Alcohol Advertising on Social Media: Examining the Content of Popular Alcohol Brands on Instagram

Cannabis advertising impacts on youth cannabis use intentions following recreational legalization in Canada: An Ecological Momentary Assessment (EMA) study

OBJECTIVE

In 2018, Canada's Cannabis Act legalized adult recreational cannabis use and limited cannabis product advertising to adults. Cannabis product advertising to youth remains illegal. The extent to which adult-targeted, or illicit youth-targeted cannabis advertisements is reaching and impacting Canadian youth is unknown. We used Ecological Momentary Assessment (EMA) to describe how often and how much exposures to cannabis advertising influence Canadian youths' real-world, real-time intentions to use cannabis.

METHODS

120 Ontario, Canada youths ages 14-18, took photos of cannabis advertising that they encountered in their natural environments over a period of nine consecutive days. Following each exposure and twice daily device-issued random prompts, they also rated their intentions to use cannabis.

RESULTS

Many participating youth (n = 85; 70.83 %) reported at least one cannabis advertising exposure during the study (range 1-30, M = 4.02). Exposures occurred through a range of advertising channels (e.g., internet ads, billboards). Multilevel modeling showed that youth advertising exposure increased cannabis use intentions in vivo (β = 0.06,SE = 0.03;t = 1.98;p =.04;n = 1,348).

CONCLUSION

Data from this study shows that cannabis advertisements are regularly reaching Canadian youth and increasing their intentions to use cannabis. This suggests that current Canadian prohibitions on cannabis advertising to youth are ineffective and/or ineffectively enforced, and that the Canadian government needs additional or enhanced prohibitions on cannabis promotion to protect youth from harms associated with increased advertisement exposure, such as increased cannabis use.

#Bartender: portrayals of popular alcohol influencer's videos on TikTok©

BACKGROUND

Despite widespread use of the short-video social media platform TikTok©, limited research investigates how alcohol is portrayed on the platform. Previous research suggests that a driver of alcohol content on TikTok©, in part, comes from bartenders demonstrating how to make drinks. This study aims to explore the characterizing patterns of how bartender influencers on TikTok© feature and incorporate alcohol in their videos.

METHODS

We identified the global top 15 most followed bartenders on TikTok© in 2021 (cumulative 29.7 million subscribers) and the videos they posted in November and December 2021, the period just before Christmas and New Year, when alcohol tends to be more marketed than in other periods. The videos were coded based on five criteria: (1) the presence of alcohol or not; (2) alcohol categories; (3); alcohol brand(s) if visible; (4) the presence of candies and other sweet products; (5) presence of cues that refer to young people's interests.

RESULTS

In total, we identified 345 videos, which received 270,325,600 views in total, with an average of 18,021,707 views per video. Among these 345 videos, 92% (n = 317) displayed alcohol in their cocktail recipes (249,275,600 views, with an average of 786,358 views). The most common types of alcohol present in videos were liquor, vodka, rum, and whiskey, all of which are high-ABV beverages. 73% (n = 230) displayed or mentioned an alcohol brand. 17% (n = 55) associated alcohol with sweet products such as different types of candy (53,957,900 views, with an average of 981,053 views per video). 13% (n = 43) contained cues appealing to young people (e.g., cartoons, characters) (15,763,300 views, with an average of 366,588 views per video).

CONCLUSIONS

Our findings suggest a large presence of positively framed alcohol content posted by popular bartenders on TikTok©. As exposure to digital marketing is related to an increase in alcohol consumption, particularly among young people, regulations are needed to protect the public from alcohol-related harms.

Characterizing Twitter chatter about temporary alcohol abstinence during "Dry January"

With roots as a public health campaign in the United Kingdom, "Dry January" is a temporary alcohol abstinence initiative encouraging participants to abstain from alcohol use during the month of January. Dry January has become a cultural phenomenon, gaining increasing news media attention and social media engagement. Given the utility of capturing naturalistic discussions around health topics on social media, we examined Twitter chatter about Dry January and associated temporary abstinence experiences. Public tweets were collected containing the search terms "dry january" or "dryjanuary" posted between 15 December and 15 February across 3 years (2020-2). A random subsample stratified by year (n = 3145) was pulled for manual content analysis by trained coders. Final codebook accounted for user sentiment toward Dry January, user account type, and themes related to Dry January participation. Engagement metadata (e.g. likes) were also collected. Though user sentiment was mixed, most tweets expressed positive or neutral sentiment toward Dry January (74.7%). Common themes included encouragement and support for Dry January participation (14.1%), experimentation with and promotion of nonalcoholic drinks (14.0%), and benefits derived from Dry January participation (10.4%). While there is promise in the movement to promote positive alcohol-related behavior change, increased efforts to deliver the campaign within a public health context are needed. Health communication campaigns designed to inform participants about evidence-based treatment and recovery support services proven to help people quit or cut down on their drinking are likely to maximize benefits.

