Adolescents’ Perceptions of Alcohol Portrayals in the Media and their Impact on Cognitions and Behaviors

Abstract

Objective:

Exposure to alcohol in the media is pervasive and may influence adolescents’ perceptions and use of alcohol. The purpose of this study was to better understand how adolescents perceive alcohol-related content in both entertainment and social media, with a focus on the valence of portrayals (i.e., positive, negative) and impacts on cognitions and behaviors.

Method:

Participants were 40 high school students (60% female). Nine focus groups were conducted via videoconferencing, stratified by grade (9^th/10^th, 11^th/12^th) and gender. Transcripts were analyzed via template style thematic analyses to identify themes.

Results:

Six themes developed, including (1) Some portrayals of alcohol may increase likelihood of using alcohol, (2) Some portrayals of alcohol in the media can discourage drinking, (3) Sometimes truly negative consequences of alcohol are portrayed positively or downplayed, (4) Media portrayals of alcohol are perceived to be based in reality but are at times exaggerated, (5) Adolescent and adult alcohol use is portrayed differently in entertainment media, and (6) The extent to which adolescents are influenced by the media may depend on their pre-existing attitudes, beliefs, and education.

Conclusions:

Adolescents have awareness of media portrayals of alcohol, both positive and negative, and their associated impacts. Findings highlight the need for much more work to understand the conditions under which, and for whom, exposure to different types of positive portrayals of alcohol in the media translate into positive expectancies about alcohol or drinking motives. Such work may ultimately inform intervention targets to reduce early initiation and/or risky drinking among adolescents.

Introduction

Adolescent alcohol use is common, dangerous, and costly to society (Miller et al., 2006). In the U.S. in 2019, approximately 6,200 adolescents per day used alcohol for the first time, and two thirds consume alcohol by high school graduation (Substance Abuse and Mental Health Services Administration, 2019). Early initiation of alcohol use in particular is associated with risk of short and long-term consequences, including increases in other health risk behaviors, unintentional death, and increased risk for alcohol use disorder (Marshall, 2014; McCambridge et al., 2011). A myriad of intrapersonal (e.g., beliefs/attitudes about drinking) and interpersonal factors (e.g., social influence) are related to alcohol use. These proximal predictors of alcohol use behavior may be shaped by exposure to content observed in different types of media.

In this regard, both social media (i.e., social networking sites, applications or websites with a focus on social interaction, communication, and content sharing) and entertainment media (e.g., television, movies, music, streaming services, video games) are relevant. Notably, the distinction between these two “types” of media is not always clear. For example, TikTok can be used both with a social interaction focus, or simply for entertainment. Likewise, some video game streaming platforms (e.g., Twitch) provide both social interaction and gaming as entertainment. Given ongoing evolutions in the media landscape, it is critical to consider the broad range of media platforms (whether they fall distinctly into one category or another) when seeking to understand the influence of media on adolescents’ thoughts and behaviors.

Use of both types of media - entertainment and social - is near ubiquitous among adolescents (Pew Research Center, 2018; Wartella et al., 2016), and results in an inundation of alcohol depictions. Approximately 60% of popular television series episodes displayed alcohol (Gabrielli et al., 2016), and one in five adolescents featured in entertainment media are depicted with alcohol, rarely with negative consequences (Stern & Morr, 2013). Alcohol is also a frequent theme of music (Siegel et al., 2013), video games (Cranwell et al., 2016), and YouTube videos (Cranwell et al., 2017; Primack et al., 2015). Increasingly, youth are exposed to alcohol content on social media as well, with depictions produced by both influencers (i.e., people with a large following that can be leveraged to promote products or ideas) and peers (Curtis et al., 2018; Geusens & Beullens, 2017; Nesi et al., 2017).

As adolescents are heavy consumers of entertainment and social media alike, both types of outlets are important when considering media impacts on adolescents’ thoughts and behaviors. Despite substantial overlap and similarities, entertainment and social media differ in several important ways. Entertainment media commonly depicts fictional content by celebrities, advertisers, and individuals not personally known to viewers. Conversely, social media often displays content intended to be perceived as authentic (e.g., Wiederhold, 2018). Through social media, one has access to content by individuals both known to them (e.g., peers and family members) and unknown (e.g., celebrities, influencers, and strangers). Moreover, social media tends to be more interactive, with viewers actively engaging with content (e.g., commenting with or sharing a post). Thus, understanding adolescents’ experiences and exposure through these different outlets and understanding similarities, differences, and unique mechanisms of influence is important is essential, although not well explored in the existing literature.

The extent to which alcohol portrayals in entertainment and social media are positive versus negative is important in that positive depictions could normalize or even glorify alcohol use. Both types of media content are rife with positive alcohol depictions (Erevik et al., 2017; Hendriks et al., 2019; Keller-Hamilton et al., 2018), frequently displaying alcohol in fun, social settings and less commonly including negative outcomes (Dal Cin et al., 2009; El-Khoury et al., 2019). Studies of Instagram and TikTok content also revealed mostly positive alcohol depictions, commonly associated with humor, camaraderie and positive experiences (Hendriks et al., 2018; Russell et al., 2021). While Instagram most commonly depicts alcohol in a positive light, Snapchat more commonly depicts negative consequences of alcohol use, at least among college students (Boyle et al., 2017). Notably, youth perceptions of the extent to which alcohol use is portrayed as a positive versus negative behavior is understudied, despite the influence these perceptions may have on drinking behavior.

