The association between exposure to social media alcohol marketing and youth alcohol use behaviors in India and Australia

How Alcohol Marketing on Social Networking Sites Influences Young Singaporeans' Binge Drinking: Application of the Prototype Willingness Model

This study used cross-sectional survey data (N = 305) to explore the relationship between alcohol marketing on social networking sites (SNS) and binge drinking among young Singaporeans. The prototype willingness model (PWM), a dual-process framework, was applied to explore how health-risk behaviors are shaped by both reasoned action and social reaction pathways. Results indicated a significant association between exposure to alcohol marketing on SNS and descriptive norms (perceived prevalence of binge drinking). Additionally, active engagement with alcohol marketing - such as liking, commenting, and sharing - was significantly associated with attitudes and both injunctive and descriptive norms. Engagement was also correlated with prototype favorability. Mediation analysis using bootstrapping further suggested that engagement with alcohol marketing was indirectly associated with binge drinking willingness through prototype favorability. These findings provide valuable insights into the direct and indirect associations between social media alcohol marketing and youth drinking behaviors, highlighting the roles of both reasoned action and social reaction pathways in relation to binge drinking.

Understanding Alcohol and Illicit Drug Use in Young College Students: A Qualitative Work from India Based on Social Norms Theory

Background and Objectives

Substance use among young college students in India poses public health challenges. This study seeks to uncover the motivation behind alcohol and illicit drug consumption, applying social norms theory.

Methods

This qualitative research utilized the framework method to analyze data from 14 college students (18-24 years) across various disciplines. Participants were selected using purposive sampling to ensure diversity in demographics and perspectives. Data collection was conducted online. The study used a combination of in-depth interviews (n = 14) and focused group discussions (n = 2). We used AtLAS.ti to facilitate data analysis. We used a mixed inductive and deductive coding approach. A mind map was generated to visualize the complex interplay between social norms and other individual and external mediators.

Results

We identified 10 themes, 20 subthemes, and 42 codes. The themes revealed descriptive (e.g., media and modernization) and injunctive (e.g., availability and legality) social norms that facilitate substance use and social disapproval and stigma that might deter young people from using substances. Family and institutional support were also found to play a protective role. The individuals also weigh the personal consequences (e.g., health and academic harm) and advantages (e.g., coping and relaxation) of substance use, which can influence their decision to use substances. Gendered norms and subtle differences in the social norms between alcohol and illicit drugs were also identified.

Conclusion

Our study illuminates culturally tailored substance use prevention/intervention strategies that operate at the social, individual, and policy levels.

Unhealthy Food and Beverage Marketing to Children in the Digital Age: Global Research and Policy Challenges and Priorities

Food and nonalcoholic beverage marketing is implicated in poor diet and obesity in children. The rapid growth and proliferation of digital marketing has resulted in dramatic changes to advertising practices and children's exposure. The constantly evolving and data-driven nature of digital food marketing presents substantial challenges for researchers seeking to quantify the impact on children and for policymakers tasked with designing and implementing restrictive policies. We outline the latest evidence on children's experience of the contemporary digital food marketing ecosystem, conceptual frameworks guiding digital food marketing research, the impact of digital food marketing on dietary outcomes, and the methods used to determine impact, and we consider the key research and policy challenges and priorities for the field. Recent methodological and policy developments represent opportunities to apply novel and innovative solutions to address this complex issue, which could drive meaningful improvements in children's dietary health.

Prevalence and correlates of alcohol use and risky drinking among undergraduate students in Johannesburg, South Africa: a cross-sectional study

BACKGROUND

Alcohol use and risky drinking are significant public health problem globally. Young people, including university students, are among the most affected populations. We conducted the study to determine the prevalence and correlates of alcohol use and risky drinking among undergraduate students in the Faculty of Health Sciences at the University of the Witwatersrand, South Africa.

METHODS

We conducted a cross-sectional study using an anonymous, self-administered online survey in REDCap. The survey questionnaire consisted of socio demographic, and alcohol use questions using the risky drinking identification screening tool (AUDIT-C). We performed descriptive statistics, bivariate and multivariable logistic regression to determine factors associated with alcohol use and risky drinking. The p-value of < 0.05 was considered statistically significant.

