Effectiveness of alcohol media literacy programmes: a systematic literature review

High-Risk Cannabis Use: A Proposal of an Operational Definition through Delphi Methodology for Scientific Consensus

INTRODUCTION

Cannabis ranks as one of the most widely used psychoactive substances worldwide. Its usage has been reported as a risk factor for developing a variety of physical and mental health issues, alongside social and economic problems. According to the World Health Organization (WHO), hazardous (or high-risk) substance use is defined as "a pattern of substance use that increases the risk of harmful consequences for the user." The primary objective of this study was to achieve a consensus on an operational definition of high-risk cannabis use suitable for a European jurisdiction (Spain).

METHODS

A three round Delphi study was conducted. The Delphi technique entails group decision-making and iterative forecasting by consulting a panel of experts and conducting systematic feedback rounds. An online survey was distributed among a diverse expert panel comprising professionals from Spain working on fields related to cannabis use (research, policy planning, and clinical professionals). One-hundred ninety-nine invitations were sent to experts, of which forty-five (22.6%) accepted to participate. All participants were provided the option to revise a background document with the latest compiled scientific evidence and guidelines related to health and social conditions associated to cannabis usage. This background document also proposed the quantification of dose using a standardized unit established for the population of Spain (the Standard Joint Unit or SJU) based on quantity of cannabis main psychoactive constituent, 9-tetrahydrocannabinol (9-THC) (1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC). Three rounds of Likert scale and open-ended questions were administered until consensus, defined as ≥75% agreement, was attained.

RESULTS

Consensus was reached on defining high-risk cannabis use as the usage of more than 4 SJU (>28 mg THC) per week or any use of cannabis with potency >10% THC. Concurrent use of cannabis with other drugs was also considered high risk, while the smoked route was considered the riskiest administration route. It was also agreed that vulnerable groups for high-risk cannabis use (for whom any pattern of cannabis use represents high risk of harm) include individuals under the age of 21, pregnant or breastfeeding women, individuals with psychiatric history, those with medical health issues related to cannabis use, professional drivers and heavy machine operators.

CONCLUSION

This operational definition of high-risk cannabis use for Spain elucidates usage patterns and individual vulnerability factors predictive of heightened harm. Its adoption holds potential to inform decision-making among individuals, professionals, and policy-makers, facilitating evidence-based interventions aimed at prevention and risk reduction.

Distilling the curriculum: An analysis of alcohol industry-funded school-based youth education programmes

BACKGROUND AND AIM

For decades, corporations such as the tobacco and fossil fuel industries have used youth education programmes and schools to disseminate discourses, ideas and values favourable to their positions, and to pre-empt regulation that threatens profits. However, there is no systematic research into alcohol industry-funded youth education programmes. This article serves to address this important gap in the literature.

METHODS

Using a discourse theoretical approach informed by poststructural discourse theory and critical discourse analysis, we analysed teaching materials from three school-based youth education initiatives which focus on alcohol consumption and health harms: Drinkaware for Education, The Smashed Project (funded by Diageo), and Talk About Alcohol (Alcohol Education Trust). These materials, some of which are disseminated internationally, are provided to schools through intermediary bodies in receipt of alcohol industry funding.

FINDINGS

The analysis found that these materials drew from and presented discourses of personal responsibility, moderate alcohol consumption, and involved a narrowing of the problem definition and causes. The locus of the problem is located by the discourses within individuals including youth, with causes of youth alcohol consumption repeatedly presented as peer pressure and 'poor choices', with little or no mention of alcohol industry marketing or other practices. All programmes promoted familiarisation and normalisation of alcohol as a 'normal' adult consumer product which children must learn about and master how to use responsibly when older. The discourses constructed in these materials closely align with those of other alcohol industry corporate social responsibility discourses which employ selective presentation of harms, including misinformation about cancer, and ambiguous terms such as "responsible drinking". Furthermore, the role of alcohol price, availability and access, and the impacts of alcohol and the industry on inequities were not articulated within the discourses. The research was limited to an analysis of teaching materials and further research is needed to explore their impact on youth, teachers and wider discourses and social norms.