Social cognitive theories (Bandura, 1986) posit a role for observational learning of drinking behavior, and an influence of perceived social norms, including both the extent to which alcohol use is common (i.e., descriptive norms) and acceptable (i.e., injunctive norms). Social cognitive theory and alcohol expectancy models (Stacy et al., 1990) also highlight the role of adolescents’ perceived likelihood of positive (e.g., “If I drink, I will have fun”) and/or negative outcomes of drinking (e.g., “If I drink, I will lose control”). Research supports the theoretical influence of both social norms (Nesi et al., 2017; Pedersen et al., 2017) and alcohol-related expectancies (Goldman et al., 1999; Janssen, Treloar Padovano, et al., 2018; Schell et al., 2005). Importantly, these cognitions may be formed and refined via exposure to media depictions of alcohol use, and may in turn predict alcohol use.

Indeed, youth exposure to alcohol use in the media has been linked with subsequent drinking behaviors, including early initiation, drinking milestones, and progression to heavier alcohol use (Anderson et al., 2009; Jackson et al., 2018; Jernigan et al., 2017). Research has increasingly focused on exploring potential mechanisms, such as changes in norms or expectancies, that might explain this link. For example, some evidence has suggested that positive alcohol depictions are associated with positive expectations about alcohol use (Mayrhofer & Naderer, 2019; Redondo et al., 2018). Frequent exposure to alcohol across media types also influences the perceived social normativity of alcohol, resulting in youth overestimation of the drinking behaviors of their friends and other peers (Boyle et al., 2016; Davis et al., 2019). Some studies have shown that these perceptions of social norms play a significant mediating role between media exposure to alcohol use and subsequent alcohol use (Janssen, Cox, et al., 2018; Nesi et al., 2017). While multiple longitudinal studies have demonstrated a consistent link between exposure to alcohol content in the media and subsequent drinking initiation and progression among youth (Anderson et al., 2009; Jernigan et al., 2017), the extent to which (and the ways in which) youth perceive this link to be true is less clear.

Qualitative methods offer rich information that would otherwise be limited with only the use of quantitative methods such as surveys or interviews (Neale et al., 2005). Specifically, these methods allow participants to describe experiences with alcohol content in the media more completely, which can help generate clearer hypotheses about how alcohol exposures in the media affect drinking behavior in adolescents (Sofaer, 1999). With opened-ended questioning, adolescents are offered more flexibility to describe their experiences with exposure to alcohol in the media, maximizing the amount that can be learned from this group of interest. Furthermore, this open-ended questioning allows youth to identify areas of impact that may not have been previously considered through quantitative assessment, an aspect particularly relevant for work done in new media environments that are continuously evolving.

Some prior studies have used qualitative methodology with adolescents to examine the potential influence of portrayals of alcohol use in entertainment or social media on perceptions of alcohol use. With respect to entertainment media, (Atkinson et al., 2013) used focus groups to understand portrayals of alcohol use on television among 11-18 year olds in the UK. Adolescents in this study were undecided about whether alcohol portrayals on television were realistic, noting at least some were exaggerated. They also provided mixed accounts of whether alcohol portrayals on television may promote versus deter drinking among youth. The extent to which these findings hold a decade later, especially given changes in how people use television/streaming platforms today, is unclear.

With respect to social media, in a sample of adolescents from the UK, MacArthur et al. (2020) utilized semi-structured interviews and focus groups and found that portrayals of alcohol use in social media are common and largely positive, and that adolescents’ reactions to seeing alcohol use in social media are also favorable. Further, results indicated that portrayal of drinking on social media can influence perceptions of peers’ social status and maturity level. Two focus group studies, one in the US (Moreno et al., 2009) and one in France (Chapoton et al., 2020) demonstrated that adolescents believe posts about drinking may be used to appear “cool” or “show off.” Other notable findings from these studies were that adolescents interpret alcohol-related posts as realistic (Moreno et al., 2009) but do not necessarily perceive themselves to be influenced by alcohol-related content on social media (Chapoton et al., 2020; MacArthur et al., 2020).

A subset of additional qualitative studies focused more specifically on alcohol advertising and branding on social media. In a focus group study with adolescents in the UK, Purves et al. (2018) found that alcohol brand content and brand choice displayed in social media can both positively and negatively impact adolescent perceptions of the social acceptability of alcohol use. In a sample of 16-21 year olds in the UK, Atkinson and colleagues used peer group interviews, wherein participants reported frequent exposure to but limited engagement with alcohol marketing in social media, noting both positive and negative perceptions of different brands (Atkinson et al., 2017). In both studies, participants also described that brand marketing had an impact on their identity formation, highlighting an important influence of social media ads on development.

Despite the important contributions of these studies, ample room to enhance our understanding of the influence of alcohol portrayals in the media remains. First, prior qualitative studies have not explored the influence of alcohol portrayals across the full range of media platforms, including both social and entertainment media, within the same sample. This has prevented any possible comparison in how adolescents perceive alcohol content viewed in different media types. Second, prior work has not fully characterized adolescents’ perceptions of intrapersonal (e.g., expectancies) or interpersonal (e.g., social norms) processes through which exposure to alcohol portrayals might impact them; yet these processes have a basis in theory and represent potential modifiable treatment targets. Third, given variability between countries in social media engagement and associated consequences of media use (Boer et al., 2020; Craig et al., 2020), the lack of qualitative research on this topic with American youth in particular is also notable. Finally, given the fast pace of evolution in media delivery and use, it is important to provide a contemporary account of how alcohol content in media may impact adolescents.

The Present Study

The goal of the present study was to conduct a qualitative inquiry of adolescents’ exposure to alcohol in the media, including both entertainment media and social media. Specifically, we sought to better understand adolescents’ perceptions of how alcohol is portrayed, with a particular focus on valence of portrayals (i.e., positive or supportive of drinking versus negative or discouraging of drinking). Further, we queried the ways adolescents perceived that they and their peers are impacted by these exposures, including perceived effects on their beliefs about how common or acceptable drinking is, personal attitudes, and decisions about whether and how much to drink.

