Predicting the potential for risky behavior among those "too young" to drink as the result of appealing advertising

How Viewing Alcohol Posts of Friends on Social Networking Sites Influences Predictors of Alcohol Use

Young adults are frequently exposed to alcohol posts from their friends on social networking sites, and little research has investigated the influences of these posts on alcohol use. Therefore, this study investigated how exposure to alcohol posts influenced determinants of alcohol use, and whether alcohol posts of close friends influenced these determinants more strongly compared to alcohol posts of distant friends. Students from Dutch universities (N = 210) participated in an experiment with a 2 (post condition: alcohol or neutral) x 2 (friend condition: close or distant) between-subjects design. Participants that were exposed to alcohol posts reported higher intention to use alcohol, F(1, 204) = 4.32, p =.039, willingness to use alcohol, F(1, 204) = 8.15, p =.005, and more positive affective attitudes about alcohol, F(1, 204) = 5.84, p =.017, than participants that were exposed to neutral posts. Additionally, participants who viewed alcohol posts of close friends reported more positive affective attitudes about alcohol compared to participants who viewed alcohol posts of distant friends, F(1, 204) = 5.15, p =.024. Developers of health interventions could use these findings to raise awareness about the unhealthy influences of alcohol posts on determinants of young adults' alcohol use.

Factors associated with alcohol consumption among early adolescents in a province in Eastern region of Thailand: a cross-sectional analysis

A cross-sectional study was applied to obtain factors associated with alcohol consumption since information among early adolescents in Thailand is limited. Data was collected from December 2016 to March 2017. A questionnaire was developed through a literature review and tested for validation and reliability. Multi-stage random sampling was used to recruit youths aged 10-14 years from Chonburi Province, Thailand. Descriptive statistics (mean and standard deviation), Chi-squared test, and multivariable logistic regression were used for data analysis. The mean and standard deviation (SD) for the age of participants was 12.07 years (1.42) with 50.23% being male. In total, 10.94% reported drinking alcohol in the past 12 months. Current drinking in the past year was positively associated with older youths of 14 years of age (AOR = 5.34, 95% CI = 2.91-9.81) having a positive attitude toward alcohol consumption behavior (AOR = 4.18 95% CI = 3.36-5.21), direct observation of friends' drinking (AOR = 4.21, 95% CI = 3.32-5.32), direct observation of villagers/community members' drinking (AOR = 1.99, 95% CI = 1.15- 3.48), adolescents whose parents stored alcohol at home (AOR = 1.35, 95% CI = 1.06-1.55), and being exposed to alcohol advertising (AOR = 1.60, 95% CI =1.16-2.23). The factor most inversely associated with current drinking appears to be male gender (AOR = 0.78, 95% CI =0.64-0.94). Strategies for delaying and reducing drinking among early adolescents should accompany these risk factors into any preventive programs.

The Implementation and Evaluation of a Media Literacy Intervention About PAES Use in Sport Science Students

With respect to both competitive and amateur/fitness sports, media may strongly influence young people's opinions and behaviors concerning the use of PAES (Performance and Appearance Enhancing Substances). The present investigation addressed this topic by focusing on sport sciences students' beliefs concerning the possible role of media related to the implementation and evaluation of a PAES-focus media literacy intervention conducted with sport science students. This study relied on a sample of 521 students (attrition rate 10.3%) (45.1% female, mean age = 22.6, SD = 2.20), which provided baseline data on students' levels of media literacy concerning the use of PAES (i.e. "descriptive sample"), and a sample of 248 students, who participated in and provided data on the media literacy intervention. This latter sample included a group of 128 students (44.5% female, mean age = 23.03, SD = 3.76) who actively participated in the intervention (i.e. "intervention group"), and a group of 120 students who did not (i.e. "control group", 53.3% female, mean age = 22.25, SD = 2.47). All students filled out media literacy questionnaires targeting students' awareness of media influence, their views about the realism of media content, their sense of confidence in dealing with media messages, and their positive attitudes toward PAES use. Analyses of questionnaire data showed that students are relatively aware of media influence on people's views and behaviors with respect to PAES use. At the same time, students also believed that young people do not consider media as "realistic sources" of information; nonetheless, they also did not consider themselves entirely capable of dealing effectively with media messages. With respect to the intervention, students overall appreciated and greatly welcomed the educational program on media literacy, and the analyses of intervention data across intervention and control groups showed that key media literacy variables changed over time, attesting to the overall effectiveness of the intervention.

A latent class analysis of adolescents' technology and interactive social media use: Associations with academics and substance use

Latent class analysis was used to identify patterns of technology and social media use among adolescents in a national study (n = 26,348). Multinomial logistic regression was used to examine associations between latent classes and academics and substance use. Results demonstrated four classes: Infrequent Users (55%), Interactive Users (21%), Television Watchers (14%), and Constant Users (10%). Compared to Infrequent Users, Interactive, and Constant Users had lower grades and higher alcohol and marijuana use. Television Watchers had lower grades and participated in fewer extracurricular activities compared to Infrequent Users, but there were no differences on substance use. Results show that adolescents with the most media-intensive profiles were also at greater risk for poor academic outcomes and substance use.

Adolescents' Sex-Related Alcohol Expectancies and Alcohol Advertisements in Magazines: The Role of Wishful Identification, Realism, and Beliefs about Women's Enjoyment of Sexualization

In the United States, approximately one in five sexually active teens report alcohol or drug use before their last sexual encounter. The co-occurrence of alcohol with sex increases risky behaviors, such as having unprotected sex. Magazines that target adolescents often feature alcohol advertisements with sexual innuendo and female objectification. Such advertisements may inform adolescents' expectancies that alcohol can facilitate sex. With an experimental design and path analysis, we examined 874 adolescents' (ages 15-17, M = 16.05) exposure to objectifying alcohol ads, their perceptions of the ads, and their attitudes about women's sexualization in relation to sex-related alcohol expectancies. For female adolescents we assessed their enjoyment of sexualization, and for male adolescents, we assessed their perceived enjoyment of sexualization among women. Teens' perceptions that alcohol ads promote the co-occurrence of alcohol with sex mediated the effect of ad exposure and perceived realism of the ads on sex-related alcohol expectancies. The enjoyment of sexualization construct mediated the effect of wishful identification and perceived realism on sex-related alcohol expectancies. Wishful identification also directly related to sex-related alcohol expectancies. Results challenge the alcohol industry's compliance with advertisement regulations and suggest media literacy as a strategy to promote healthy sex-related alcohol expectancies among adolescents.