CONCLUSION

Alcohol industry-sponsored youth education programmes serve industry interests and promote moderate consumption while purportedly educating children about harms and influences of alcohol use. There are considerable conflicts of interest in the delivery of alcohol education programmes funded by the alcohol industry and intermediary bodies in receipt of such funding. Alcohol education materials should be developed independent from industry, including funding, and should empower children and young people to understand and think critically about alcohol, including harms and drivers of consumption, and effective interventions needed to protect them and others from alcohol-related harms. Independent organisations can use this analysis to critique their materials to strengthen alignment with meeting student and public health interests. The ongoing exposure of children and young people to such conflicted and misleading materials needs urgent attention from policymakers, practitioners, teachers and parents, and resources dependent on industry support should cease being used in schools.

Promoting Sexual Health in High School: A Feasibility Study of A Web-based Media Literacy Education Program

Comprehensive sexual health education (SHE) is an effective strategy for improving adolescent sexual health. However, few of these programs address media influence on sexual cognitions and behaviors. Also, more research is needed on using web-based instruction for SHE. Seventeen classes (N = 331 students) in one high school in the United States were enrolled in a pre-post randomized controlled trial to assess the feasibility of Media Aware, a web-based SHE program that uses a media literacy education (MLE) approach. Compared to a delayed-intervention group, students who received Media Aware had significant reductions in their perceived realism of and similarity to media messaging, improved cognitive elaboration of media messages, more realistic perceptions of teen sex norms and risky sex norms, increased efficacy and intention to act as a bystander to potential sexual assault, increased intent to communicate before sex, and increased efficacy to use contraception/protection. These students reported being less willing to hook up, being less willing to have unprotected sex (for males), and positive feedback on their experiences using a web-based program. This study provides evidence that web-based MLE sexual health programming is a feasible and acceptable strategy for improving media-related and sexual health outcomes among adolescents.

Assessing the relationship between youth religiosity and their alcohol use: A meta-analysis from 2008 to 2018

OBJECTIVE

Underage alcohol use, and associated deleterious consequences, persists as a serious public health issue. In particular, early initiation of alcohol use increases risk for the development of alcohol use disorders later on in life. Religiosity - a multidimensional construct, encompassing personal beliefs, commitments, practices, and public behaviors - has demonstrated a strong protective effect on alcohol consumption; as one's religiosity increases their alcohol use behaviors decrease. This meta-analysis includes research spanning years 2008-2018, and specifically examines whether measuring religiosity via a single dimension, as compared to multiple dimensions, impacts the association between alcohol use and religiosity.

METHOD

A systematic electronic database search spanning three databases using relevant key terms was conducted. Overall, 16 studies were deemed appropriate for subsequent analyses. Effect sizes were calculated, homogeneity of effect sizes was assessed, overall weighted effects were computed, and moderator analyses were conducted to examine the effects of study-level characteristics on the variability of effect sizes.

RESULTS

Religiosity demonstrated a statistically significant protective effect on adolescent alcohol use (Z = -0.21, p < .001). Measurement of religiosity (i.e., unidimensional versus multidimensional) explained a statistically significant amount of effect-size heterogeneity (Q_b(1) = 7.38, p = .007). Thus, religiosity measure dimensionality had a significant effect on the protective effect of youth religiosity on alcohol use.

CONCLUSION

Results highlight the protective effect of youth religiosity on alcohol use. To further understand the scope of this protective association, future research would benefit from exploring the multidimensional nature of religiosity and the associations between varying conceptualizations of religiosity and adolescent alcohol use outcomes.

Critical big data literacy tools—Engaging citizens and promoting empowered internet usage

Datafied societies need informed public debate about the implications of data science technologies. At present, internet users are often unaware of the potential consequences of disclosing personal data online and few citizens have the knowledge to participate in such debates. This paper argues that critical big data literacy efforts are one way to address this lack of knowledge. It draws on findings from a small qualitative investigation and discusses the effectiveness of online critical big data literacy tools. Through pre and post use testing, the short- and longer-term influence of these tools on people’s privacy attitudes and behavior was investigated. The study’s findings suggested that the tools tested had a predominantly positive initial effect, leading to improved critical big data literacy among most participants, which resulted in more privacy-sensitive attitudes and internet usage. When analyzing the tools’ longer-term influence, results were more mixed, with evidence suggesting for some that literacy effects of the tools were short-lived, while for others they led to more persistent and growing literacy. The findings confirm previous research noting the complexity of privacy attitudes and also find that resignation toward privacy is multi-faceted. Overall, this study reaffirms the importance of critical big data literacy and produces new findings about the value of interactive data literacy tools. These tools have been under-researched to date. This research shows that these tools could provide a relevant means to work toward empowering internet users, promoting a critical internet usage and, ideally, enabling more citizens to engage in public debates about changing data systems.

