming community that play a significant role in the frequency of alcohol consumption amongst the Lahu community.

Originality/value

The results should support the development of peer education on the negative impact of alcohol use among the young people, and development of a community agreement on reducing excessive alcohol use in the Lahu community should be implemented.

'Hidden Habitus': A Qualitative Study of Socio-Ecological Influences on Drinking Practices and Social Identity in Mid-Adolescence

This study explored mid-adolescents' views and experiences of socio-ecological influences on their drinking practices in order to help inform the development of interventions to reduce alcohol-related risk. We conducted 31 in-depth interviews with young people aged 13-17 in North East England. Verbatim interview transcripts and field notes were coded systematically and analysed thematically, following the principles of constant comparison. We adopted Bourdieu's idea of social game-playing and elements of his conceptual toolkit (particularly habitus, capital and field) during analysis. Analysis yielded three intersecting themes: (1) 'drinking etiquette': conveying taste and disgust; (2) 'playing the drinking game': demonstrating cultural competency; (3) 'hidden habitus'-the role of alcohol marketing. Our work demonstrates that there is a nexus of influential factors which come together to help shape and reinforce mid-adolescents' behaviour, norms and values in relation to alcohol consumption. Drinking practices are not just formed by friendships and family traditions, these are also subject to wider cultural shaping including by the alcohol industry which can encourage brand identification, and gear specific products to add 'distinction'. However young people are not inactive players and they use aspects of capital and social games to help cement their identity and present themselves in particular ways which in turn are influenced by age, gender and social status. Guided by promising work in the tobacco field, interventions which focus on critical awareness of the framing of alcohol products by key stakeholders, such as policymakers, commercial industry and public health professionals, and by wider society may facilitate behaviour change among young people.

The Myriad Influences of Alcohol Advertising on Adolescent Drinking

Purpose of Review

This review investigates effects of alcohol advertising on adolescent drinking. Prior reviews focused on behavioral outcomes and long-term effects. In contrast, the present review focuses on subgroups with greater exposure to alcohol advertising, research methods to study alcohol advertising, potential mechanisms underlying relationships between adolescent exposure to alcohol advertising and increased drinking and points to prevention/intervention strategies that may reduce effects of alcohol advertising.

Recent Findings

Alcohol advertising influences current and future drinking. Further, evidence suggests adolescents may be targeted specifically. Alcohol advertisements may influence behavior by shifting alcohol expectancies, norms regarding alcohol use, and positive attitudes. Media literacy programs may be an effective intervention strategy.

Summary

Adolescents are exposed to large quantities of alcohol advertisements, which violates guidelines set by the alcohol industry. However, media literacy programs may be a promising strategy for adolescents to increase critical thinking and create more realistic expectations regarding alcohol.