Awareness of alcohol marketing, ownership of alcohol branded merchandise, and the association with alcohol consumption, higher-risk drinking, and drinking susceptibility in adolescents and young adults: a cross-sectional survey in the UK

OBJECTIVES

To explore awareness of alcohol marketing and ownership of alcohol branded merchandise in adolescents and young adults in the UK, what factors are associated with awareness and ownership, and what association awareness and ownership have with alcohol consumption, higher-risk drinking and susceptibility.

DESIGN

Online cross-sectional survey conducted during April-May 2017.

SETTING

The UK.

PARTICIPANTS

Adolescents and young adults aged 11-19 years in the UK (n=3399).

MAIN OUTCOME MEASURES

Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) (0-12) and indication of higher-risk consumption (>5 AUDIT-C) in current drinkers. Susceptibility to drink (yes/no) in never drinkers.

RESULTS

Eighty-two per cent of respondents were aware of at least one form of alcohol marketing in the past month and 17% owned branded merchandise. χ2 tests found that awareness of marketing and ownership of branded merchandise varied within drinking variables. For example, higher awareness of alcohol marketing was associated with being a current drinker (χ2=114.04, p<0.001), higher-risk drinking (χ2=85.84, p<0.001), and perceived parental (χ2=63.06, p<0.001) and peer approval of consumption (χ2=73.08, p<0.001). Among current drinkers, multivariate regressions (controlling for demographics and covariates) found that marketing awareness and owning branded merchandise was positively associated with AUDIT-C score and higher-risk consumption. For example, current drinkers reporting medium marketing awareness were twice as likely to be higher-risk drinkers as those reporting low awareness (adjusted OR (AOR)=2.18, 95% CI 1.39 to 3.42, p<0.001). Among never drinkers, respondents who owned branded merchandise were twice as likely to be susceptible to drinking as those who did not (AOR=1.98, 95% CI 1.20 to 3.24, p<0.01).

CONCLUSIONS

Young people, above and below the legal purchasing age, are aware of a range of alcohol marketing and almost one in five own alcohol branded merchandise. In current drinkers, alcohol marketing awareness was associated with increased consumption and greater likelihood of higher-risk consumption. In never drinkers, ownership of branded merchandise was associated with susceptibility.

Examining Factors Influencing Internet Addiction and Adolescent Risk Behaviors Among Excessive Internet Users

In China, public concern continues to mount regarding the risks of excessive Internet use among adolescents. This study investigated the factors influencing Internet addiction and adolescent risk behaviors among excessive Internet users. Proposing a conceptual model with a theoretical origin in risk behavior theory and media dependency theory, this study examined the influence of personality traits, online gaming, Internet connectedness (both the overall index and various scopes), and demographics on Internet addiction and risk behaviors (smoking, drinking, gambling, and risky sexual behaviors). Clinical data (N = 467) were retrieved from one of the earliest and largest Internet addiction clinics in China. The findings reveal that certain personality traits are significantly associated with Internet addiction and risk behaviors. Online gaming had a strong impact on both Internet addiction and risk behaviors among excessive Internet users. The study also reveals that various scopes of Internet connectedness, such as site scope, facilitate addictive Internet use, and risk behaviors among adolescents. The findings can contribute to the prevention of and intervention into Internet addiction and adolescent risk behaviors.

"Decide Now, Buy Marlboro": Examining the influence and appeal of Marlboro's new brand architecture among Filipino adolescents

In recent years, Philip Morris International (PMI) launched a global rebranding strategy to expand the reach of Marlboro. Using a mixed-methods design, this study evaluated the appeal and influence of Marlboro advertising among Filipino youth. Six hundred and twenty-three adolescents aged 13-17 years old in Metro Manila participated in a survey, including three advertising conditions: two for Marlboro and one for Mighty, a local cigarette brand. One-way repeated measures analysis of variance (ANOVA) and paired t-tests evaluated differences between the three conditions on participants' attitudes toward advertisements [measured as identification, likeability, and perceived effectiveness (PE)]. Compared to Mighty, never-smokers rated Marlboro advertisements as more identifiable and likeable. Comparing by smoking status (never vs. ever), multivariable logistic regression assessed the influence of these attitudes on intention to smoke. Increased likeability was associated with greater intention to smoke among never-smokers, and greater PE increased odds of intention to smoke for both never- and ever-smokers. Additionally, six focus group discussions (FGD) explored responses to campaign messaging. Themes were compared within and across groups. Marlboro was also appealing to FGD participants, who described the ads as attractive to youth and promoting "adventure" and "freedom", whereas the Mighty brand was seen as being for adults and current smokers. Our findings illustrate that Marlboro advertisements are distinctly appealing to youth. Marlboro rhetoric - where consumers are urged to "decide" to "Be Marlboro" - was particularly powerful. These findings support the need for addressing gaps in policies regulating the marketing and promotion of tobacco in the Philippines.