Materials and Methods

Participants and Procedures

Participants were 40 high schoolers identifying as female (n = 24), male (n = 12) and genderqueer/non-conforming (n = 4). Recruitment took place via social media advertisements (i.e., Facebook, Instagram). Interested participants were directed to a website with study information and a link to a brief online screening questionnaire. To be eligible, participants had to report (a) age 15-19, (b) high school grade 9-12, (c) living in the US, and (d) smartphone ownership (due to our interest in ultimately measuring media exposure using a smartphone-based survey application). Eligible participants ages 18-19 were directed to the online informed consent form. Eligible participants ages 15-17 were sent an email with a link to an informational study website and an online parental consent form, to forward to their parent. Youth 15-17 provided assent once parental consent was obtained. Following consent/assent, youth were contacted to schedule a Zoom focus group session, and were sent an email requesting they complete a short survey, for which they were entered into a raffle for an additional $5.

Nine focus groups (n = 3-6 per group) were conducted via Zoom videoconferencing and stratified by both grade (9^th/10^th versus 11^th/12^th) and gender (male, female, non-binary). We did not determine our sample size a priori; rather, we conducted groups until saturation was reached and no new information was learned (Morse, 1995). Groups were conducted in April and May 2021, were moderated by 1-2 leaders (often including authors JEM, EC, AE or HD) and a note-taker (e.g., research assistant), and lasted approximately 90 minutes. While multiple individuals led these groups, all were trained by JEM and all groups followed the same semi-structured agenda. A virtual card sort was used for participants to collectively decide how frequently alcohol shows up (never, rarely, sometimes, or often) across a range of platforms. Focus group domains relevant to the present study focused on (a) how alcohol is portrayed in the media and whether portrayals are positive versus negative, and (b) adolescent perceptions of the influences of media on thoughts/behaviors¹. Table 1 shows key questions in these domains, which were in part developed with a basis in social cognitive and expectancy theories. Discussions were video-recorded, auto-transcribed via Zoom, and captured in observational notes. Transcripts were cleaned by following along with audio recordings, and all identifying information was removed. Additionally, a standardized debriefing form completed after each group included sections on the tone of the group, adherence to the interview guide, observations not evident from reading the transcript, new concepts learned (e.g., new ideas emerging in that particular group), and areas where saturation was being reached (e.g., the same ideas being repeated across groups). Saturation on key topics was discussed among the staff present at each focus group, as well as with the larger investigative team, within one week of the group. Participants received $30 Amazon.com gift cards at the end of the group. All procedures were approved by the university Institutional Review Board.

Table 1.

Focus group questions, codes, and code descriptions

Focus group questions	Code	Code description
What are some examples of ways in which alcohol is portrayed positively in the media? What kinds of good things have you seen happen to people drinking in media?	Positive media portrayal	Ways alcohol is portrayed positively in the media.
What are examples of ways in which alcohol is portrayed negatively in media? What kinds of not-so-good things have you seen happen to people drinking in media?	Negative media portrayal	Ways alcohol is portrayed negatively in the media
n/a (code was not listed a priori based on focus group guide, but arose during transcript review)	Portrayal example without valence	An example of how alcohol shows up in the media that is not necessarily described as either positive or negative
Are experiences related to drinking that might actually be harmful or embarrassing or unpleasant ever portrayed positively in the media? (Tell me about that).	Negative portrayed positively	Ways that the negative effects of alcohol may be portrayed positively in the media, dismissed, or not shown at all
How realistic are any of these examples of the effects of alcohol that you see in the media? Do they map onto what you see in real life? In what ways do they differ?	Realism of media portrayals	Participant perception regarding extent to which media displays of alcohol are realistic, map onto real life; may involve comparisons between what they see in media and what they’ve experienced or seen others experience.
How, if at all, are adolescent versus adult displays of alcohol use in the media different?	Adolescent vs adult portrayals	Differences in the way that alcohol use by adolescents and alcohol use by adults is portrayed in the media.
How much would you say adolescents’ beliefs, choices, and behaviors related to alcohol are affected by what they’re exposed to in the media? How does media affect adolescents’ thoughts about how common drinking is? Thoughts about how acceptable their peers think drinking is? Personal attitudes about drinking?	Alcohol cognitions	Influences of exposure to alcohol in the media on adolescents’ perceived norms about alcohol, personal attitudes about alcohol
How does media affect adolescent’s willingness to drink or decisions to drink? Decisions about what people your age drink? how much people your age drink?	Alcohol behavior	Influences of exposure to alcohol in the media on adolescents’ actual drinking behavior, including at what age, how often, and how much they choose to drink

Note: In addition to questions in Table 1 that map most directly onto to codes applied to the data and used in analysis, participants were also asked, “Does the way that media affects teens attitudes or beliefs about alcohol depend at all on the type of media where it’s seen? For example, does social media have more of an impact on how teens think or act than entertainment media, or vice versa?” Data from this question was typically coded on either the “alcohol cognitions” or “alcohol behavior” code, depending on participant response, and was also included in analysis.

Measures

A brief survey included items developed by the investigators and adapted from the Pew Research Center (Anderson, 2015; Pew Research Center, 2018). The survey assessed demographics, use of media, and alcohol use. Participants were asked “On a typical weekday, how many hours do you…” (e.g., watch TV; watch movies) with response options including none, 30 minutes or less, 1 hour, 2 hours, or 3+ hours. Participants were asked whether they had an account(s) on each social media platform. Alcohol use in the past 3 months was assessed with response options: I did not drink alcohol in past 3 months, once, 2-3 times, or once a week or more. To assess heavy drinking, participants were also asked how often they consumed 5 or more drinks in a single occasion during the past 3 months, using these same response options. Finally, participants were asked how many of their close friends drink alcohol (0, 1, 2, or 3+).

