Association between exposure to digital alcohol marketing and alcohol use: a systematic review and meta-analysis
Research articles
Key Finding
Teens and young adults who see alcohol promotions in their social media feeds are more likely to consume alcohol and engage in binge alcohol consumption, according to a Rutgers Health review of 31 studies that tracked links between exposure to digital alcohol marketing and real-world alcohol use. The review was published in Lancet Public Health.
Research in context
Evidence before this study
The researchers searched PubMed, PsychINFO, Web of Science, Scopus, Embase, and Communication & Mass Media for systematic reviews and meta-analyses examining the link between exposure to digital alcohol marketing and alcohol use, published from January 1, 2004 up to February 1, 2025.
The researchers limited their search to peer-reviewed English language publications and used the search terms: (digital alcohol marketing OR online alcohol advertising OR social media alcohol exposure) AND (alcohol use OR drinking behavior) AND (systematic review OR meta-analysis).
Previous research has suggested that exposure to digital alcohol marketing was associated with increased alcohol consumption. However, previous studies have been either qualitative systematic reviews or observational studies focusing on individual populations.
To the knowledge of the study authors, no meta-analysis to date has quantitatively synthesised global evidence on this relationship or examined how methodological characteristics, including digital platform type, are linked with alcohol use behaviours.
Added value of this study
This study is the first to provide a quantitative synthesis of the association between digital alcohol marketing exposure and alcohol use outcomes. Using a multilevel random-effects meta-analysis of 31 studies comprising 62,703 participants across 17 countries, the study found that exposure to digital alcohol marketing was linked with increased odds of past 30-day alcohol use, binge alcohol consumption, susceptibility to alcohol use among never users, and lifetime alcohol use.
Implications of all the available evidence
The evidence highlights the need for experimental and longitudinal research that can clarify the temporal order around, and causal relationship between, exposure to digital alcohol marketing and alcohol-related behaviours.
Alcohol-Related Social Media Content Is Harmful to Youth
Jon-Patrick Allem, an associate professor at the Rutgers School of Public Health and Rutgers Robert Wood Johnson Medical School and a senior author of the study, said the public debate about time spent on social media misses the most important point, as per Medical Express reporting.
There’s growing evidence that it’s not how long you spend on social media but what content you see that affects you,” Allem said, as per Medical Express.
Young people being exposed to alcohol promotions online is associated with alcohol use across different contexts and populations.”
Jon-Patrick Allem, associate professor, Rutgers School of Public Health and Rutgers Robert Wood Johnson Medical School, and a senior author of the study
The meta-analysis pooled data from 62,703 people. Participants exposed to digital alcohol marketing content, compared with those not exposed, had greater odds of reporting past 30-day alcohol use, binge alcohol intake, and susceptibility to use alcohol among never users. Researchers analysed results of studies published since the emergence of major social platforms and combined results with multilevel random effects models from six databases.
In this study, “digital alcohol marketing” refers to content designed to increase alcohol use, including brand pages, sponsored influencer videos, promotional campaigns and contests, as well as web and app advertising.
Across this international sample, those who saw alcohol marketing online were about twice as likely to report [alcohol use] or binge [alcohol use],” said Scott Donaldson, lead author and an assistant professor of general internal medicine at Rutgers Robert Wood Johnson Medical School, according to Medical Express.
Scott Donaldson, lead author and assistant professor of general internal medicine, Rutgers Robert Wood Johnson Medical School
Although youth alcohol use is declining overall, personalised feeds could still normalise alcohol for subsets of young people who linger on such content.
Algorithmic amplification means a small cue can be shown again and again,” Associate Prof. Allem said, as per Medical Express.
Across the studies, exposure to digital marketing was linked with roughly 75% higher odds of any reported alcohol use in the past 30 days and about 80% higher odds of binge alcohol use. Susceptibility to alcohol consumption among never-users was elevated by a similar margin, and lifetime alcohol use also showed a significant association.
The signal was strongest in adolescents using social media, which now mix paid placements, branded posts and influencer partnerships with user-generated clips.
Entirely unsponsored content doesn’t count.
Many of the studies underlying the meta-analysis were cross-sectional surveys, which can detect associations but cannot prove that alcohol ads push teens to start consuming alcohol rather than reaching those already inclined to consume alcohol.
Associate Prof. Allem said his group is testing that question directly. In a pilot experiment with about 2,000 young adults, participants who watched lifestyle influencer videos that incidentally featured alcohol were about 1.5 to 2.5 times more likely to express interest in alcohol consumption than peers who viewed matched videos with no alcohol, even after accounting for recent alcohol use.
The review found that exposure was particularly pronounced on social media and effects appeared stronger for adolescents than adults, a pattern that could guide regulators toward youth-specific safeguards.
Platforms already collect age and interest data that could curb exposure, but alcohol industry self-regulation online is inconsistent, and age gating is easy to bypass.
They could solve this overnight,” Associate Prof. Allem said, as per Medical Express.
The question is will, not capability.”
Jon-Patrick Allem, associate professor, Rutgers School of Public Health and Rutgers Robert Wood Johnson Medical School, and a senior author of the study
Summary
Background
Exposure to digital alcohol marketing content might be linked with pro-alcohol-related attitudes and behaviours, including the likelihood of initiating or sustaining the use of alcohol, especially among adolescents (aged <18 years) and young adults (aged 18–25 years).
This study aimed to examine the relationship between exposure to digital alcohol marketing content and alcohol use outcomes.
Methods
Alcohol-related, digital media-related, and marketing-related search terms were entered into six online databases: PubMed, Web of Science, Scopus, PsycINFO, Embase, and Communication & Mass Media.
Peer-reviewed articles written in English, published between January 1, 2004, and February 1, 2025, were included in the search. Studies that were included measured self-reported exposure to digital alcohol marketing content; used an unexposed control group; measured past 30-day alcohol use, binge drinking, or susceptibility to use alcohol among never users; and provided raw data to compute odds ratios (ORs) or reported ORs in the manuscript.
When available, adjusted odds ratios were included; otherwise, unadjusted estimates were computed from raw data. A multilevel random-effects meta-analysis was used to estimate ORs and 95% CI, and heterogeneity (I2) was calculated for each alcohol use outcome. Study quality and publication bias were assessed. The study protocol was registered on the Open Science Framework.
Findings
The search identified 9913 articles. 96 articles were eligible for full-text review, of which 65 articles were removed based on the exclusion criteria.
31 studies were included in the final meta-analysis. The total sample size was 62,703 participants (32,314 [51.5%] female; 30,389 [48.5%] male, including 52,475 (83.7%) adolescents (aged 11–17 years) and 10,228 (16.3%) adults (aged ≥18 years).
Participants exposed to digital alcohol marketing content, compared with those not exposed, had greater odds of reporting
- past 30-day alcohol use (19 studies, 46,361 participants),
- binge alcohol use (13 studies, 25,603 participants), and
- susceptibility to use alcohol among never users (seven studies, 18,698 participants).
Interpretation
Findings demonstrated a link between exposure to digital alcohol marketing content and alcohol-related behaviours. Future research is needed to clarify the temporal order between exposure to digital alcohol marketing content and alcohol-related behaviours.