Unpacking policy formulation and industry influence: the case of the draft control of marketing of alcoholic beverages bill in South Africa

Alcohol is a major contributor to the Non-Communicable Disease burden in South Africa. In 2000, 7.1% of all deaths and 7% of total disability-adjusted life years were ascribed to alcohol-related harm in the country. Regulations proposed to restrict alcohol advertising in South Africa present an evidence-based upstream intervention. Research on policy formulation in low- and middle-income countries is limited. This study aims to describe and explore the policy formulation process of the 2013 draft Control of Marketing of Alcoholic Beverages Bill in South Africa between March 2011 and May 2017. Recognising the centrality of affected actors in policy-making processes, the study focused on the alcohol industry as a central actor affected by the policy, to understand how they-together with other actors-may influence the policy formulation process. A qualitative case study approach was used, involving a stakeholder mapping, 10 in-depth interviews, and review of approximately 240 documents. A policy formulation conceptual framework was successfully applied as a lens to describe a complex policy formulation process. Key factors shaping policy formulation included: (1) competing and shared values-different stakeholders promote conflicting ideals for policymaking; (2) inter-department jostling-different government departments seek to protect their own functions, hindering policy development; (3) stakeholder consultation in democratic policymaking-policy formulation requires consultations even with those opposed to regulation and (4) battle for evidence-evidence is used strategically by all parties to shape perceptions and leverage positions. This research (1) contributes to building an integrated body of knowledge on policy formulation in low- and middle-income countries; (2) shows that achieving policy coherence across government departments poses a major challenge to achieving effective health policy formulation and (3) shows that networks of actors with commercial and financial interests use diverse strategies to influence policy formulation processes to avoid regulation.

Is there a nocebo response that results from disease awareness campaigns and advertising in Australia, and can this effect be mitigated?

Direct-to-consumer advertising is banned in Australia, and instead pharmaceutical companies use disease awareness campaigns as a strategy to raise public awareness of conditions for which the company produces a treatment. This practice has been justified by promoting individual autonomy and public health, but it has attracted criticism regarding medicalisation of normal health and ageing, and exaggeration of the severity of the condition in question, imbalanced reporting of risks and benefits, and damaging the patient-clinician relationship. While there are benefits of disease awareness promotion, there is another possible adverse consequence that has not yet been rigorously considered: the possibility of inducing a nocebo response via the campaign. We will discuss the creation of a nocebo response in this context.

Are media literacy interventions effective at changing attitudes and intentions towards risky health behaviors in adolescents? A meta-analytic review

Youth are inundated with media products promoting risky health behaviors (RHBs), including substance use and risky sexual activity. Media literacy interventions emphasize critical media consumption to decrease RHBs. However, it is unclear whether they positively influence attitudes and behavioral intentions towards RHBs. We conducted meta-analyses of 15 studies (N = 5000) testing intervention effectiveness on media literacy skills and 20 studies (N = 9177) testing effectiveness on attitudes and intentions towards RHBs. We found positive effects on media literacy skills (Hedge's g = .417, [95% CI, .29-.54]) and attitudes and intentions (Hedge's g = .100 [95% CI, .01-.19]). Intervention medium and target behavior moderated intervention success on attitudes and intentions, but no moderators emerged for media literacy skills. These interventions produce positive effects on media literacy skills and positive but smaller effects on attitudes and behavioral intentions, depending on medium and target behaviour. Implications for adolescent health initiatives are discussed.

The Differential Effects of Exposure to “Youth-Oriented” Magazines on Adolescent Alcohol Use

This study examines the effects of exposure to “youth-oriented” magazines on normative beliefs about teenage drinking, drinking expectancies, and drinking frequency during the past 30 days among a group of 972 seventh- and eighth-grade students from two Western U.S. states. Three magazine categories were considered: music/entertainment, sports, and men's lifestyle. Structural equation modeling was used to test the simultaneous influences (direct and indirect) of magazine exposure, religiosity, parental drinking, and the number of best friends who drink on the three outcome variables (normative beliefs, expectancies, and current drinking). Exposure to each magazine type was tested in a separate model. Men's lifestyle magazine reading frequency was positively associated (both directly and indirectly) with all three outcomes. Music and entertainment magazine reading was positively linked to normative beliefs and drinking expectancies, but was unrelated to drinking frequency in the past 30 days. Sports magazine reading was unrelated to the three outcomes.

Assessing Youth-Appealing Content in Alcohol Advertisements: Application of a Content Appealing to Youth (CAY) Index

Underage drinking is a serious public health problem in the United States, and youth exposure to alcohol advertising has been indicated as a possible contributing factor. Although a number of studies have identified advertising content features that youth find appealing, a key limitation of this research is the absence of a broader tool to examine those features, especially those used by alcohol brands that are popular with underage drinkers. We created an index of content elements found in the research literature to be appealing to youth, and then used this index in a content analysis to identify the degree to which youth-appealing content appeared in a sample of alcohol ads that aired on television shows popular among youth. Finally, using bivariate analysis, we tested the relationship between alcohol brands' use of this content and the popularity of those brands among youth. We found that many of the ads featured youth-appealing content, and that the ads for the alcohol brands most popular among youth had more youth-appealing content than the less popular brands.

The Effects of a Nutrition Media Literacy Intervention on Parents' and Youths' Communication about Food

Interventions addressing links between media exposure and obesity risk for school-age youth have not explicitly addressed the role of family communication about media. Youths' influence attempts on parents to purchase advertised foods can create conflict and negatively affect parental food choices. This study tested whether a family-based media literacy curriculum improves parents' media management skills and decreases youths' susceptibility to appealing but unrealistic food marketing. A matched-group pretest/posttest field experiment of parent-youth dyads with control group (N = 100 dyads, youth M = 11 years of age) tested the six-session curriculum. Hypotheses were analyzed using a Bayesian structural equation model. The curriculum increased parents' active negative mediation to foster youths' critical thinking about food marketing, b* = 0.35, 95% CCI [0.17, 0.50], increased parent Efficacy for making healthy dietary changes for their families, b* = 0.59, 95% CCI [0.41, 0.75], and fostered family discussion about nutrition labels (total effect = 0.22). Additionally, cumulative influences of Perceived Desirability and Wishful Identification on youths' requests for marketed foods were reduced (total effect = 0.04). Media literacy education can empower parents and improve youths' critical thinking to reduce effects of food marketing on families and improve use of media to obtain nutrition information.