Analytic Plan

Data analysis was approached via a combination of deductive and inductive methods, relying primarily on template style thematic analyses (Crabtree & Miller, 1992, 1999; King, 2018) guided by the critical realism paradigm (Bhaskar, 1998)which is a philosophical framework relevant to social scientific research (at an empirical level, it helps researchers understand events understood through human interpretation). First, consistent with template style thematic analyses, JEM and HD co-developed an initial hierarchical codebook (Brooks et al., 2015) that included a priori codes based on key questions of interest from the focus group agenda (deductive). Next, five team members independently coded the first transcript, additional codes were derived from the data and defined, and the coding structure was further refined during this early stage of analysis (inductive). Final codes and their descriptions are shown in Table 1. Subsequently, each transcript was coded by two coders, using NVivo12 software (QSR International, 2018). Coders met to resolve discrepancies, bringing all transcripts into 100% agreement.

For analysis, data tagged with each code were extracted separately by age group (9^th/10^th grade versus 11^th/12^th grade) and analyzed by JEM, GL, AE, and MP. Summaries of the codes were written to describe the most commonly reported experiences. Next, themes and sub-themes from the codes were identified, refined, and defined. Finally, a selection of quotes from each theme was selected for presentation. All coders reconvened to review final themes and representative quotes, ensuring all agreed that they well characterized the original data.

Transparency and Openness

We report how we determined our sample size, all data exclusions (if any), all manipulations, and all measures in the study. Data and coding structures may be available upon request to the corresponding author. This study was not pre-registered.

Results

Descriptives

Participants were 40 adolescents ($\overline{x}$ age = 16.5), identifying as 60% female, 30% male, 10% gender non-conforming/genderqueer. Participants were in 9^th (n = 3; 7.5%), 10^th (n = 12, 30%), 11^th (n = 7, 17.5%), and 12^th (n = 18, 45%) grade. Participants indicated race and ethnicity by selecting all options that applied. The sample identified as 52.5% Asian, 30% White, 15% Black, 2.5% American Indian/Alaskan Native, and 2.5% Native Hawaiian/Pacific Islander. Five percent indicated they identify as Hispanic only and not as any race; 87.5% of the overall sample identified as non-Hispanic. Table 2 includes descriptive statistics on media use and alcohol use. A quarter of the sample reported alcohol use in the prior 3 months, and frequency of drinking did not differ by age (χ2 = 6.71, p = .66). Table 3 summarizes themes and includes representative quotes. Card sort results indicated that the forms of media/platforms where alcohol content appears “often” included Snapchat, Instagram, movies, television, and music (lyrics and videos). Platforms where alcohol content appears less often included podcasts, Pinterest, Tumblr, Reddit, VSCO, Twitch and Discord. For other platforms discussed (Facebook, YouTube, TikTok, video games, direct messaging), there was less consensus on the frequency of alcohol depictions.

Table 2.

Self-reported social media and alcohol use

Average time spent using media (approx. mins)1	M(SD) or n (%)
Listening to music	123.00 (61.07)
Using social networking sites	102.75 (57.20)
Video-chatting	83.25 (67.08)
Watching videos on YouTube	80.25 (61.29)
Texting	79.50 (52.86)
Watching videos on TikTok	58.50 (68.60)
Watching television shows	55.50 (55.00)
Watching movies	39.75 (49.64)
Playing Video Games	30.00 (42.43)
Watching music videos	26.25 (37.33)
Making videos on TikTok	3.00 (9.11)
Use of social media sites/apps (# participants with 1+ account) 2
Instagram	40 (100%)
Snapchat	40 (100%)
YouTube	39 (97.5%)
Facebook	31 (77.5%)
Twitter	26 (65%)
TikTok	25 (62.5%)
Pinterest	24 (60%)
Reddit	24 (60%)
Video game chat	12 (30%)
Tumblr	7 (17.5%)
Alcohol use frequency in past 3 months
Did not drink	30 (75%)
1x	3 (7.5%)
2-3x	6 (15%)
1x per week	1 (2.5%)
Heavy drinking frequency in past 3 months
Did not drink heavily	36 (90%)
1x	3 (7.5%)
2-3x	1 (2.5%)
1x per week	0 (0%)
# Friends who drink
0	20 (50%)
1	5 (12.5%)
2	4 (10%)
3+	11 (27.5%)

¹Response options referred to a typical weekday and included none, 30 minutes or less, 1 hour, 2 hours, 3+ hours. For ease of presenting means, these response options were recoded to 0, 30, 60, 120, and 180, respectively;

²Participants were asked how many accounts they have on each platform, ns indicate those with at least one account

Table 3.