Alcohol Social Media Marketing in Hong Kong: A Content Analysis of Facebook Posts

PURPOSE

The near universal use of social media by young people in many parts of the world has led to increased exposure to alcohol social media marketing (SMM). This study aimed to examine the content of SMM posts from alcohol brands and venues in the southern China region.

METHODS

This study randomly sampled posts from Hong Kong Facebook pages of 10 well-known alcohol brands (n = 639) and four popular drinking venues (n = 335) between 2011 and 2019. Content analysis, using deductive and inductive coding, was conducted on SMM posts to identify common marketing strategies (e.g., promotional giveaways) and themes.

RESULTS

Alcohol SMM posts increased eight-fold during this period and showed continuous adaptation to regional tastes and drinking culture. Alcohol SMM strategies included explicit encouragement to drink, real-world event tie-ins (e.g. concerts, sporting matches), and special postings during local holidays such as Chinese New Year. Viewers were actively encouraged to interact through "likes", shares, and comments on SMM posts. Alcohol brands had substantially higher user interactions than drinking venues (mean = 228.7/post vs. 19.0/post; p < .05). Alcohol SMM themes included celebratory events, friendship, cultural heritage, and popular music. SMM also promoted an exclusive, aspirational lifestyle, and emphasis on the high quality of their products. Only 8.1% of the brand posts and none of the venue posts contained responsible drinking messages.

DISCUSSION

Alcohol SMM has been increasingly promoting social norms that encourage heavy drinking in young people. Future policy discussions in this emerging alcohol market region should consider regulation of alcohol SMM.

Exposure to Alcohol-Related Content on Social-Media

Objective

Exposure to alcohol-related content is unavoidable on social media. In this study level of exposure to alcohol marketing content on Twitter and Instagram for those in recovery was examined, and the effectiveness of privacy settings to mitigate exposing content was assessed.

Methods

Four fictitious accounts were created on Instagram and Twitter in a case-control design in Spring 2022. All accounts followed 19 alcohol brands, with two accounts (1 male, 1 female) following only alcohol brand accounts while the other two (1 male, 1 female) additionally followed recovery resources. Four weeks of data collection were done with default privacy and advertisement settings, followed by two additional weeks of data collection with advertisement and privacy settings for blocking alcohol content.

Results

Privacy settings did not help with blocking the alcoholic brand-related photographic content on either platform, meaning that the accounts received the same amount of alcohol-related content from the accounts they were following with and without changing the privacy settings. However, Twitter algorithms were more effective in suppressing alcohol-related content for accounts following recovery resources and alcohol brands.

Conclusions

These results suggest that risks of exposure to triggering/cueing photographic alcohol content may outweigh the benefits of social media for social connection if an individual is considering seeking recovery.

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.

Formula milk brands marketing on Chinese social media Weibo - a content analysis

Background

Parents' feeding practices in the first 2 years of life have profound effects on children's survival, health and development throughout their lives. Decisions on how to feed infants and young children should be based on the best information and evidence, not influenced by commercial interests. China is the largest and fastest-growing market for formula milk products. Social media has emerged as a distinctive marketing avenue that can reach consumers directly. Weibo is one of the most popular Chinese social media platforms. This study examined four of the most popular milk formula brands' official Weibo accounts: Biotime, Mead Johnson, YiLi-Prokido, and Friso.

Question

What messages posted and what marketing practices and tactics are used by formula milk brands on Weibo.

Methods

We manually downloaded all posts in the four accounts between 1 January and 31 December 2018. Based on previous studies, we developed a marketing practices coding framework and selected ten mutually exclusive categories for coding and analysing the posts.

Findings

Among 2667 original posts analysed, 65% were from three dominant categories: user engagement (939/2667, 35.2%), parenting advice (516/2667, 19.3%), and celebrity endorsement (327/2667, 12.3%). Other categories included making pseudo-health or nutrition claims and portraying breastfeeding as a painful or problematic experience.