RESULTS

The response rate was 15.7%. Most participants were female (69.6%) and majority of the participants were White (38.1%). The prevalence of lifetime use of alcohol was 79.1%, and among the lifetime users; 70.2% reported alcohol use in the last 12-months, 37.1% reported alcohol use in the last 30 days. The prevalence of risky drinking was 54.8% among lifetime drinkers. Factors significantly associated with current alcohol use were siblings alcohol use (aOR = 1.79, 95% CI: 1.02-3.15) and parents alcohol use (aOR = 2.58, 95% CI: 1.39-4.80), white race (aOR = 5.70, 95% CI: 3.12-10.41), and always or daily exposure to alcohol marketing in the media (aOR = 3.31, 95% CI: 1.07-10.24). Factors associated with risky drinking were: Indian/Asian race (aOR = 2.82, 95% CI: 1.09-7.31), White race (aOR = 2.15, 95% CI: 1.14-4.04), and exposure to alcohol marketing in the media as follows, most of the time (aOR = 3.42, 95% CI: 1.29-9.04) and Always/daily exposure (aOR = 3.31, 95% CI: 1.07-10.24).

CONCLUSION

The reported alcohol use and risky drinking were common amongst undergraduate students at Wits university. There is an urgent need to design, pilot and adapt targeted interventions for this population group.

Determinants of alcohol use among young males in two Indian states: A population-based study

OBJECTIVES

There is insufficient evidence about the determinants of alcohol use amongst young people in India and other low-and middle-income countries, despite alcohol's high contribution to disease burden and increasing consumption in this population. We aimed to identify and estimate the determinants of alcohol use in a representative sample of 2716 young men from Bihar and Uttar Pradesh who participated in the 'Understanding the Lives of Adolescents and Young Adults' (UDAYA) study.

METHODS

First, we developed an exploratory conceptual framework of potential alcohol use determinants in the study settings based on available literature. We then estimated the effects of 35 potential alcohol use determinants identified in the conceptual framework (including 14 latent factors identified through exploratory factor analysis) on any alcohol use in the past 3 years and regular alcohol use amongst past three-year drinkers, using mixed-effects logistic models. The determinants explored were operationalised using longitudinal data from the UDAYA study.

RESULTS

Our adjusted models identified 18 determinants for past 3-year alcohol use and 12 determinants for regular use. Distal determinants (e.g., socioeconomic status), intermediate determinants (e.g., parental alcohol use, media use), and proximal determinants (e.g., emotional regulation, early tobacco use) were identified. Geographical variations in both outcomes indicate potential differences in unmeasured community-level determinants (e.g., alcohol availability and acceptability).

CONCLUSIONS

Our findings extend the generalizability of several known determinants across settings, yet highlight the importance of addressing alcohol use in young people as a complex and context-dependent issue. Many identified determinants (e.g., education, media use, poor parental support, early tobacco use) are amenable to intervention through multi-sectoral prevention programs/policies. Such determinants should be the focus of ongoing policy/intervention development efforts in the region, and our revised conceptual framework may inform further research in India or similar South Asian settings.

Alcohol use in Australia: countering harm with healing

Harmful use of alcohol consumption in Australia is a serious socio-political and public health issue that is exacerbated by exploitative marketing campaigns by the alcohol industry. In Indigenous populations harmful alcohol use is directly related to the legacy of colonisation that has led to complex social issues and adverse intergenerational trauma. To effectively address alcohol-related harm in Australia, it is necessary to critically apply the 'Three Pillars of Harm Minimisation', which are demand reduction, supply reduction, and harm reduction. This can be facilitated through approaches such as the 'Interplay Wellbeing Framework', which situates concepts of wellbeing and risky alcohol use within the context of systemic inequities across all social determinants of health. Culturally responsive approaches embody a holistic view of community, mutually respectful collaboration, culture, healing, and self-determined change. This is underpinned by Indigenous leadership that promotes existing resistance, resilience, interpersonal relationships, and strengths that instil healing to counter the harms associated with alcohol use.