Themes and representative quotes

Themes and quotes	Gender, grade Media type referenced
Theme 1: Some portrayals of alcohol may increase likelihood of using alcohol
Yes, on social media…you post like a picture of alcohol and people are going to be like, “yes that’s so cool”. No one’s gonna tell you off, because they’re your friends, and there’s like a bunch of the comments, so that encourages teens to drink, and it makes them feel that, yes, other people will support me they’re not going to tattletale on me. And that’s with social media like Instagram, Snapchat, Twitter.	Female, grade 9/10 Social media
That they might turn to alcohol, because of the influencers they follow because they might make it seem cool or like they’re having a great time because they’re drunk. And teens might be more likely to think like ‘Okay, maybe I should try this.’	Male, grade 11/12 Social media
Subtheme 1a. The media influences social norms, portraying alcohol as common and acceptable among adolescents
I think, seeing it more frequently makes you feel more comfortable and confident in doing it because you think ‘I’m not alone. I’m not an alcoholic, you know, I’m starting what my friends are.’ There is some sort of normalcy even if it’s just perceived, and it could just be three people posting about it that could make all the difference because if you’re just clicking on those posts, you have to have a sample size of the six or seven posts you actually look at and if half of those have alcohol in them, then you your mind thinks subconsciously or consciously that ‘half my friends are doing this. Why am I not?’	Male, grade 11/12 Social media
I think it can really inflate it sometimes, because I do think of say, your classic teen movies, in any regard, I feel like there’s…often it’s not always some scene or multiple that portray high school parties with a bunch of alcohol. So I think it really does inflate it because the quote unquote I guess “ideal” that we see in movies or shows is linked to that partying.	Gender non-conforming, grade 11/12 Entertainment media
Subtheme 1b. The media influences positive expectancies, portraying drinking is portrayed in the media as fun, cool, or a helpful coping mechanism
I can’t speak for everyone, but especially within the culture, you know hood culture, it’s just an experience of showing that oh, you know I’m doing drugs or drinking alcohol at a party, that sort of gives you clout in the culture and sort of you know, I guess, gives you more respect because it’s the sort of thing that is admired almost.	Male, grade 11/2 Social media
I listen to a bunch of artists who write songs and there’s always alcohol influenced in them as a way to like escape from your problems	Female, grade 9/10 Entertainment media
Theme 2: Some portrayals of alcohol in the media can discourage drinking.
A post by someone who had a negative experience with alcohol…that can deter someone from consuming it.	Male, grade 9/10 Social media
I also definitely feel as though there’s like a personal awareness of the fact that they could become like those people that they see on TV, being like the jerk or being the person who’s a burden on the rest of their friends at the social occasion, and I feel like that also puts like a mental note of people not to over drink, because they don’t want to be that person.	Male, grade 11/12 Entertainment media
Subtheme 2a. The media influences negative expectancies for alcohol use.
Big news stories, like that one girl from the UK that came up awhile back…and it raised awareness for like sexual assault and everything. I think that things like that where it’s just like, oh yeah someone’s been drugged…it’s like a really big case somewhere, and awareness for it will be spread everywhere around social media and you’ll see people sharing posts to their stories, and then you become more aware of it. So I think definitely you can see negative connotations of alcohol through those things.	Female, grade 9/10 Social media
At the end of a lot of those ads they have that big disclaimer or like on the box too, on like the quick read through, some kind of script that as a warning of a lot of really horrible things. And that kind of catches my eyes slightly, or my ear if I hear it, depending on the format, but not enough to really influence me or us to do something.	Male, grade 11/12 Entertainment media (ads)
Subtheme 2b. Negative portrayals depict both minor and severe consequences of drinking.
I also think that most of the alcoholism is geared to women, but there also are some news outlets and also TV shows that I’ve watched are also geared to men when it comes to when I go to college and there’s a lot of frat initiations with hazing that do a lot of drinking games that can lead to people dying from alcohol poisoning or things that have happened after they get drunk like sexual assault, so I think definitely the news shows what alcohol can lead to.	Female, grade 11/12 Entertainment media
Negative portrayals would be like somebody who’s like, really flat out like really drunk or like you know, bad stuff that can happen when you get drunk like sexual assault was one thing, or people who die or get into car accidents because they’re driving under the influence or stuff. They’re, they’re really, really good or really negative is all I see. There’s never really an in-between where people are safe drinking essentially or they’re just being really bad or really good.	Female, grade 9/10 Social media
Theme 3: Sometimes truly negative consequences of alcohol are portrayed positively and/or downplayed.
I would say that high school students wouldn’t post stuff like that, but maybe influencers would because they think it’s funny or something.	Male, grade 9/10 Social media
I think the way a lot of shows portray it is that they only consider the first steps of alcoholism, like they consider the drinking, they may consider the partying, but they don’t really consider the other steps like, you know, the hangovers they don’t consider. They don’t often portray rehabilitation programs, or you know, all the problems that comes with an addiction. They kind of water those down if they show those at all.	Male, grade 11/12 Entertainment media
Theme 4: Media portrayals of alcohol are perceived to be based in reality but are at times exaggerated
I think that drinking and doing any type of drugs is just so prevalent among teenagers now that TV shows and movies just have no choice but to add content like that because they know that that’s what teens would be interested in.	Female, grade 11/12 Entertainment media
I think social media…gives like that view of like real life and that’s what’s really happening in your life and you know that with movies and TV shows, to an extent aren’t real.	Female, grade 9/10 Social media
Theme 5: Adolescent and adult alcohol use is portrayed differently in television/ movie media
In regards to like some movies or shows where with teens it’s like you go to prom and you just party it up with alcohol. And then for adults, you have a nice glass of wine after you’ve had a hard day you know, you wind down, go on a date. That seems more mellow, and in a way sophisticated, whereas it is sort of trashy in the way that teens are portrayed.	Gender non-conforming, grade 11/12 Entertainment media
I think teen alcohol use seems to be more careless, like they always end up drunk…whereas adults, there are definitely instances where they end up drunk or whatever, but it definitely seems kind of more like a passive thing, kind of like you’re drinking water…they don’t seem to experience the negative side effects as frequently.	Male, grade 11/12 Entertainment media
Theme 6. The extent to which adolescents are influenced by the media may depend on their pre-existing attitudes, beliefs, and education.
I think again, it depends on the person, like if you’re already prone to drinking, and you already think drinking is fun, then you think it’s fine you think it’s cool versus someone who says ‘don’t ever drink alcohol’ will never drink alcohol, seeing that that would be like oh…	Female, grade 9/10
I think that usually in high school most teens already have like their own opinions and they’ve already thought about what road they want to go down if that makes any sense. So I don’t think that media sways people as easily as one might think.	Male, grade 9/10

Qualitative Themes

Theme 1: Some portrayals of alcohol may increase likelihood of using alcohol.