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.

Exposure to Alcohol Content in Movies and Initiation of Early Drinking Milestones

BACKGROUND

Exposure to alcohol content in movies has been shown to be associated with adolescent use of alcohol, including earlier onset. This study examined the influence of movie alcohol exposure on subsequent alcohol onset, considering the social context (whether the movie was viewed with a friend or parent). We examined whether media's influence holds across a spectrum of early drinking milestones: sipping (but not consuming a full drink of) alcohol, consuming a full drink of alcohol, and engaging in heavy episodic drinking (HED).

METHODS

Data were taken from a sample of 882 middle school youth (52% female; 24% non-White) enrolled in an ongoing study on alcohol initiation and progression. Exposure to alcohol content in films was measured using a method that combines content analysis and random assignment of movie titles to youth surveys. The hazard of initiating alcohol use (sip, full drink, HED) as a function of exposure was estimated using survival analysis. Associations were adjusted for demographic, personality, and social influence factors known to be associated with both movie exposure and alcohol use.

RESULTS

Exposure to alcohol content was common. Hours of exposure prospectively predicted earlier onset of alcohol involvement across all outcomes. Viewing movies with friends appeared to augment the media exposure effect, in contrast to viewing movies with parents, which was not a significant predictor of initiation.

CONCLUSIONS

Exposure to alcohol in films is involved in the entry into early stages of alcohol involvement. Findings support further investigation into the role of the media in underage drinking, especially in the context of consuming media with friends and peers. Limiting media exposure and/or stronger Federal Trade Commission oversight of movie ratings should be a priority for preventing underage drinking.

Mediating alcohol use in Eastern Nigeria: a qualitative study exploring the role of popular media in young people's recreational drinking

Nigeria has high levels of alcohol consumption, and little or no regulation of the alcohol industry. There is a dearth of studies exploring young adults' drinking in a Nigerian context with only a few predominantly quantitative surveys. These do not explore the social meanings attached to drinking practices nor do they shed light on potential gender differences and how these are mediated by popular media. This qualitative study addresses this gap with semi-structured interviews involving 31 undergraduate students. It identifies that media consumption shapes drinking behaviour in ways which are highly patterned and gendered. Participants with high consumption of both Hollywood films and popular American reality television series associate heavy alcohol consumption with high social status, economic independence and gender equality. By contrast, Nollywood (local) films which are intended to act as moral tales and warn of the dangers of drinking appear paradoxically to support participants' views of alcohol as positive (alleviating anxiety, depression and menstrual discomfort). Nigeria currently has no serious regulation of alcohol on television which is embedded in everyday life. Attempts to develop wider public health campaigns and policies should take this saturated media landscape into account to develop harm reduction strategies which are linked directly to media literacy programmes.

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.

Qualitative process evaluation of an Australian alcohol media literacy study: recommendations for designing culturally responsive school-based programs

Background

Alcohol media literacy programs seek to mitigate the potentially harmful effects of alcohol advertising on children’s drinking intentions and behaviours through equipping them with skills to challenge media messages. In order for such programs to be effective, the teaching and learning experiences must be tailored to their specific cultural context. Media in the Spotlight is an alcohol media literacy program aimed at 9 to 12 year old Australian children. This study evaluates the process and implementation of the program, outlining the factors that facilitated and inhibited implementation. From this evaluation, a pedagogical framework has been developed for health professionals implementing culturally responsive programs in school settings.

Methods

Process measures included: semi-structured interviews with teachers before and after the program was implemented (n = 11 interviews), program evaluation questionnaires completed by children (n = 166), lesson observations completed by teachers (n = 35 observations), and reflective journal entries completed by the researcher (n = 44 entries). A thematic analysis approach was used to analyse all of the data sets using NVivo. Inductive coding was used, whereby the findings were derived from the research objectives and multiple readings and interpretations of the data.