The Association of Influencer Marketing and Consumption of Non-Alcoholic Beer with the Purchase and Consumption of Alcohol by Adolescents

In this study, we examined influencer marketing and consumption of non-alcoholic beer by adolescents to determine how these factors could affect the intentions of adolescents to purchase and drink alcohol. A total of 3121 high-school students recruited from 36 schools in Taiwan completed a self-administered questionnaire during the COVID-19 pandemic in 2022. The results indicate that 19% of these adolescents consumed non-alcoholic beer and 28% consumed alcohol in the past year. Multivariate analysis positively associated adolescents' exposure to influencer marketing with their purchase and consumption of non-alcoholic beer. Adolescents' exposure to influencer marketing of non-alcoholic beer combined with lower levels of parental restrictive mediation was associated with increased odds of the purchase and consumption of alcohol. For individuals who did not purchase alcohol in the past year, both the exposure to influencer marketing and the consumption of non-alcoholic beer were associated with intending to purchase alcohol in the future. Similarly, individuals who previously abstained from the consumption of alcohol, both the exposure to influencer marketing and the consumption of non-alcoholic beer were associated with intending to consume alcohol. In conclusion, when adolescents were exposed to influencer marketing of non-alcoholic beer they were more likely to consume it, which resulted in an increased likelihood that they would then purchase and consume alcohol.

Methods to Establish Race or Ethnicity of Twitter Users: Scoping Review

BACKGROUND

A growing amount of health research uses social media data. Those critical of social media research often cite that it may be unrepresentative of the population; however, the suitability of social media data in digital epidemiology is more nuanced. Identifying the demographics of social media users can help establish representativeness.

OBJECTIVE

This study aims to identify the different approaches or combination of approaches to extract race or ethnicity from social media and report on the challenges of using these methods.

METHODS

We present a scoping review to identify methods used to extract the race or ethnicity of Twitter users from Twitter data sets. We searched 17 electronic databases from the date of inception to May 15, 2021, and carried out reference checking and hand searching to identify relevant studies. Sifting of each record was performed independently by at least two researchers, with any disagreement discussed. Studies were required to extract the race or ethnicity of Twitter users using either manual or computational methods or a combination of both.

RESULTS

Of the 1249 records sifted, we identified 67 (5.36%) that met our inclusion criteria. Most studies (51/67, 76%) have focused on US-based users and English language tweets (52/67, 78%). A range of data was used, including Twitter profile metadata, such as names, pictures, information from bios (including self-declarations), or location or content of the tweets. A range of methodologies was used, including manual inference, linkage to census data, commercial software, language or dialect recognition, or machine learning or natural language processing. However, not all studies have evaluated these methods. Those that evaluated these methods found accuracy to vary from 45% to 93% with significantly lower accuracy in identifying categories of people of color. The inference of race or ethnicity raises important ethical questions, which can be exacerbated by the data and methods used. The comparative accuracies of the different methods are also largely unknown.

CONCLUSIONS

There is no standard accepted approach or current guidelines for extracting or inferring the race or ethnicity of Twitter users. Social media researchers must carefully interpret race or ethnicity and not overpromise what can be achieved, as even manual screening is a subjective, imperfect method. Future research should establish the accuracy of methods to inform evidence-based best practice guidelines for social media researchers and be guided by concerns of equity and social justice.

You've got mail: Drinks are on sale! A study to assess volume and content of direct marketing received from online alcohol retailers in Australia

BACKGROUND

Customers of online alcohol retailers are exposed to marketing displayed on alcohol retailers' websites and may also receive direct marketing via email and text message once contact details are provided in an online sale. To date, this direct marketing activity from online alcohol retailers has not been studied. This study aims to document the quantity and content of marketing material received by customers of online alcohol retailers in Australia, and whether the material complies with relevant regulation.

METHODS

A cross-sectional study of direct marketing from the 100 most popular online alcohol retailers in Australia. Marketing material received via email and text message was collected for three-months from March to June 2021. Email and text messages were coded for 17 variables in four categories: primary purpose of the communication; compliance with relevant regulations; marketing themes and practices used; and offers, promotions, and discounts.