Participants provided numerous examples of alcohol in the media with potential to influence behavior, including content in both entertainment media (video games, television, music) and social media (via influencers, peer and friend posts). With respect to influencers, participants indicated that adolescents take steps to be like those they idolize; if someone they admire drinks alcohol, they may begin to drink too. One noted “I know some teenagers are struggling to find themselves… they kind of start this Alter Ego, or they start making themselves like their influencer. So they see that their influencer does this, they also have to do it” (male, grade 9/10). Adolescents also noted that the media glamorizes alcohol, which increases the influence on behavior. Moreover, participants noted that the influence is not necessarily immediate but may grow over time. One stated “I think that also stems from influence that happens over time, not necessarily just like you see an ad ‘oh I’m going to go have a beer right now’ type of thing, but say you’re watching some type of TV show that occurred over the course of like three or four years…I feel like those behaviors that you watch often on a screen will slowly start seeping into the daily life” (female, grade 11/12). Participants reported they may first learn about their friends’ drinking, or friends’ positive attitudes toward drinking, through social media posts. Such posts (depicting peers drinking) also signal to adolescents from which of their peers they may be able to obtain alcohol. Some adolescents agreed that media may influence how much adolescents drink. They noted that the media at times portrays the purpose of drinking as getting drunk, particularly among adolescents. As described in subthemes 1a and 1b, it became clear that the mechanisms through which social media depictions of alcohol may influence behavior include both perceived social norms and positive alcohol expectancies.

Subtheme 1a. The media influences social norms, portraying alcohol as common and acceptable among adolescents.

Adolescents reported that media influences the extent to which they view alcohol as common (descriptive norms), noting that seeing alcohol more over time, both in entertainment and social media, led them to view alcohol use as something more typical and frequent among adolescents than they previously believed. Likewise, they described media impacts on the extent to which adolescents may think alcohol use is acceptable (i.e., injunctive norms). They noted that media influences perceptions of alcohol use as normalized within society as a whole, as well as within more immediate peer groups. A representative quote was “…teens just posting stories of them, you know at a party drinking… I think that’s the most popular form of how it shows up in social media. …in that way it sort of sends a message that, oh my God, you know all my other friends are partying, so I think it’s okay” (male, grade 11/12).

Subtheme 1b. The media influences positive expectancies, portraying drinking as fun, cool, or a helpful coping mechanism.

Evidence of the influence of media on positive alcohol expectancies arose in participants’ reports that media displays of drinking games enhance beliefs that drinking is a fun activity. Most adolescents agreed that drinking is “romanticized” and often portrayed as fun or cool, which could encourage beliefs that drinking might make them feel/appear similarly well-liked. One reported, “Positive portrayals would be like, people like partying and they’re celebrating something or just going out, especially girls’ night type of stuff, I always see on like Instagram. They’re like, ‘Oh, just a group of friends hanging out and having fun’” (female, grade 9/10). Also highlighting the potential influence of media on positive alcohol expectancies, participants reported media often portrays use of alcohol as a distraction from life stressors. This kind of portrayal was more relevant to entertainment than social media. One noted, “As a kind of a backstory for a lot of characters sometimes it’s like ‘oh, the alcohol took the pain away, that was my escape from reality’” (female, grade 11/12).

Theme 2: Some portrayals of alcohol in the media can discourage drinking.

Despite consensus that adolescents perceive the media to promote adolescent drinking, there were some examples wherein media may discourage drinking. These included warning messages at the beginning or end of television shows or movies that depict substance use, and news reports about celebrities. One participant said, “I’m also pretty influenced by what media outlets have to say so especially news reports, so it’s like a celebrity who becomes an alcoholic or dies of alcohol then you’re more likely to be persuaded not to take alcohol” (female, grade 9/10). Other examples included depictions of someone’s personal negative experience with drinking, prompting a desire to avoid acting in a way they saw others act under the influence of alcohol. As described in subthemes 2a and 2b, media’s deterrent influences on alcohol use may occur via development of negative expectancies, for both less and more severe consequences of drinking.

Subtheme 2a. The media influences negative expectancies for alcohol use.

Participants described that negative alcohol portrayals usually entail raising awareness around negative effects of drinking. Adolescents provided several examples of ways in which media explicitly tries to raise awareness such as providing warnings or statistics around drinking and sharing specific consequences of what can happen when using alcohol. In these examples, media was described to influence negative rather than positive alcohol expectancies. As an example of social media, one noted, “That like have facts about how alcohol like negatively affects people’s lives and stuff. Like they might share some statistics with posts and stuff, and then people might repost it, so it also shares a lot of the negative side effects” (female, grade 9/10). Some adolescents shared that it might be helpful to be aware of these portrayals, but most did not comment on whether it actually impacted their likelihood of drinking. Of note, one explicitly said such content, particularly with respect to commercials embedded in entertainment media, may not have the intended impact, “But one thing is like at the end of a lot of those ads they have that big disclaimer or like on the box too, on like the quick read through, some kind of script that as a warning of a lot of really horrible things. And that kind of catches my eyes slightly…but not enough to really influence me or us to do something” (male, grade 11/12).

Subtheme 2b. Negative portrayals depict both minor and severe consequences of drinking.

Adolescents described media portrayals of negative consequences of drinking that ranged from minor (e.g., throwing up, hangovers) to more serious (e.g., driving under the influence, sexual assault, alcohol poisoning, death). While some described consequences such as throwing up after drinking as a normal adolescent experience, other adolescents reflected about more severe consequences seen in the media. Participants reported that alcohol dependency was an additional type of drinking consequences they had observed in the media. A very common consequence portrayed in media is that of driving while intoxicated. One noted, “I’ve seen a lot of posts about people who drive under the influence and stories about that. Um…that’s like one of the worst things. Like a party, you’re at a party, you get drunk and then you try to drive home, and then car crash kind of stuff” (gender non-conforming, grade 11/12). Additionally, sexual assault was a pervasive negative portrayal of alcohol only reported by females in this study.

Theme 3: Sometimes truly negative consequences of alcohol are portrayed positively or downplayed.

