Alcohol Marketing and Adolescent and Young Adult Alcohol Use Behaviors: A Systematic Review of Cross-Sectional Studies
A systematic review of cross-sectional research examining associations between exposure to alcohol marketing and alcohol use behaviors among adolescents and young adults. Understanding if and how exposure to marketing influences young people is an important issue for researchers, public health advocates, and practitioners.
Summary
Objective
This article provides a systematic review of cross-sectional research examining associations between exposure to alcohol marketing and alcohol use behaviors among adolescents and young adults.
Although there have been previous literature reviews on alcohol advertising among youth, most have been narrative reviews, and none have undertaken a systematic consideration of the extensive cross-sectional literature. As part of the larger consensus project investigating alcohol marketing and alcohol use, the researchers address differences across forms of media, types of exposures, and alcohol use outcomes, and whether the evidence of associations is robust across studies.
The researchers also critically consider the quality of the research and provide directions for future studies focusing on strengthening the measurement and conceptualization of both exposure to marketing and alcohol use outcomes.
Last, the researchers discuss the implications of the findings for policy and prevention or intervention.
Method
Literature searches of eight electronic databases were carried out in February 2017. Searches were not limited by date, language, country, or peer-review status.
The search of key concepts yielded 27,351 results. After de-duplication and two rounds of title and abstract screening, 409 titles remained potentially eligible for our cross-sectional review.
After abstract and full-text screening for eligibility and study quality, 38 studies that examined the relationship between alcohol marketing and alcohol use behaviors were selected for inclusion.
Results
Most research was conducted in the United States (47%) or Europe (16%). Data were collected from 1980 to 2015, and samples ranged from 89 to ∼63,000 participants. Of the studies in the review, 11 used objective measures of alcohol marketing exposure compared with 27 studies that relied only on perceived exposures.
Across alcohol use outcomes, various types of marketing exposure, and different media sources, the study findings suggest that cross-sectional evidence indicating a positive relationship between alcohol marketing exposure and alcohol use behaviors among adolescents and young adults was greater than negative or null evidence. In other words, cross-sectional evidence supported that alcohol marketing exposure was associated with young peoples’ alcohol use behaviors.
In general, relationships for alcohol promotion (e.g., alcohol-sponsored events) and owning alcohol-related merchandise exposures were more consistently positive than for other advertising exposures. These positive associations were observed across the past four decades, in countries across continents, and with small and large samples.
Lifetime alcohol use
In total, 10 studies from 8 countries (Australia, Brazil, Germany, Italy, Netherlands, Poland, Scotland, United States) assessed 32 different associations between marketing exposures and lifetime alcohol consumption outcomes. These studies covered many different types of media and used different measures to assess exposure to alcohol marketing.
- Alcohol advertising
Positive associations were found across different media types including advertising on television, in magazines and newspapers, in mixed media types, in music, at bottle shops and the point of sale, and in bars and pubs.
There is moderate evidence for the association between alcohol advertising exposures across media types and lifetime alcohol use outcomes among young people. No unexpected direction associations were observed for these outcomes.
- Alcohol promotion and owning alcohol-related merchandise.
Results related to associations between lifetime alcohol use and alcohol promotion or owning alcohol-related merchandise were more consistent. Across all six studies assessing these relationships, positive associations were observed for alcohol promotion and self-reported ownership of alcohol-related merchandise.
Past-year alcohol use
The researchers identified five studies from four countries (Australia, New Zealand, Thailand, United States) that assessed 19 different associations between alcohol marketing exposures and past-year alcohol use outcomes. These studies assessed different types of media and used a range of exposure measures.
- Alcohol advertising
Positive associations were found across television, bar or pub, and mixed media advertising types.
There is inconclusive evidence for the relationship between alcohol advertising across media types and past-year alcohol use outcomes among young people. No unexpected direction associations were observed for these outcomes.
- Alcohol promotion and owning alcohol-related merchandise
None of the studies included in our review examined the relationship between ownership of alcohol-related merchandise and past-year alcohol use. The only study examining alcohol promotion found a null association. Specifically, this single study from Australia found no association between seeing promotional materials and past-year alcohol use frequency.