An Exploration of the Associations of Alcohol-Related Social Media Use and Message Interpretation Outcomes to Problem Drinking Among College Students

College students' use of digital communication technology has led to a rapid expansion of digital alcohol marketing efforts. Two surveys (total usable n = 637) were conducted to explore college students' experiences with alcohol-related social media, their decision making related to alcohol use, and their problematic drinking behaviors. Study results indicated that students' use of alcohol-related social media predicted their problem drinking behaviors. In addition, students' wishful identification, perceived desirability, perceived similarity, and normative beliefs predicted their expectancies for drinking alcohol. Finally, students' expectancies for drinking alcohol predicted their problematic drinking behaviors.

Exposure to alcohol advertising and adolescents' drinking beliefs: Role of message interpretation

OBJECTIVE

Recent research revealed momentary associations between exposure to alcohol advertising and positive beliefs about alcohol among adolescents (Martino et al., 2016). We reanalyzed those data to determine whether associations depend on adolescents' appraisal of ads.

METHOD

Over a 10-month period in 2013, 589 youth, ages 11-14, in the Los Angeles, CA, area, participated in a 14-day ecological momentary assessment, logging all exposures to alcohol advertisements as they occurred and completing brief assessments of their skepticism toward, liking of, and identification with any people in each ad, as well as their alcohol-related beliefs at the moment. Participants also completed measures of their alcohol- related beliefs at random moments of nonexposure throughout each day. Mixed-effects regression models compared beliefs about alcohol at moments of exposure to alcohol advertising that was appraised in a particular way (e.g., with liking, without liking) to beliefs at random moments.

RESULTS

When youth encountered ads they appraised positively, their beliefs about alcohol were significantly more positive than when they were queried at random moments. Beliefs in the presence of ads that were not positively appraised were generally similar to beliefs at random moments.

CONCLUSION

Youth are active participants in the advertising process. How they respond to and process alcohol advertising strongly moderates the association between exposure and alcohol-related beliefs. More effort is needed to identify attributes of alcohol advertisements, and of youth, that determine how youth process alcohol ads. This information can be used to either limit exposure to problematic ads or make youth more resilient to such exposure. (PsycINFO Database Record

Television and drinking expectancies: the influence of television viewing on positive drinking expectanc and alcohol use among US and Norwegian adolescents: a comparative analysis

Objective

Exposure to incidental portrayals of drinking on television and cleverly crafted advertisements has been linked to the development of positive alcohol expectancies in children and teenagers. Researchers hoping to demonstrate this connection, however, have difficultly in finding adolescent groups with little or no exposure to alcohol advertising for comparative purposes. One of the cornerstones of Norwegian alcohol policy has been a government-enacted ban on all forms of advertising for alcohol products containing more than 2.5% alcohol by volume. As a consequence, Norwegian youth have almost no experience with alcohol advertising. This study represents a comparative analysis of Norwegian and US teenagers that seeks to improve our understanding of television's and alcohol advertising's potential role in shaping attitudes about alcohol.

Method

Self-report data on television viewing, normative beliefs about teenage drinking, and alcohol expectancies were collected from convenience samples of 972 junior high students in the US and 622 junior high students in Norway.

Results

Although students in both countries watch about the same amount of television and about equal numbers have tried alcohol, the Norwegian students were more likely to see drinking as a normal teenage behavior and to have more positive outcome expectancies. For students from both countries who had no personal experience with alcohol, frequent television viewers were more likely than light viewers to see drinking as a normative behavior with positive outcomes. This was particularly true for Norwegian students who viewed large amount of US and British programs as well as music videos.

Conclusion

The absence of alcohol advertising in Norway may be overshadowed by the general cultural acceptance of adolescent and young adult drinking. For students with no personal experience with alcohol, however, television may be functioning as an important socializing agent, providing them with portrayals of drinking behaviors, cultivating normative beliefs, and presenting opportunities to cognitively model and rehearse the behaviors shown.

Factors that influence children's gambling attitudes and consumption intentions: lessons for gambling harm prevention research, policies and advocacy strategies

BACKGROUND

Harmful gambling is a public health issue that affects not only adults but also children. With the development of a range of new gambling products, and the marketing for these products, children are potentially exposed to gambling more than ever before. While there have been many calls to develop strategies which protect children from harmful gambling products, very little is known about the factors that may influence children's attitudes towards these products. This study aimed to explore children's gambling attitudes and consumption intentions and the range of consumer socialisation factors that may influence these attitudes and behaviours.

METHODS

Children aged 8 to 16 years old (n = 48) were interviewed in Melbourne, Australia. A semi-structured interview format included activities with children and open-ended questions. We explored children's perceptions of the popularity of different gambling products, their current engagement with gambling, and their future gambling consumption intentions. We used thematic analysis to explore children's narratives with a focus on the range of socialising factors that may shape children's gambling attitudes and perceptions.

RESULTS

Three key themes emerged from the data. First, children's perceptions of the popularity of different products were shaped by what they had seen or heard about these products, whether through family activities, the media (and in particular marketing) of gambling products, and/or the alignment of gambling products with sport. Second, children's gambling behaviours were influenced by family members and culturally valued events. Third, many children indicated consumption intentions towards sports betting. This was due to four key factors: (1) the alignment of gambling with culturally valued activities; (2) their perceived knowledge about sport; (3) the marketing and advertising of gambling products (and in particular sports betting); and (4) the influence of friends and family.

CONCLUSIONS

This study indicates that there is a range of socialisation factors, particularly family and the media (predominantly via marketing), which may be positively shaping children's gambling attitudes, behaviours and consumption intentions. There is a need for governments to develop effective policies and regulations to reduce children's exposure to gambling products and ensure they are protected from the harms associated with gambling.

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

Aim

To systematically review evidence on the influence of specific marketing components (Price, Promotion, Product attributes and Place of sale/availability) on key drinking outcomes (initiation, continuation, frequency and intensity) in young people aged 9–17.

Methods

MEDLINE, EMBASE, SCOPUS, PsychINFO, CINAHL and ProQuest were searched from inception to July 2015, supplemented with searches of Google Scholar, hand searches of key journals and backward and forward citation searches of reference lists of identified papers.