Adolescents reported that negative consequences are usually normalized or portrayed through a comedic lens. Adolescents provided examples of consequences that are clearly negative, such as drunk driving, vomiting, crying, and being hungover, being portrayed positively. One noted, “For some reason, people are very proud of being extremely hung over or throwing up 10-20 times, like that’s something to brag about and post. I don’t think that’s really portrayed negatively” (male, grade 11/12). Some adolescents indicated a perception that consequences are portrayed in extremes, either as very funny or very sad, but never as something more balanced or neutral. Adolescents reported that negative consequences are also downplayed in entertainment media. They noted that characters who drink often do not experience negative consequences. Specifically, they reported that drinking for fun is more often shown, and the problems associated with addiction and/or the need to seek treatment are either not shown at all or are “watered down.” This phenomenon may provide teens with an unrealistic balance of positive versus negative expectancies for alcohol use, and a biased view of the extent to which risky drinking is normative in spite of negative consequences.

Theme 4: Media portrayals of alcohol are perceived to be based in reality but are at times exaggerated.

Adolescents reported that the alcohol use that occurs in television/movie media is generally consistent with what happens in real life. However, they noted that both positive (e.g., a perfectly prepared alcoholic beverage) and negative (e.g., driving after drinking) media portrayals of alcohol can be exaggerated. One aptly noted, “Either they sugarcoat it or they go really as bottom-of-the-barrel as they can with the portrayals. And I guess like from a teen perspective, it makes sense, alcoholism is culturally portrayed often as a negative and that can either mean ‘haha that’s funny’ or ‘wow that’s sad’ and…I don’t think I can really think of something that goes like in the middle of those two. It’s almost always: its comedic or it’s just depressing” (male, grade 11/12). Notably, older teens in particular described that they thought that television portrayal of alcohol was exaggerated when they were younger but believe it is more realistic now that they are older. Adolescents noted that alcohol portrayals on social media appear more realistic and less exaggerated than those in television/movie media (e.g., “On Instagram, it seems it would be more real. It’s more likely to be real than seeing it in a movie, ” female, grade 9/10). Teens stated that this was the case even though their peers may do things to disguise their alcohol use online (e.g., in a photo, covering an alcohol container with an emoji).

Theme 5: Adolescent and adult alcohol use is portrayed differently in entertainment media.

It was noted that the “coming of age” genre of media regularly portrays adolescent alcohol use, and these portrayals differ from those among adult characters. Adolescents perceived adult alcohol use as portrayed more positively and favorably (i.e., more controlled, intentional), compared to adolescent alcohol use portrayed in a more negative light (e.g., more careless, heavier). They noted that adults are depicted as knowing how to handle alcohol better than adolescents, and are depicted as experiencing fewer negative consequences. One reported, “When teens drink alcohol it’s usually shown as recklessness, but when adults drink it, it’s all been shown as a sign of class…they might be at a fancy ball, drinking wine or things like that” (male, grade 11/12). A final difference that was noted was that adolescents are depicted as having to “sneak around” to drink, whereas adults are not.

Theme 6. The extent to which adolescents are influenced by the media may depend on their pre-existing attitudes, beliefs, and education.

Participants noted that not all adolescents are influenced by portrayals of alcohol in the media, and that some hold strong anti-alcohol beliefs and are less likely swayed by what they see others do on social media. Additionally, they acknowledged individual differences in the extent to which people are affected by a desire to fit in. They indicated that “strong-willed” adolescents would not be influenced, whereas those who are “impressionable” may be. A representative quote was, “I know people who are like…super strong willed and social media doesn’t really affect them. They know what they think, they know what they wanna do and they don’t let social media impact them. But there are other people who maybe aren’t so clear on what they wanna do and they do give in…they see an example of someone drinking and think that… ‘maybe I should just go try it’” (female, grade 11/12).

Discussion

This study presents a novel and in-depth qualitative exploration of the ways adolescents perceive portrayals of alcohol in the media, both social and entertainment. Identified themes were enlightening with respect not only to the perceived valence of media portrayals but also the ways in which adolescents believe they and their peers may be influenced by those portrayals. Findings supported prior work suggesting that positive portrayals of alcohol in the media may be both common and especially influential. Additionally, results were consistent with social cognitive and expectancy theories, suggesting that mechanisms through which alcohol content in media may influence behavior include both perceived social norms and beliefs about the effects of alcohol. Importantly, results also point to hypotheses that should be rigorously and quantitatively tested in future studies.

Adolescents reported that much of the content they observe in both entertainment and social media is promotive of drinking. This aligns with prior work specific to both social (Hendriks et al., 2018; MacArthur et al., 2020; Russell et al., 2021) and entertainment media (Stern & Morr, 2013; Stern, 2005). A novel observation was that some consequences of drinking that are typically thought of as negative (e.g., vomiting) can be portrayed positively or downplayed (e.g., “no big deal”) in the media. One hypothesis to be tested in subsequent work is that media may influence not only the extent to which youth believe drinking consequences are likely but also the extent to which they are perceived to be concerning or severe (i.e., subjective consequence evaluations; Merrill et al., 2016). Although participants in this study also described some negative portrayals of alcohol in the media, these were noted to appear less frequently, particularly in social media, a finding consistent with prior work with college students (Moreno et al., 2012). Sexual assault was mentioned as a negative portrayal, but was only raised by participants that identified as female. This finding may suggest that adolescent girls and boys may focus on different aspects of what they see in media, which could differentially influence their cognitions and behaviors related to alcohol use. It might also suggest that teens, depending on gender, may focus on aspects that might be specifically relevant to them and to their safety or potential for consequences as a result of alcohol use. The field can benefit from future work taking a more rigorous approach to examining gender differences in media influence particularly as it relates to sense of safety and likelihood to experience negative consequences.