RESULTS

We received 1496 emails from 85 of the 100 retailers. Of the retailers who sent emails, the number sent varied widely (Mdn=8; IQR=2-21). Seven retailers sent a total of 18 text messages. The primary purpose of most emails (67.4%) was to advertise a special or offer a discount. Almost all emails (98.6%) complied with spam legislation to include an unsubscribe link, but around half (46.5%) of emails from retailers in jurisdictions where the inclusion of a liquor license number is mandatory, failed to include one. The most common marketing theme was to link specific times or events to drinking (18.8%). Almost half (48.5%) of emails advertised free or discounted delivery for purchasing over a specified threshold.

CONCLUSION

Most online alcohol retailers in Australia are engaging in direct marketing to their customers via email. More research is needed to understand how these emails may influence purchasing and consumption.

Alcohol use among adolescents in India: a systematic review

BACKGROUND

Alcohol use is typically established during adolescence and initiation of use at a young age poses risks for short- and long-term health and social outcomes. However, there is limited understanding of the onset, progression and impact of alcohol use among adolescents in India. The aim of this review is to synthesise the evidence about prevalence, patterns and correlates of alcohol use and alcohol use disorders in adolescents from India.

METHODS

Systematic review was conducted using relevant online databases, grey literature and unpublished data/outcomes from subject experts. Inclusion and exclusion criteria were developed and applied to screening rounds. Titles and abstracts were screened by two independent reviewers for eligibility, and then full texts were assessed for inclusion. Narrative synthesis of the eligible studies was conducted.

RESULTS

Fifty-five peer-reviewed papers and one report were eligible for inclusion in this review. Prevalence of ever or lifetime alcohol consumption ranged from 3.9% to 69.8%; and prevalence of alcohol consumption at least once in the past year ranged from 10.6% to 32.9%. The mean age for initiation of drinking ranged from 14.4 to 18.3 years. Some correlates associated with alcohol consumption included being male, older age, academic difficulties, parental use of alcohol or tobacco, non-contact sexual abuse and perpetuation of violence.

CONCLUSION

The evidence base for alcohol use among adolescents in India needs a deeper exploration. Despite gaps in the evidence base, this synthesis provides a reasonable understanding of alcohol use among adolescents in India and can provide direction to policymakers.

Drinking and Social Media Use Among Workers During COVID-19 Pandemic Restrictions: Five-Wave Longitudinal Study

Background

The COVID-19 pandemic restricted everyday life during 2020-2021 for many people worldwide. It also affected alcohol consumption patterns and leisure activities, including the use of social media.

Objective

The aim of this study was to analyze whether social media use predicts increased risky drinking over time and during the COVID-19 pandemic restrictions in particular.

Methods

This 5-wave longitudinal survey study, based on a nationwide sample of workers, was conducted in Finland in 2019-2021. A total of 840 respondents (male: 473/840, 56.31%; age range 18-64 years; mean age 43.90, SD 11.14 years) participated in all 5 waves of the study. The outcome variable was risky drinking, measured using the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). Multilevel linear hybrid modeling enabled the investigation of both within-person and between-person effects. Predictors included social media use and communication, involvement in social media identity bubbles, psychological distress, and remote working. Controls included sociodemographic factors and the Big Five personality traits.

Results

Increased involvement in social media identity bubbles was associated with an increase in risky drinking behavior. Of all social media platforms examined, online dating app use was associated with riskier use of alcohol over time during the COVID-19 crisis. Daily social media communication with colleagues about nonwork topics was associated with risky drinking. Female gender, younger age, university education, nonindustrial occupational field, conscientiousness, agreeableness, and neuroticism were associated with lower levels of risky drinking.

Conclusions

Social media use during a pandemic carries some risks for alcohol consumption. Involvement in social media identity bubbles and online dating are risk factors for excessive drinking during the COVID-19 pandemic.