Conclusion

Widespread marketing practices and tactics were found in the four examined Weibo accounts of formula milk brands. Monitoring and regulation of formula milk marketing on social media are urgently needed. Social media platforms should also be held accountable for protecting a supportive breastfeeding environment.

E-Cigarette Retailers' Use of Instagram in New Zealand: A Content Analysis

E-cigarette companies claim their products are key to improving health outcomes by providing smokers with lower-risk alternatives. However, the rapid uptake of e-cigarettes among young people has prompted concern about company marketing practices. In 2019, there was no legislation to govern e-cigarette marketing in New Zealand. This period provides an ideal context for examining how e-cigarette companies promoted their products before the introduction of marketing regulations. We conducted a content analysis of the Instagram accounts of five prominent e-cigarette retailers based in New Zealand during 2019-2020. We assessed health- and risk-related claims and marketing techniques. Less than 10% of Instagram posts refer to smoking alternatives or risk of nicotine addiction. E-cigarette devices were more likely to be promoted for stylistic features such as colours and ease of use (29.7%). Music festival sponsorship (19.1%), social media influencers (9.2%), and lifestyle marketing (41.5%) were identified as youth-oriented promotional strategies. E-cigarette retailers claim to promote harm-reduction tools to smokers, yet this study finds few references to smoking alternatives in any content. Instead, retailers utilised strategies to engage with a young audience, including festival sponsorship and stylish influencers. This youth-oriented marketing, in combination with weak and delayed government action, may have contributed to the high use of e-cigarettes among young New Zealanders.

#Cheers: An Examination of User-Generated Alcohol Advertising on Instagram

Background: Alcohol marketing is a known risk factor for youth drinking. The growth in digital marketing has generated a new form of alcohol advertisement in which brands solicit and/or share consumer-generated or user-generated content. Objectives: The current study investigates the prevalence of UGC alcohol advertising on social media and examines the content of UGC advertising to determine potential violations of current regulatory guidelines. Results: The Instagram accounts of 20 Nova Scotia breweries were monitored for the month of July 2021. User-generated content made up a substantial portion (41%) of all Instagram stories (n = 1531), and there were 321 violations of the Canadian Radio-television and Telecommunications Commission code for broadcast advertising of alcoholic beverage. Ten percent of violations encouraged consumption, 59% depicted irresponsible use, 14% appealed to youth, 14% associated alcohol with activities requiring a degree of skill or care, 2.5% associated alcohol with social or personal success. Conclusions/Importance: These findings indicate that UGC is a commonly used marketing strategy among alcohol producers and the current self-regulatory system is insufficient in preventing advertising that appeals to youth and exacerbates a culture of immoderate consumption.

Analysis of related factors for adolescents' intention to use alcohol in Korea

The harmful effects of alcohol consumption by adolescents have been increasingly emphasized. Thus, it is necessary to identify individual and environmental factors that encourage drinking. This study investigated factors associated with the sustainable use of alcohol (SUA) in adolescents who consume alcohol, and the possibility of future drinking (PFD) in non-drinking adolescents. Data from "The Adolescents Awareness Survey of Alcohol Encouraging Environment" by the Ministry of Health and Welfare and the Korea Health Promotion Institute (2017) were used. The survey was completed by 1,038 participant, selected through a proportional allocation extraction method, who were aged 13-18 years and lived in five cities with a population of over 1 million. The factors associated with SUA included gender (β = 0.634, p = 0.004), grade (8th β = 1.591, p<0.001, 9th β = 1.674, p<0.001, 10th β = 1.497, p = 0.001, 11th β = 1.041, p = 0.004, 12th β = 2.610, p<0.001), drinking alone (β = -2.147, p = 0.002), liquor commercial (β = 1.644, p<0.001), ease of alcohol purchase (β = 1.541, p = 0.025), parent's recommendation for drinking (β = 1.084, p<0.001), not knowing the mother's education level (β = -0.685, p = 0.045), positive expectancy of drinking (β = 0.141, p<0.001), number of pubs (β = 0.303, p = 0.002), internet game cafes (β = 0.456, p = 0.019), and karaokes (β = -0.098, p = 0.023) in the community. The factors associated with the PFD in non-drinkers were grade (8th β = 0.531, p = 0.024, 10th β = 0.717, p = 0.035, 12th β = 1.882, p = 0.001), liquor commercial (β = -1.355, p<0.001), parent's recommendation for drinking (β = 0.783, p = 0.020), positive expectancy of drinking (β = 0.139, p<0.001), and relationship with the father (β = 0.072, p = 0.033). Multidimensional interventions, including those by individuals, parents, peers, and local communities, are needed to prevent SUA and the PFD in adolescents.