Results

Five key pedagogical considerations were identified that facilitated implementation. These were: connecting to the students’ life worlds to achieve cultural significance; empowering students with real-world skills to ensure relevance; ensuring programs are well structured with strong connections to the school curriculum; creating developmentally appropriate activities while providing a range of assessment opportunities; and including hands-on and interactive activities to promote student engagement. Three potential inhibitors to implementing the alcohol media literacy program in upper-elementary school classrooms were identified. These included topic sensitivities, classroom management challenges, and fitting new programs into already busy school schedules.

Conclusion

Overall, the program content and individual lessons were well received by the teachers and students. The lessons learned from the development, implementation and evaluation of this program can provide health professionals with key pedagogical strategies for designing culturally responsive educational programs. Culturally responsive programs are critical for ensuring interventions are effective for their specific context.

Factors associated with younger adolescents' exposure to online alcohol advertising

Little is known about the extent and nature of youth exposure to online alcohol advertising, or factors that may be associated with exposure. The current study recruited middle school students who completed a paper survey and then logged each alcohol advertisement that they encountered over a 2-week period using cell phones as part of an ecological momentary assessment design. We examined the percentage of youth who reported exposure to online alcohol advertising in the past 2 weeks, average weekly rate of exposure, types of online alcohol advertisements youth reported seeing, and factors that increased youths' risk of exposure to online alcohol advertising. Analyses are based on 485 participants (47% female; 25% Hispanic, 25% White, 27% Black; 6% Asian, 16% other). Youth logged exposures to a total of 3,966 (16,018 weighted for underreporting) alcohol advertisements across the monitoring period; 154 (568 weighted) or 3.6% were online ads. Seventeen percent of youth reported seeing any online alcohol ad; the majority of online ads seen were video commercials (44.8%) and banner/side ads (26.6%). Factors associated with greater ad exposure were being older, rebellious, and Black race; greater parental monitoring and more hours spent on social media were associated with less exposure. Findings provide important information about adolescents' exposure to online alcohol advertising and what might contribute to a greater likelihood of exposure. Given that online ad exposure is linked to drinking behavior, prevention programming for younger adolescents should continue to address this issue to help youth make healthy choices regarding alcohol use. (PsycINFO Database Record

Effects of a food advertising literacy intervention on Taiwanese children's food purchasing behaviors

Unhealthy food advertising is an important contributor to childhood obesity. The purpose of this pilot study was to evaluate the impact of a food advertising literacy program that incorporated components of health-promoting media literacy education on fifth-grade children. Participants were 140 fifth-graders (10 and 11 years old) from one school who were randomly divided into three groups. Experimental Group A received a food advertising literacy program, experimental Group B received a comparable knowledge-based nutrition education program and the control group did not receive any nutrition education. Repeated measures analysis of variance and multivariate analysis of covariance were used to test mean changes between pretest, posttest and follow-up on participants' nutritional knowledge, food advertising literacy and food purchasing behavior. Results showed that, as compared with Group B and the control groups, Group A showed higher nutritional knowledge, food advertising literacy and food purchasing behavior at post-intervention, but had no significant improvements in nutritional knowledge and food purchasing behavior at the 1-month follow-up. Although some improvements were observed, future studies should consider a long-term, settings-based approach that is closely connected with children's daily lives, as this might be helpful to solidify children's skills in recognizing, evaluating and understanding unhealthy food advertising.

Alcohol-Branded Merchandise Ownership and Drinking

CONTEXTS

Alcohol-branded merchandise (ABM) has a longer shelf-life than other forms of alcohol marketing and the potential to become integrated into children's self-identities.

OBJECTIVE

This review sought to explore the current literature on children's exposure to, and the impact of, ABM.

DATA SOURCES

PsycInfo, Proquest, Science Direct, and ABI-Inform databases were searched from the earliest available date to May 2015. Additional studies were identified by a manual review of the reference lists of retrieved articles and contacting the corresponding author of each included study.

STUDY SELECTION

Articles that reported on child or adolescent ownership of ABM and/or the relationship between ABM ownership and drinking were included.