Results

Forty-eight papers covering 35 unique studies met inclusion criteria. Authors tended to report that greater exposure to alcohol marketing impacted on drinking initiation, continuation, frequency and intensity during adolescence. Nevertheless, 23 (66%) studies reported null results or negative associations, often in combination with positive associations, resulting in mixed findings within and across studies. Heterogeneity in study design, content and outcomes prevented estimation of effect sizes or exploration of variation between countries or age subgroups. The strength of the evidence base differed according to type of marketing exposure and drinking outcome studied, with support for an association between alcohol promotion (mainly advertising) and drinking outcomes in adolescence, whilst only two studies examined the relationship between alcohol price and the drinking behaviour of those under the age of 18.

Conclusion

Despite the volume of work, evidence is inconclusive in all four areas of marketing but strongest for promotional activity. Future research with standardized measures is needed to build on this work and better inform interventions and policy responses.

A Systematic Review of the Impact of Exposure to Internet-Based Alcohol-Related Content on Young People's Alcohol Use Behaviours

AIMS

To conduct a systematic review of studies exploring the relationship between exposure to Internet-based alcohol-related content and alcohol use among young people.

METHODS

Searches of electronic databases and reference lists of relevant articles were conducted to retrieve studies of relevance up until December 2015. Full texts of the studies that met the inclusion criteria were read, appraised for quality using the Kmet forms and guidelines, and included in this review.

RESULTS

Fifteen relevant studies were identified. The included studies were a mix of cross-sectional, longitudinal, experimental and qualitative studies conducted in the USA, the UK, Australia and New Zealand. The age range of the participants involved in these studies was 12-25 years. Included studies employed a variety of study designs and a range of different exposure variables and outcome measures. Studies demonstrated significant associations between exposure to Internet-based alcohol-related content and intentions to drink and positive attitudes towards alcohol drinking among young people.

CONCLUSION

Exposure to alcohol-related content on the Internet might predispose young people to patterns of alcohol use by promoting alcohol as a natural and vital part of life. However, the research exploring the influence of this novel form of advertising on young people's alcohol use is emergent, and comprised primarily of cross-sectional studies. To evaluate the direction of the association between exposure to online alcohol-related content and alcohol use, we call for further research based on longitudinal designs.

SHORT SUMMARY

From 15 relevant studies identified, this review reports significant associations between exposure to Internet-based alcohol-related content and intentions to drink and positive attitudes towards alcohol drinking among young people, with different influences found at different stages of alcohol use.

Immediate effects of alcohol marketing communications and media portrayals on consumption and cognition: a systematic review and meta-analysis of experimental studies

BACKGROUND

Restricting marketing of alcoholic products is purported to be a cost-effective intervention to reduce alcohol consumption. The strength of evidence supporting this claim is contested. This systematic review aimed to assess immediate effects of exposure to alcohol marketing on alcoholic beverage consumption and related cognitions.

METHODS

Electronic searches of nine databases, supplemented with reference list searches and forward citation tracking, were used to identify randomised, experimental studies assessing immediate effects of exposure to alcohol marketing communications on objective alcohol consumption (primary outcome), explicit or implicit alcohol-related cognitions, or selection without purchasing (secondary outcomes). Study limitations were assessed using the Cochrane Risk of Bias tool. Random and fixed effects meta-analyses were conducted to estimate effect sizes.

RESULTS

Twenty four studies met the eligibility criteria. A meta-analysis integrating seven studies (758 participants, all students) found that viewing alcohol advertisements increased immediate alcohol consumption relative to viewing non-alcohol advertisements (SMD = 0.20, 95 % CI = 0.05, 0.34). A meta-analysis integrating six studies (631 participants, all students) did not find that viewing alcohol portrayals in television programmes or films increased consumption (SMD = 0.16, 95 % CI = -0.05, 0.37). Meta-analyses of secondary outcome data found that exposure to alcohol portrayals increased explicit alcohol-related cognitions, but did not find that exposure to alcohol advertisements influenced explicit or implicit alcohol-related cognitions. Confidence in results is diminished by underpowered analyses and unclear risk of bias.

CONCLUSIONS

Viewing alcohol advertisements (but not alcohol portrayals) may increase immediate alcohol consumption by small amounts, equivalent to between 0.39 and 2.67 alcohol units for males and between 0.25 and 1.69 units for females. The generalizability of this finding beyond students and to other marketing channels remains to be established.

Italian Alcohol Advertising Regulation and Enforcement

In European countries alcohol advertising is regulated by two channels: The law and self-regulation. At present in Italy both control systems exist, even if in reality only the self-code works. After a debate that lasted for more than ten years the recent law on alcohol (2001) has not introduced significant innovations. Meanwhile, alcohol advertising has become more and more aggressive. Nowadays alcohol advertising is forbidden only in a few situations: TV programs devoted to children, on TV from 4 p.m. to 7 p.m for spirits ads, and in environments mainly attended by underage people. Otherwise alcohol advertising should respect the restrictions indicated in the self-regulation code. These limitations regard only the contents of the advertising. The article examines how content regulations on Italian alcohol advertising and promotion work in different media channels (TV, radio, magazines, billboards, environments attended by adolescents). The Italian self-regulation code and other laws are described, along with the complaint procedures. Content control in alcohol advertising does not seem to work because the rules are formulated in vague terms and therefore are open to various interpretations. Thus it is too difficult to decide what is or what it is not inducing the “audience to think that use of alcoholic drinks increases clearness of mind, physical and sexual health,” or that the message is addressed to minors. Although research on effects of advertising on alcohol consumption does not show clear results, following the Council of the European Union Recommendation (2001), contents regulation should be much more restricted to ensure that alcoholic beverages are not designed or promoted to appeal to children and adolescents. There remains the more radical alternative, namely, to forbid alcohol advertising, at least on TV networks.

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.