Analyzing Twitter Chatter About Tobacco Use Within Intoxication-related Contexts of Alcohol Use: "Can Someone Tell Me Why Nicotine is So Fire When You're Drunk?"

INTRODUCTION

Alcohol and tobacco are commonly used together. Social influences within online social networking platforms contribute to youth and young adult substance use behaviors. This study used a sample of alcohol- and tobacco-related tweets to evaluate: (1) sentiment toward co-use of alcohol and tobacco, (2) increased susceptibility to tobacco use when consuming alcohol, and (3) the role of alcohol in contributing to a failed attempt to quit tobacco use.

METHODS

Data were collected from the Twitter API from January 1, 2019 through December 31, 2019 using tobacco-related keywords (e.g., vape, ecig, smoking, juul*) and alcohol-related filters (e.g., drunk, blackout*). A total of 78,235 tweets were collected, from which a random subsample (n = 1,564) was drawn for coding. Cohen's Kappa values ranged from 0.66 to 0.99.

RESULTS

Most tweets were pro co-use of alcohol and tobacco (75%). One of every ten tweets reported increased susceptibility to tobacco use when intoxicated. Non-regular tobacco users reported cravings for and tobacco use when consuming alcohol despite disliking tobacco use factors such as the taste, smell, and/or negative health effects. Regular tobacco users reported using markedly higher quantities of tobacco when intoxicated. Individuals discussed the role of alcohol undermining tobacco cessation attempts less often (2.0%), though some who had quit smoking for prolonged periods of time reported reinitiating tobacco use during acute intoxication episodes.

CONCLUSIONS

Tobacco cessation interventions may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts.

IMPLICATIONS

Sentiment toward co-use of alcohol and tobacco on Twitter is largely positive. Individuals reported regret about using tobacco, or using more than intended, when intoxicated. Those who had quit smoking or vaping for prolonged periods of time reported reinitiating tobacco use when consuming alcohol. While social media-based tobacco cessation interventions like the Truth Initiative's "Ditch the Juul" campaign demonstrate potential to change tobacco use behaviors, these campaigns may benefit from including alcohol-focused components designed to educate participants about the association between increased susceptibility to tobacco use when consuming alcohol and the role of alcohol in undermining tobacco cessation attempts.

Exposure to Media Messages Portraying Effects of Alcohol Use in a Young Adult Sample

Background: Young adults are prolific media users and tend to use substances, such as alcohol, more than people of other ages. Despite much research on young adults' exposure to alcohol advertisements and portrayals of alcohol use in the media, much is still unknown about the nuances of young adults' exposure to and engagement with alcohol-related media content. The present paper examined how college students' media exposure differed for messages portraying positive and negative alcohol effects, how exposure to alcohol-related content differed across media sources, which themes of alcoholrelated content were seen most, and whether exposure to alcohol-related content was associated with hazardous/harmful drinking. Method: Participants (N=500) were two- and four-year college students (Mage=20.90, SDage=1.70, 63.2% female) recruited for a longitudinal study examining the efficacy of a mobile app intervention for high-risk drinking college students. The data used here comes from the baseline survey. Results: Participants reported the greatest exposure to alcohol-related messages in movies/TV/on-demand streaming shows followed by in social media, and they reported greater exposure to messages portraying positive than negative effects of alcohol. Findings from linear regressions indicated that exposure to messages portraying positive or negative effects of alcohol generally did not predict hazardous/harmful drinking. Conclusion: This sample of high-risk college student drinkers reported seeing alcohol-related content through a variety of media sources, with most content portraying alcohol in a positive light. Future research should assess the effects that messages of different types and from different sources have on use, expectancies, norms, and other outcomes.

