Alcohol Marketing Exposure and Youth Drinking
A Systematic Review and Meta-Analysis
Original Investigation
Key Points
Question
Is alcohol marketing exposure linked with subsequent increases in youth alcohol use?
Findings
This systematic review and meta-analysis of 19 cohorts (82 498 participants from 10 high-income countries) found that alcohol marketing exposure was linked with a small increase in the risk of initiating alcohol use and binge alcohol consumption among youth that was unlikely due to chance; 86% of estimated relative risks were positive, consistent across countries, marketing measures, and alcohol consumption levels.
Meaning
A large body of evidence shows that alcohol marketing exposure is linked with increased risk of youth alcohol use; confirmatory research is needed among youth in low- and middle-income countries.
Quote
The meta-analysis by Cukier et al has comprehensively and convincingly synthesized and augmented the evidence of an association between youth exposure to alcohol marketing and subsequent youth alcohol use behavior and consequences. They find that the risk of youth alcohol use rises with higher exposure to alcohol advertising, with television advertising having the strongest association with alcohol use.”
David H. Jernigan, PhD, Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
Abstract
Importance
Alcohol marketing is ubiquitous. Although numerous longitudinal studies have examined its link with youth alcohol use, few have been synthesized in a meta-analysis.
Objective
To quantify the longitudinal link between alcohol marketing exposure and youth alcohol use.
Data Sources
MEDLINE, Scopus, and PsycInfo from inception to September 2, 2025.
Study Selection
Longitudinal population-based studies assessing marketing exposure and alcohol use in youth younger than 25 years.
Data Extraction and Synthesis
Data were extracted independently and in duplicate. The Risk of Bias in Nonrandomized Studies—of Exposures (ROBINS-E) tool was used to assess risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess evidence certainty.
Main Outcomes and Measures
Exposures included television advertising, other channel (eg, online) advertising, alcohol portrayals in entertainment media (brand placement), promotional activities, branded merchandise ownership, advertisement or brand liking, and composite exposure measures.
Continuous exposures were scaled to reflect low-to-high comparisons, odds ratios were converted to relative risks (RRs), and multilevel meta-analysis was conducted to obtain pooled RRs. Subgroups were compared by exposure type, outcome, and risk of bias.
Results were narratively synthesized where meta-analysis was not possible.
Results
A total of 19 cohorts were identified (10 high-income countries; 23 publications; 94 RRs; n = 82 498). All studies were judged to be at risk of bias for self-report outcome assessment.
There was an increased risk of youth alcohol use with high vs low advertising exposure, with moderate certainty of evidence (upgraded due to evidence of dose response).
Narrative synthesis suggested that changes in attitudes and cognitions mediated the association.
In subgroup analyses, exposure to television advertising was found to have the strongest link with youth alcohol use.
Conclusions and Relevance
The results of this systematic review and meta-analysis show a link between alcohol marketing exposure and alcohol use outcomes across a variety of exposure types.
Additional research is needed using single exposure measures that capture multiple marketing channels, to better address risk of bias, and to include studies from low- to middle-income countries, where alcohol marketing is expanding.