Underage access to online alcohol marketing content: a YouTube case study

AIMS

With the proliferation of the Internet and online social media use, alcohol advertisers are now marketing their products through social media sites such as YouTube, Facebook and Twitter. As a result, new recommendations have been made by the Federal Trade Commission concerning the self-regulation of digital marketing strategies, including content management on social and digital media sites. The current study sought to determine whether alcohol companies were implementing the self-imposed mandates that they have developed for online marketing. Specifically, we examined whether alcohol companies were implementing effective strategies that would prevent persons under the minimum legal drinking age in the USA from accessing their content on YouTube.

METHODS

We assessed 16 alcohol brands (beer and liquor) associated with the highest prevalence of past 30 day underage alcohol consumption in the USA. Fictitious YouTube user profiles were created and assigned the ages of 14, 17 and 19. These profiles then attempted to access and view the brewer-sponsored YouTube channels for each of the 16 selected brands.

RESULTS

Every underage profile, regardless of age, was able to successfully subscribe to each of the 16 (100%) official YouTube channels. On average, two-thirds of the brands' channels were successfully viewed (66.67%).

CONCLUSION

Alcohol industry provided online marketing content is predominantly accessible to underage adolescents. Thus, brewers are not following some of the self-developed and self-imposed mandates for online advertising by failing to implement effective age-restriction measures (i.e. age gates).

Regulating alcohol advertising: content analysis of the adequacy of federal and self-regulation of magazine advertisements, 2008-2010

OBJECTIVES

We analyzed beer, spirits, and alcopop magazine advertisements to determine adherence to federal and voluntary advertising standards. We assessed the efficacy of these standards in curtailing potentially damaging content and protecting public health.

METHODS

We obtained data from a content analysis of a census of 1795 unique advertising creatives for beer, spirits, and alcopops placed in nationally available magazines between 2008 and 2010. We coded creatives for manifest content and adherence to federal regulations and industry codes.

RESULTS

Advertisements largely adhered to existing regulations and codes. We assessed only 23 ads as noncompliant with federal regulations and 38 with industry codes. Content consistent with the codes was, however, often culturally positive in terms of aspirational depictions. In addition, creatives included degrading and sexualized images, promoted risky behavior, and made health claims associated with low-calorie content.

CONCLUSIONS

Existing codes and regulations are largely followed regarding content but do not adequately protect against content that promotes unhealthy and irresponsible consumption and degrades potentially vulnerable populations in its depictions. Our findings suggest further limitations and enhanced federal oversight may be necessary to protect public health.

Defining strategies for promoting product through 'drink responsibly' messages in magazine ads for beer, spirits and alcopops

BACKGROUND

Neither federal regulations nor industry voluntary codes require 'responsibility' statements in alcohol advertising. Stand alone 'public service' responsibility campaigns have been found to convey pro-drinking themes. We analyzed responsibility statements placed in conventional alcohol advertising to consider how responsible drinking is presented, and potential communicative goals for responsibility messages.

METHODS

We conducted a descriptive textual analysis of 'drink responsibly' messages appearing in all advertisements pertaining to beer, spirits and alcopop products placed in U.S. national, newsstand magazines from 2008 to 2010 (N=1795). We coded advertisements for presence, prominence and content of responsibility messages. Using a qualitative approach, we created a taxonomy of product promotional elements within the responsibility messages.

RESULTS

Analysis revealed that 87% of the advertisements included a responsibility message (N=1555); responsibility messages were less prominent than any included tagline (product slogan). Messages never defined responsible drinking or promoted abstinence. No link was made between warnings and activities conveyed in the advertisements. There were 197 unique responsibility messages, 88% of which (N=174) were promotional of the advertised product. Responsibility promotional content was categorized into 5 strategies: Product name, Consumption information, Product qualities, Product promise, Qualities of the drinker.

CONCLUSIONS

Responsibility messages were overwhelmingly used to promote product rather than convey relevant public health information. Based on this analysis, existing responsibility messages are largely ineffective at conveying relevant public health information, and should be supplemented by or replaced with prominently placed, externally developed, cognitively tested warnings that do not reinforce marketing messages.

Get real: how current behavior influences perceptions of realism and behavioral intent for public service announcements

This research examined how realism and current behavior influence message reception and processing for public service announcements (PSAs) designed to help parents with meal planning. Findings from 19 in-depth interviews revealed that the perceived realism of the message, the similarity, and the wishful identification with informants' lives influenced message acceptance, in line with the Message Interpretation Process (MIP) model. Results of an online survey with mothers show that realism matters more for those individuals who already engage in the featured behavior. In line with theory, "experts" (meal planners) show increased behavioral intent of the featured behaviors when viewing the more realistic PSA.

The impact of media-related cognitions on children's substance use outcomes in the context of parental and peer substance use

Media-related cognitions are a unique influence on adolescents' substance use outcomes even after accounting for the powerful influence of parent and peers. This cross-sectional study expands upon prior research by investigating the impact of media-related cognitions on children's alcohol and tobacco outcomes in the context of parental and peer substance use. Six hundred forty-nine elementary school children (M = 9.4 years of age, SD = 1.1 years; 51 % female) completed self-report questionnaires. After accounting for peer and parental substance use, children's media-related cognitions were independently associated with three outcomes: preferences for alcohol-branded merchandise, moral beliefs about underage alcohol and tobacco use, and intentions to use alcohol and tobacco. Children's perceptions of the desirability and realism of alcohol and tobacco ads--and their similarity to and identification with these ads--predicted greater intentions to use. Desirability and identification with alcohol and tobacco ads were associated with stronger preferences for alcohol-branded merchandise, and understanding advertising's persuasive intent predicted weaker preferences. Media deconstruction skills predicted stronger beliefs that underage alcohol and tobacco use is wrong. Peer and parental substance use were associated with stronger substance-use intentions among children and weaker feelings that substance use is wrong. The findings highlight the role of media influence in contributing to youth substance use and the potential role of media literacy education in the early prevention of substance use.