Social media's influence on adolescents' food choices: A mixed studies systematic literature review

Over 90% of adolescents have at least one social media account, and their presence on social media continues to grow. Food and beverage brands capitalize on this trend by marketing their products on social media to adolescents. Depending on the nutrition value of the products being marketed, social media advertisements' influence may contribute to the risk of developing unfavorable health outcomes such as obesity, hypertension, and type 2 diabetes. This review aimed to investigate social media's food and beverage advertisements' role in influencing adolescents' food choices by appraising published literature. A systematic literature review was conducted reporting on social media's role in adolescents' food choices. Articles were searched through CINAHL and PubMed from scholarly journals between 2015 and 2020, using the search terms: social media use, food advertisements, adolescents, and food choices. Eligible articles were selected based on inclusion criteria. PRISMA guidelines were followed, and study quality was assessed using the Mixed Methods Appraisal Tool. The analysis was conducted using narrative analysis to identify key findings. Of the 234 records, six articles met inclusion criteria. The studies revealed two major findings: adolescents were more likely to recall unhealthy food and celebrity influence was a common component of the advertisements. This review suggests that food and beverage companies use social media for marketing their products by targeting the adolescent population. The use of celebrities and influencers and the promotion of "unhealthy" products appear to be commonly used tactics. With these findings, healthcare professionals should consider screening adolescents routinely for social media use and current eating habits and educating the adolescents, parents, and families about health risk. Additionally, implementing legislation and policies may be beneficial in preventing this exposure.

Exploring the potential of citizen science for public health through an alcohol advertising case study

Citizen science connects academic researchers with the public through combined efforts in scientific inquiry. The importance of involving impacted populations in health research is well established. However, how to achieve meaningful participation and the methodological impact of citizen science needs further examination. We examined the feasibility of using citizen science to understand the impact of alcohol advertising on Australian women through a breast cancer prevention project. Two hundred and eighty-two ('participants') citizen scientists completed demographic and behavioural questions via an online survey. The research participants moved into the role of citizen scientists by completing the data collection tasks of capturing and classifying images of alcohol advertising they saw online. Interrater reliability tests found high levels of agreement between citizen scientists and academic researchers with the classification of alcohol advertising brand (Kappa = 0.964, p < 0.001) and image type (Kappa = 0.936, p < 0.000). The citizen scientists were women aged 18 and over, with 62% between 35 and 55 years old. The majority were from major cities (78%), had attained a bachelor's degree or higher-level education (62%) and were recruited via email or Facebook (86%). The use of citizen science provided methodological gains through the creation of a unique dataset with higher levels of validity than the existing literature, which employed traditional investigator-driven research methodologies. Citizen science enriched the dataset and provided a powerful methodological vehicle to understand an environmental determinant of health. The study illuminates how public participation benefitted the research process, the challenges and the potential for citizen science to improve public health.

Harmful smartphone applications promoting alcohol and illicit substance use: a review and content analysis in the United States

Few studies have conducted analysis of commercially available smartphone applications designed to promote alcohol and illicit substance use. The aim of this review is to determine harmful themes of content in applications promoting alcohol and illicit substance use found using recovery app search terms. A systematic search, via Apple iTunes and Google Play stores, was conducted of applications targeting abstinence or reduced substance use in online app stores (n = 1,074 apps) in March 2018. We conducted a secondary analysis of apps encouraging alcohol and illicit substance use in July 2018. Our initial search yielded 904 apps pertaining to alcohol and illicit substance use. Four reviewers conducted a content analysis of 102 apps meeting inclusion criteria and assessed app design, delivery features, text, and multimedia content pertaining to substance use. The initial coding scheme was refined using a data-driven, iterative method grouping in thematic categories. The number of apps coded to a specific substance include: alcohol (n = 74), methamphetamine (n =13), cocaine (n = 15), heroin (n = 12), and marijuana (n = 15), with nine apps overlapping more than one substance. Key themes identified among apps included: (i) tangibility (alcohol home delivery services); (ii) social networks (builtin social media platforms promoting substance use); (iii) software design (gamification or simulation of substance use); and (iv) aesthetics (sexual or violent imagery). Despite claims of restricting apps promoting substance use, further efforts are needed by online app stores to reduce the availability of harmful content.

[Alcohol in social media: Where is the space for prevention?]

BACKGROUND

Alcohol has an almost ubiquitous presence, both offline and online.

RESEARCH AIM

This paper therefore aims to describe the status quo of alcohol prevention on leading social media platforms in German-speaking countries.

MATERIAL AND METHODS

To this end, the international state of research on alcohol communication in social media is first summarized by means of a narrative review. Social media analysis is then conducted to evaluate which German-language alcohol channels reach large numbers on platforms such as Facebook and Instagram. Next, content analysis is used to examine N = 470 posts and N = 3015 user comments from the alcohol prevention social media channel with the largest reach. Finally, an online survey of N = 1150 youth (aged 16-20) explores their alcohol-related social media use.