Deep Learning for Identification of Alcohol-Related Content on Social Media (Reddit and Twitter): Exploratory Analysis of Alcohol-Related Outcomes

BACKGROUND

Many social media studies have explored the ability of thematic structures, such as hashtags and subreddits, to identify information related to a wide variety of mental health disorders. However, studies and models trained on specific themed communities are often difficult to apply to different social media platforms and related outcomes. A deep learning framework using thematic structures from Reddit and Twitter can have distinct advantages for studying alcohol abuse, particularly among the youth in the United States.

OBJECTIVE

This study proposes a new deep learning pipeline that uses thematic structures to identify alcohol-related content across different platforms. We apply our method on Twitter to determine the association of the prevalence of alcohol-related tweets with alcohol-related outcomes reported from the National Institute of Alcoholism and Alcohol Abuse, Centers for Disease Control Behavioral Risk Factor Surveillance System, county health rankings, and the National Industry Classification System.

METHODS

The Bidirectional Encoder Representations From Transformers neural network learned to classify 1,302,524 Reddit posts as either alcohol-related or control subreddits. The trained model identified 24 alcohol-related hashtags from an unlabeled data set of 843,769 random tweets. Querying alcohol-related hashtags identified 25,558,846 alcohol-related tweets, including 790,544 location-specific (geotagged) tweets. We calculated the correlation between the prevalence of alcohol-related tweets and alcohol-related outcomes, controlling for confounding effects of age, sex, income, education, and self-reported race, as recorded by the 2013-2018 American Community Survey.

RESULTS

Significant associations were observed: between alcohol-hashtagged tweets and alcohol consumption (P=.01) and heavy drinking (P=.005) but not binge drinking (P=.37), self-reported at the metropolitan-micropolitan statistical area level; between alcohol-hashtagged tweets and self-reported excessive drinking behavior (P=.03) but not motor vehicle fatalities involving alcohol (P=.21); between alcohol-hashtagged tweets and the number of breweries (P<.001), wineries (P<.001), and beer, wine, and liquor stores (P<.001) but not drinking places (P=.23), per capita at the US county and county-equivalent level; and between alcohol-hashtagged tweets and all gallons of ethanol consumed (P<.001), as well as ethanol consumed from wine (P<.001) and liquor (P=.01) sources but not beer (P=.63), at the US state level.

CONCLUSIONS

Here, we present a novel natural language processing pipeline developed using Reddit's alcohol-related subreddits that identify highly specific alcohol-related Twitter hashtags. The prevalence of identified hashtags contains interpretable information about alcohol consumption at both coarse (eg, US state) and fine-grained (eg, metropolitan-micropolitan statistical area level and county) geographical designations. This approach can expand research and deep learning interventions on alcohol abuse and other behavioral health outcomes.

Alcohol consumption in India: A rising burden and a fractured response

ISSUES

To review the burden of alcohol use in India, examine current policy initiatives and programs specific to India and provide a roadmap for future actions.

APPROACH

A literature search was undertaken to review available published research papers, unpublished reports and anecdotal media information in the period 2000-2020 to assess the burden and pattern of alcohol use and appraise alcohol control policies in India.

KEY FINDINGS

The per-capita alcohol consumption among individuals aged 15+ years was 5.7 L, which increased over time. Prevalence of alcohol use varied across states with considerable impact on the nation. Regulatory policies and alcohol control programs vary across Indian states, with poor enforcement and implementation. Taxation and pricing policies are revenue oriented. Policies are needed to address the aggressive and innovative marketing strategies of the alcohol industry. The system for regular monitoring of alcohol burden and conducting alcohol policy analysis needs strengthening.

IMPLICATIONS

Alcohol use and its public health impact would continue to increase in India in the absence of effective policy and programs; the country may not achieve its stated goal of relative reduction of alcohol use prevalence by 10% by 2025.

CONCLUSION

The prevailing alcohol control policies and programs in India have been less than fully effective in controlling the burden of alcohol use and its associated impact. There is a need for comprehensive, evidence-based and consensus-driven national alcohol control policy to appropriately guide and support the Indian states in regulating alcohol and reducing the associated burden. Effective implementations of such policies are central to its success.