DATA EXTRACTION

Data on key measures were tabulated; where data of interest were not reported, requests for further information were sent to the articles' authors.

RESULTS

Nine cross-sectional and 4 longitudinal studies were identified. ABM ownership ranged from 11% to 59% and was higher among older children and males. Seven cross-sectional studies reported associations between ABM ownership and drinking-related behaviors. All 4 longitudinal studies reported a significant relationship between ownership at baseline and drinking initiation at follow-up.

LIMITATIONS

The small number of available studies, with different measures of ABM ownership and of associations/effects.

CONCLUSIONS

The few studies exploring ABM ownership are consistent in showing high rates of ownership and associations between ownership and current and future drinking. There is a need for further research into specific aspects of ABM ownership. However, there is also a need for policy interventions to reduce children's access to and ownership of ABM.

Examining How Media Literacy and Personality Factors Predict Skepticism Toward Alcohol Advertising

To examine the potential effectiveness of media literacy education in the context of well-established personality factors, a survey of 472 young adults, focused on the issue of alcohol marketing messages, examined how individual differences in personality associate with constructs representing aspects of media literacy. The results showed that need for cognition predicted social expectancies and wishful identification with media portrayals in alcohol advertising only through critical thinking about media sources and media content, which are foci of media literacy education. Need for affect did not associate with increased or diminished levels of critical thinking. Critical thinking about sources and messages affected skepticism, represented by expectancies through wishful identification, consistent with the message interpretation process model. The results support the view that critical thinking about media sources is an important precursor to critical thinking about media messages. The results also suggest that critical thinking about media (i.e., media literacy) reflects more than personality characteristics and can affect wishful identification with role models observed in media, which appears to be a key influence on decision making. This adds support to the view that media literacy education can improve decision making across personality types regarding alcohol use by decreasing the potential influence of alcohol marketing messages.

Implications for visually stimulating advertisements on NYC subway platforms

Despite the fact that the New York City (NYC) Metropolitan Transportation Authority (MTA) no longer advertises tobacco products, there is no ban on ads for alcohol. The purpose of this pilot study was to evaluate the frequency of alcohol-related advertising content on the platforms of two populated subway lines in NYC. Advertisements were evaluated on one subway line (the green line) that runs through Bronx and Manhattan in NYC. In the stations included in the study, the total number of advertisements were tallied and classified according to the type of advertisement. When an advertisement for alcohol was identified, it was determined whether the ad was for an alcoholic beverage, or it if was for a different product but exhibited an alcoholic beverage in some way. A total of 26 advertisements were identified which marketed an alcohol product. An additional 24 ads were noted for marketing another product or service whereby, alcohol was depicted as being consumed. There was a statistically significant difference in ads between the different lines t (20.04)=7.62, p<0.001, with an average of 1.5 ads on the uptown lines (heading toward and through the borough with the lowest median income) versus 0.06 ads on the downtown lines (heading toward and through the borough with the highest median income). Given the far reach that subway advertisements have, focus could shift to health promoting products, versus those that are deleterious.

Empowering students to respond to alcohol advertisements: results from a pilot study of an Australian media literacy intervention

OBJECTIVE

Alcohol media literacy programs in the United States have increased students' media literacy skills and lowered pre-drinking behaviour. In Australia, no such programs have yet been implemented or evaluated. This pilot study aimed to examine the feasibility and potential impact of an alcohol media literacy program for Australian upper-primary school children.

METHODS

Thirty-seven Year 5 and 6 students (aged 10-12) from one school in the Sydney region participated in 10 one-hour media lessons. Teacher interviews, student exit slips, teacher observations and a researcher reflective journal were analysed to examine the implementation process, while a pre- and post-questionnaire was analysed to measure outcome.

RESULTS

Key factors in implementation were the importance of school context; attainment of English and PDHPE learning outcomes to differing extents; program's useability provided flexibility; perceived complexity and achievability of the lessons and program's engagement and relevance for the students. The program significantly increased media literacy skills and understanding of persuasive intent; decreased interest in alcohol branded merchandise; and lowered perception of drinking norms.

CONCLUSION AND IMPLICATIONS

An Australian alcohol media literacy program for upper-primary school children appears feasible, and has potential to lead to measurable outcomes.