RESULTS

According to the state of research, communications glorifying alcohol consumption are frequently seen on social media. On leading social media platforms, the German-language alcohol channels with the widest reach are devoted to marketing and humor; prevention is significantly less prevalent. To date, the social media channel with the highest reach for alcohol prevention is the Facebook page of the BZgA youth campaign "Alcohol? Kenn dein Limit," which achieves the highest interaction rates through videos and user polls. Here, young social media users both express criticism of alcohol consumption (11% of comments) and continue to favor it (21%). Around half of the surveyed young people have already participated in alcohol-related online communication.

DISCUSSION

Alcohol prevention faces the task of countering the glorification of alcohol that dominates social media with sensitizing messages.

Exposure to Digital Alcohol Marketing and Alcohol Use: A Systematic Review

Objective:

Alcohol marketing has proliferated on digital media, such as websites, social media, and apps. A systematic review was conducted to examine studies of associations between exposure to digital alcohol marketing and alcohol consumption.

Method:

Eight electronic databases were searched for “alcohol” and “marketing” through 14 February 2017. Studies were included if exposure to digital alcohol marketing and alcohol consumption, or related attitudes and intentions, were assessed. Studies were excluded if they only measured exposure to alcohol depictions posted online by family and friends. Study quality was also assessed.

Results:

In all, 25 studies were included, including 2 randomized controlled trials, 15 cross-sectional studies, and 8 prospective cohort studies. There was a consistent finding across studies that participation and engagement with digital alcohol marketing—such as clicking on an alcohol ad, visiting an alcohol-branded website, liking or sharing an ad on social media, or downloading alcohol-branded content—was positively associated with alcohol use. The effects of simple exposure to digital alcohol advertising were inconclusive. Proper blinding of subjects, measuring exposures before the outcomes, and measuring the exposures multiple times would improve study quality.

Conclusions:

Although more research is needed, existing studies suggest that engagement with digital alcohol marketing is positively associated with increased alcohol consumption and increased binge or hazardous drinking behavior. Governments should consider implementing digital alcohol marketing regulations under the precautionary principle as the alcohol industry’s self-regulated marketing codes are likely ineffective at protecting populations vulnerable to alcohol-related harm.

Adolescents' Perceived Drinking Norms Toward Alcohol Misuse: An Integrative Review

The purpose of this integrative review is to synthesize prior research on the relationship between adolescents' perceived subjective and descriptive drinking norms and their drinking intention and behaviors. Four databases (CINAHL, PubMed, Cochrane, and Sociological Abstracts) were searched to identify relevant articles. Thirty-one peer-reviewed articles published from 2010 to 2020 were reviewed. The results highlight that adolescents' perceived drinking norms derived from their parents and peers, such as approving or disapproving attitudes, significantly influence adolescents' drinking intention and behaviors. Moreover, pro-drinking messages, advertisements, and postings from electronic media (i.e., TV, movies, and the Internet) and online social networks (e.g., Facebook, Instagram, and Twitter) shape adolescents' drinking intention and encourage adolescents to initiate alcohol consumption early and/or escalate their drinking. Thus, future interventions should focus on subjective drinking norms that stem from interpersonal relationships in combination with perceived descriptive drinking norms derived from various media exposure.

Changing Alcohol Cravings Using Social Media Comments

Background: Alcohol marketing has proliferated on social media. When exposed to social media advertisements, users view comments written in response to the ad and user engagement metrics, in addition to the ad itself. Here, the independent effect of different types of comments on alcohol craving was assessed. Methods: In all, n = 722 participants were randomized to view either no comments, pro-drinking comments, anti-drinking comments, warning labels, or industry responsibility messages associated with six alcohol ads. Alcohol cravings, measured using the Desires for Alcohol Questionnaire (DAQ), were assessed before and after ad exposure. Smoking urges were also assessed. The significance of main effects was determined using repeated-measures ANCOVA. Results: Warning labels significantly decreased scores on the desires and intentions to drink DAQ sub-scale (p = .025) and decreased smoking urges (p = .024). Pro-drinking comments significantly increased scores on the control of drinking sub-scale (p = .006). Conclusions: The findings suggest that user-generated comments can influence the desire to drink and smoking urges, beyond the effects of ads themselves. If so, alcohol warning labels may decrease alcohol cravings when used in this way. Additionally, to limit the loss of control over drinking, the ability of social media users to post pro-drinking comments may need to be curtailed.