Past-month and current alcohol use
The majority of studies included in this review assessed past-month or current alcohol use outcomes. In total, 21 studies from seven countries (Australia, Brazil, Cambodia, Germany, New Zealand, United Kingdom, United States) assessed 52 associations between alcohol marketing exposures and past-month or current alcohol use outcomes.
- Alcohol advertising
In studies that assessed young peoples’ exposure to alcohol advertising, positive relationships were found across media types including television, magazines and newspapers, movie, mixed media, bar and pub, internet, and brand allegiance.
Taken together, moderate evidence for the relationships between alcohol advertising exposures and past-month and current alcohol use among young people was observed.
- Alcohol promotion and owning alcohol-related merchandise
Four studies assessed associations between past-month or current alcohol use and exposure to alcohol promotion.
The limited evidence from different countries using different measures makes it difficult to summarize findings about associations between alcohol promotion and past-month alcohol use. Focusing on owning alcohol-related merchandise, the two studies that assessed this marketing exposure found positive associations between owning alcohol-related merchandise and past-month alcohol status, using samples in the United States and Australia.
Heavy or problematic alcohol use
Sixty-one different associations between alcohol marketing exposures and heavy or problematic alcohol use outcomes were reported in 18 studies included in our review. Samples from 14 countries (Australia, Brazil, Cambodia, Chile, Germany, Italy, Netherlands, Poland, New Zealand, Philippines, Thailand, United Kingdom, United States, Zambia) and many different types of media and measures of exposures were assessed.
- Alcohol advertising
Of the studies that assessed alcohol advertising, positive associations were found across television, magazines and newspapers, music, and mixed media.
There is mixed evidence for the relationship between alcohol marketing and heavy or problematic alcohol use outcomes in cross-sectional research.
- Alcohol promotion and owning alcohol-related merchandise
Positive associations for alcohol promotion and ownership of alcohol-related merchandise were also observed. In a study in Zambia, having been offered free samples of alcohol from an industry representative was associated with lifetime drunkenness or problem-alcohol use status.
Taken together, considerable evidence for the association between alcohol promotion or owning alcohol-related merchandise and heavy or problematic alcohol use outcomes among young people was observed.
Conclusions
Despite issues of measurement and construct clarity within this body of literature, this review suggests that exposure to alcohol industry marketing may be important for understanding and reducing young peoples’ alcohol use behavior.
The goal of this systematic review was to summarize cross-sectional research investigating the relationship between alcohol marketing exposures and alcohol use behaviors among young people.
Across alcohol use outcomes, marketing exposure types, and different media sources, the study findings suggest that, overall, the cross-sectional research provides more evidence for a positive relationship between alcohol marketing exposure and alcohol use behavior among adolescents and young adults than negative or null evidence. In other words, the cross-sectional evidence supports that alcohol marketing exposure may be associated with young peoples’ alcohol use behaviors.
In general, relationships for alcohol promotion and owning alcohol-related merchandise exposures were found to be more consistently related to alcohol consumption than for other marketing exposures. These positive associations were observed across the past four decades, in countries across continents, and with small and large samples.
Future policies aimed at regulating alcohol marketing to a greater extent may have important short- and long-term public health implications for reducing underage or problematic alcohol use among youth. And prevention interventions to reduce potential effects of exposure to alcohol marketing on young peoples’ alcohol use and problems may be important. For example, media campaigns or other interventions can be tailored to reduce effects of such exposures.
Findings from this review may have important policy and prevention implications.
Current voluntary codes for the alcohol industry that are designed to limit underage youth’s exposure to marketing may be insufficient. It may be important to adjust these industry standards or assign external agencies to assess compliance with them.
Indeed, research suggests young people are frequently exposed to alcohol advertising.
Evidence from this review supports these concerns as it highlights the wealth of research that demonstrates positive associations between diverse marketing exposures across media types and alcohol use behaviors among vulnerable populations. Results of this review also highlight the need to eliminate or reduce youth exposure to alcohol promotion, such as free sampling or owning alcohol-related merchandise.