The effectiveness of different approaches to media literacy in modifying adolescents' responses to alcohol

Fearing the negative effect that alcohol advertising might have on adolescents' receptiveness to the consumption of alcohol, health educators have used media literacy as an effective strategy to mitigate the effect of these messages in the media. The present study applied parental mediation to the design and evaluations of a media literacy curriculum that targets alcohol decision-making processes illustrated in the message interpretation process model. The authors conducted a pretest-posttest quasi-experiment of 171 adolescents to examine the effect of a negative evaluative approach and a balanced evaluative approach (a combination of negative and positive evaluative strategies) to media literacy on modifying adolescents' responses to alcohol messages. Results showed that different media literacy approaches had varying degrees of effectiveness on adolescent boys and girls. After receiving a negative media literacy lesson, adolescent boys regarded television characters as less realistic and believed that drinking alcohol had negative consequences. In contrast, adolescent girls benefited more from a balanced evaluative approach as their media skepticism attitude was enhanced. Results suggest that health educators should choose tailored pedagogical approaches that are based on gender to improve decision making regarding alcohol consumption.

The role of media literacy in shaping adolescents' understanding of and responses to sexual portrayals in mass media

This study was a theory-based, pretest-posttest quasi-experiment conducted in the field (N = 922) to determine whether and how a media literacy curriculum addressing sexual portrayals in the media would influence adolescents' decision-making processes regarding sex. Results of the evaluation, based on the Message Interpretation Process Model, indicated that participants who received media literacy training better understood that media influence teens' decision making about sex and were more likely to report that sexual depictions in the media are inaccurate and glamorized. In addition, participants who received media literacy lessons were more likely than were control group participants to believe that other teens practice abstinence and reported a greater ability to resist peer pressure. An interaction effect existed between gender and condition on attitudes toward abstinence, suggesting that the lessons helped girls and boys in somewhat different ways. Overall, the results indicated that media literacy strengthened key aspects of participants' logic-oriented decision-making process.

Good self-control moderates the effect of mass media on adolescent tobacco and alcohol use: tests with studies of children and adolescents

OBJECTIVE

To investigate whether self-control moderates the effect of media influences on tobacco and alcohol use among youth and if so how this effect occurs.

DESIGN

In Study 1, a regional sample of 10-year olds (N = 290) was interviewed in households; attention to tobacco/alcohol advertising was assessed. In Study 2, a national sample of youth ages 10-14 years (N = 6,522) was surveyed by telephone; exposure to tobacco/alcohol use in movies was assessed. Good self-control was measured in both studies.

MAIN OUTCOME MEASURES

Willingness to use substances and affiliation with peer substance users (Study 1); involvement in smoking or drinking (Study 2).

RESULTS

In Study 1, the effect of tobacco/alcohol advertising on predisposition for substance use was lower among persons scoring higher on good self-control. In Study 2, the effect of movie smoking/alcohol exposure on adolescent tobacco/alcohol use was lower, concurrently and prospectively, among persons scoring higher on good self-control. Moderation occurred primarily through reducing the effect of movie exposure on positive smoking/alcohol expectancies and the effect of expectancies on adolescent use; some evidence for moderation of social processes was also noted. Covariates in the analyses included demographics, sensation seeking, and IQ.

CONCLUSION

Good self-control reduces the effect of adverse media influences on adolescent tobacco and alcohol use. Findings on the processes underlying this effect may be useful for media literacy and primary prevention programs.

Alcohol marketing in the 21st century: new methods, old problems

Marketing and advertising for alcoholic beverages is abundant throughout the United States and the rest of the world. Despite the fact that alcohol advertising is related to earlier initiation of drinking, higher rates of consumption, and positive expectancies among youth populations, alcohol companies continue to design new products and related campaigns with youth-friendly attributes. Alcopops and caffeinated alcoholic beverages are two particularly dangerous types of products, and new social networking technologies make direct promotion easy and voluminous. In order to stop the harm from these alcohol products and promotion, advocacy from the research community is imperative.

Media literacy education for elementary school substance use prevention: study of media detective

OBJECTIVES

Media Detective is a 10-lesson elementary school substance use prevention program developed on the basis of the message interpretation processing model designed to increase children's critical thinking skills about media messages and reduce intent to use tobacco and alcohol products. The purpose of this study was to conduct a short-term, randomized, controlled trial to evaluate the effectiveness of Media Detective for achieving these goals.

METHODS

Elementary schools were randomly assigned to conditions to either receive the Media Detective program (n=344) or serve in a waiting list control group (n=335).

RESULTS

Boys in the Media Detective group reported significantly less interest in alcohol-branded merchandise than boys in the control group. Also, students who were in the Media Detective group and had used alcohol or tobacco in the past reported significantly less intention to use and more self-efficacy to refuse substances than students who were in the control group and had previously used alcohol or tobacco.

CONCLUSIONS

This evaluation provides evidence that Media Detective can be effective for substance use prevention in elementary school-aged children. Notably, media-related cognitions about alcohol and tobacco products are malleable and relevant to the development and maintenance of substance use behaviors during late childhood. The findings from this study suggest that media literacy-based interventions may serve as both a universal and a targeted prevention program that has potential for assisting elementary school children in making healthier, more informed decisions about use of alcohol and tobacco products.

Patterns of alcohol use among Brazilian adolescents

OBJECTIVE: To describe patterns of alcohol consumption by adolescents in Brazil. METHOD: From November 2005 to April 2006, a sample composed of 661 subjects aged between 14 to 17 years was rigorously selected in Brazil using a multistage probabilistic method to represent the profile of the adolescent Brazilian population. RESULTS: 34% of Brazilian adolescents drink alcoholic beverages. The mean age of drinking initiation was 14 years of age. Older adolescents, as well as those living in the southern part of Brazil, those who are not attending school and those who are working, and black individuals and those with personal income reported a higher frequency of drinking. Socio-demographic factors such as gender, income bracket, family income and student status do increase the amount of alcohol consumed. Males report a higher frequency of binge drinking than females. Moreover, more than half of the males that had drunk in the previous year reported having engaged in binge drinking on at least one occasion. Beer represents approximately half of all the drinks consumed by adolescents. There was no significant difference between genders in the kind of alcohol consumed. DISCUSSION: Among adolescents who drink, the consumption of several drinks is frequent. Alcohol consumption varies from region to region, social economic status (including self-generated income) and age. These findings are discussed in light of their importance for the development of alcohol prevention policies in Brazil.