Vaping and Instagram: A Content Analysis of e-Cigarette Posts Using the Content Appealing to Youth (CAY) Index

The promotion of flavors, perceptions of "coolness," and general curiosity are characteristics of electronic nicotine delivery systems (ENDS) that have appealed to young adults. However, little is known about the characteristics of popular social media posts related to ENDS on the social media network, Instagram. Methods: Content analysis was performed using the Content Appealing to Youth (CAY) index. Over 700 posts were collected from August 2019 - December 2019 by searching the Instagram hashtags, #vape and #vapelife. Frequencies and percentages were calculated for each of the six major categories and 35 sub-categories. Results: Nearly all of the images were color photographs and 84% featured an ENDS device (mod) as the focal point. The style of the device was often matte (75%) in only one or two main colors (55%). Warnings about age restrictions and nicotine were included in 28% of images, but commonly used promotional tactics, such as humor, presence of vapor puffs, and flavors were rarely utilized. Conclusions: Instagram posts featuring ENDS are visually appealing and like cigarette packaging, may have the capacity to influence perceptions about the product. Since it is culturally normative for appealing images to be shared on Instagram, greater attention should be placed on media literacy skills to educate young adults about ENDS viewed on social media.

Representation of addiction and drugs victims through TV media

Misrepresentation of social groups and communities targeted by addiction and drugs in developing countries-where the media are exclusive to the government-has reduced the Media's validity in the prevention control, and treatment of addiction. This study proceeds to scrutinize the demeanor by which the national media of Iran portrays addiction and drugs victim groups to the community, whilst focusing on the prime incentives behind such representations. This is a combinational research design seeking out both qualitative and quantitative factors involved in the study. The findings conjecture that the Iranian national television has, to a large degree, failed to accurately present the social verity of addiction in the community, due to certain errors and omissions in regards to identifying target groups and considering social components of addiction and drugs. the most notable factor behind this misrepresentation is censorship and framing of the subject of addiction in line with political tendencies of the state as regards social problems. The 5 major frames considered by the media as regards victim groups of addiction and drugs and their social characteristics include: frames on "addiction among male adolescents"; "addiction among social degenerates"; "epicurean addiction"; "addiction as the consequence of modern living"; and "law enforcement in drugs". The frame building procedure employed by the Iranian national television for the subject of addiction and drugs entails the curtailment of addiction to exclusive groups of the community, primarily comprised of what the media perceives as disreputable and degrading individuals, so as to allow for society to appear as a separate and somewhat immaculate entity. Such frames have disparaged the authority and influence of the media in controlling the aftermath and damages of drugs and addiction.

Characterizing HPV Vaccine Sentiments and Content on Instagram

Background. With its growing popularity, inclusion of image and text, and user-friendly interface, Instagram is uniquely positioned for exploring health behaviors and sources and types of informational exposure related to the human papillomavirus (HPV) vaccine. Aims. To characterize public Instagram posts about the HPV vaccine and quantify the impact of sentiment and context on engagement via likes. Method. Using Netlytic, 3,378 publicly available English-language posts were collected using the search terms "#HPV," "#HPVVaccine," and "#Gardasil." We randomly selected 1,200 posts to content analyze. Our final analytic sample included 360 posts after excluding posts whose links were no longer active (n = 221) or that were not relevant (n = 619). Results. A higher proportion of posts were pro-vaccine (55.8%) than anti-vaccine (42.2%). Pro-HPV vaccination posts were liked significantly less than anti-vaccination posts (24 vs. 86 likes; p < .001). More posts contained actionable information/resources (63.9%) than personal narrative elements (36.1%). Less than one in three posts (30.0%) came from health-related sources. Discussion. Pro-vaccine posts were more prevalent on Instagram, and anti-vaccine posts had higher engagement and typically included misleading information about the HPV vaccine. Personal narratives skewed toward anti-vaccine sentiments and most were produced by individual users. Pro-vaccine narratives portrayed individuals who received the vaccine, but provided limited details on vaccine experiences, starkly contrasting with the depth of details in anti-vaccine personal narrative posts. Conclusion. On Instagram, individuals and organizations have an opportunity to promote HPV vaccination by continuing to provide informational resources in addition to creating more narrative-style posts.