The role of realism, similarity, and expectancies in adolescents' interpretation of abuse-prevention messages

Scholars continue to identify the conditions under which exposure to alcohol-related messages predict related behaviors and outcomes. To examine this issue further, researchers used an experiment (n = 452) to investigate the role of participants' perceptions of prevention message realism, similarity, identification, and desirability in their expectancies regarding alcohol use and impaired driving. Results of the experiment indicated that exposure to the messages reduced participants' expectancies for drinking and driving and increased their efficacy for avoiding potentially dangerous situations only when the messages activated mediating variables. No overall difference existed between the treatment groups and the control group without accounting for participants' cognitive and affective reactions to the messages. These results indicate that campaign planners must consider individual differences in audience members' interpretation of messages in order to increase message effectiveness even within seemingly homogeneous target groups.

The Extent of Global Alcohol Marketing and its Impact on Youth

Alcohol marketing is a global phenomenon, in which an increasingly small number of companies spend considerable sums to establish and embed their brands in the lives and lifestyles of populations. Market research data offers insight into the size and extent of the global alcohol trade, and the magnitude of alcohol advertising expenditures. Recent examples of alcohol marketing in a variety of national contexts illustrate the techniques used by the global companies. The effects of this marketing on young people are described in reviews of recent research studies on youth exposure to alcohol marketing and the effects of that exposure, interpretive models to explain the effects of alcohol marketing on young people, whether alcohol advertising targets young people, and assessments of the effectiveness of regulatory restrictions on marketing and other countermeasures. Despite the failure of public health research to keep pace with newly developing marketing technologies, there is a growing body of evidence that alcohol marketing influences young people's drinking behavior. Measures to reduce that impact should be considered by national governments seeking to limit the public health burden caused by harmful use of alcohol.

Television alcohol advertising: do children really mean what they say?

Few studies have investigated children's responses to television alcohol advertising. Two separate studies evaluated the appeal of alcohol advertisements on children aged 7-10. An exploratory interview study (N = 17) was carried out to assess children's verbal responses to both alcohol and non-alcohol advertisements and to elicit vocabulary to be used in the second study. Whilst the 7- 8-years-old children were very positive about the alcohol advertisements, older children did not like them, nor did they perceive them to be effective. The second study was designed to assess children's implicit knowledge, in view of developmental theory that knowledge is not always available for verbal report. This study (N = 179) used a simple categorization programme on computer. Using this methodology, children of all ages liked the alcohol advertisements and perceived them as effective. Advertising styles affected popularity with humour, cartoon format or the inclusion of an animal, or character increasing the appeal of an advertisement. The discussion draws attention to the importance of multiple methodologies in eliciting valid and accurate information from children, and to policy matters with regard to alcohol advertising regulation.

The Food Marketing Defense Model: Integrating Psychological Research to Protect Youth and Inform Public Policy

Marketing practices that promote calorie-dense, nutrient-poor foods directly to children and adolescents present significant public health risk. Worldwide, calls for government action and industry change to protect young people from the negative effects of food marketing have increased. Current proposals focus on restricting television advertising to children under 12 years old, but current psychological models suggest that much more is required. All forms of marketing pose considerable risk; adolescents are also highly vulnerable; and food marketing may produce far-reaching negative health outcomes. We propose a food marketing defense model that posits four necessary conditions to effectively counter harmful food marketing practices: awareness, understanding, ability and motivation to resist. A new generation of psychological research is needed to examine each of these processes, including the psychological mechanisms through which food marketing affects young people, to identify public policy that will effectively protect them from harmful influence.

The long arm of expectancies: adolescent alcohol expectancies predict adult alcohol use

AIMS

Alcohol expectancies are strong concurrent predictors of alcohol use and problems, but the current study addressed their unique power to predict from adolescence to midlife.

METHOD

Long-term longitudinal data from the national British Cohort Study 1970 (N = 2146, 59.8% female) were used to predict alcohol use and misuse in the mid-30s by alcohol expectancies reported in adolescence.

RESULTS

Cohort members with more positive alcohol expectancies at age 16 reported greater alcohol quantity concurrently, increases in alcohol quantity relative to their peers between ages 16 and 35, and a higher likelihood of lifetime and previous year alcohol misuse at age 35, independent of gender, social class in family of origin, age of alcohol use onset, adolescent delinquent behavior and age 16 exam scores.

CONCLUSIONS

Alcohol expectancies were strong proximal predictors of alcohol use and predicted relative change in alcohol use and misuse across two decades into middle adulthood.

Exposure of children and adolescents to alcohol advertising on Australian metropolitan free-to-air television

AIM

This study investigated the exposure of underage youth to alcohol television advertising on metropolitan free-to-air television in the five mainland capital city markets of Australia.

DESIGN

Exposure levels (target audience rating points; TARPs) were obtained for all alcohol advertisements screened from November 2005 to October 2006 in each capital city market for: children 0-12 years; underage teens 13-17 years; young adults 18-24 years; and mature adults 25+ years. The 30 most exposed advertisements across age groups were then content-analysed for elements appealing to children and underage youth.

RESULTS

In each of the five metropolitan markets, mature adults were most exposed to alcohol advertising. Children were exposed to one-third the level of mature adults and underage teens to approximately the same level as young adults. However, there was considerable variation in media weight between markets, such that underage teens in two markets had higher advertising TARPs than young adults in other markets. All 30 highest exposed advertisements contained at least one element known to appeal to children and underage youth, with 23 containing two or more such elements. Fifteen of the 30 advertisements featured an animal.

CONCLUSIONS

The self-regulation system in Australia does not protect children and youth from exposure to alcohol advertising, much of which contains elements appealing to these groups.