Overall, the relative balance of positive versus negative portrayals that was perceived by participants might be understood in the context of literature describing self-presentation on social media as strategic, involving impression management (Schlosser, 2020). Due to people’s efforts to present themselves or their behavior in a positive light on social media, alcohol use may be normalized and even glorified for the youth who are exposed to these online posts. Future work could be designed to examine whether the balance of observed media portrayals of alcohol use that do versus does not result in negative consequences impacts the likelihood that individuals adopt similar drinking behaviors.

Indeed, positive portrayals of alcohol in media were perceived to influence cognitions that may support alcohol use, including social norms (e.g., “drinking is common for teens”), consistent with social cognitive theories (Bandura, 1986), and beliefs about alcohol (e.g., “drinking helps people relax”), consistent with expectancy theories (Stacy et al., 1990). The influence of media exposure on these cognitions has been shown in prior quantitative work (e.g., Dal Cin et al., 2009; Fournier et al., 2013; Gibbons et al., 2010; Kulick & Rosenberg, 2001; Litt & Stock, 2011). In turn, both of these cognitive mechanisms– social norms (Janssen, Cox, et al., 2018; Nesi et al., 2017) and expectancies (Goldman et al., 1999; Janssen, Treloar Padovano, et al., 2018; Schell et al., 2005) have been linked to drinking behavior among adolescents.

The results of this qualitative research provide several novel insights that raise important concepts that could add specificity to our understanding of these processes, or could inform future hypothesis testing. Adolescents themselves acknowledged that media influences their perceptions and beliefs, and that this has the potential to affect their behavior. Findings suggested that, with respect to norms, while entertainment media may play a role in the extent to which alcohol is perceived as common and acceptable among adolescents in general (i.e., distal norms), social media content more likely influences what is perceived as normative among one’s more proximal peer groups (e.g., friends, classmates). That is, adolescents recounted depictions of alcohol in social media as reflections of real-life events that occurred among peers they knew personally (as well as the lives of influencers and celebrities who teens desire to emulate), while recognizing that those in entertainment media often involved fictional characters and exaggerated circumstances. Notably, some participants reported first discovering that specific friends drank via social media posts. That exposure to social versus entertainment media depictions of alcohol are more strongly and specifically linked to proximal versus distal peer norms, respectively, is a hypothesis to be tested in future work.

These findings suggest that depictions of alcohol on social (versus entertainment) media could be perceived as more directly relevant and uniquely contribute to inaccurate descriptive and injunctive social norms, particularly if adolescents are exposed to these posts frequently, from more friends, or by friends they regard highly. Ample evidence also suggests that more proximal normative influences, like friends and peers, generally have a stronger influence on behavior (Cox & Bates, 2011; Salvy et al., 2014). Together, these results suggest that exposure to alcohol content in social (versus entertainment) media may be more likely to influence risky drinking behavior among youth. Future work should test this hypothesis empirically.

Another unique insight these findings raise is that adolescents’ perceptions of alcohol-related consequences in the media could also influence their beliefs and behavior. Participants perceived media portrayals of alcohol to be generally realistic, consistent with findings specific to social media only (Moreno et al., 2009). However, in this study, participants reported that, at times, both the positive and negative effects seem exaggerated. As noted above, they recognized that sometimes negative consequences of alcohol are portrayed positively or downplayed, across television, movies, and on social media profiles. Some described that negative effects of drinking can be sensationalized in entertainment media to add entertainment value, or in media campaigns specifically designed to deter drinking. In contrast, they noted that social media portrayals of alcohol often appear less exaggerated than in entertainment media, even in content posted by influencers, perhaps because social media portrayals feel less scripted to them. These observations are particularly important given that social media portrayals of alcohol were often described as highlighting the positive aspects of drinking, and that in this group of participants, survey data indicated social media platforms as the type of media with which they were most highly engaged. Thus, portrayals of alcohol in the media are complex, and their concordance with reality may differ depending on which media platforms it is viewed. A hypothesis to be tested in future studies is that the influence of media portrayals of alcohol use on one’s own alcohol-related cognitions or behaviors is moderated by the degree to which those portrayals are perceived to be realistic.

Also novel and interesting was the distinction between how alcohol use is portrayed in the media among adolescents versus adults, particularly in entertainment media. Specifically, participants described that adolescent drinkers are portrayed as reckless, especially in “coming of age” media, which dramatizes the lives of high-school-age adolescents and often includes frequent and heavy alcohol use. In contrast, participants noted that alcohol use in adults is commonly seen as being more controlled and intentional. Nevertheless, participants reported that entertainment media regularly shows both adolescent and adult alcohol consumption and normalizes both, albeit in different ways. Future work could examine the hypothesis that adolescent versus adult media depictions of drinking influence adolescents to a greater extent, and could help to clarify at what point in their development either is more influential.

Of course, the influence of alcohol content in the media on adolescents’ beliefs and behaviors does not occur in a vacuum. Adolescents themselves noted the extent to which they are influenced by the media may depend on the way they were brought up, the social norms in their larger communities, their prior education around the risks of alcohol, and the strength of their desire to resist pressures to drink. They noted that adolescents who may have less established views on alcohol use may be more influenced by alcohol portrayals in the media. Moreover, across development, adolescents vary in their capacity to critically evaluate the accuracy of media messages related to alcohol depictions. As such, hypotheses that could be tested in work that follows the present study would be that age, social norms, and pre-existing attitudes about alcohol moderate whether and how media portrayals of alcohol impact teens.

Additional Future Directions

Important next steps include examining both the fine-grained (e.g., daily influences) and long-term effects of exposure to both social and entertainment media on alcohol use among youth. It is likely that such effects are cumulative across both number of platforms used and repeated exposures over time. Subsequently, it will be critical to identify mechanisms of such effects. Our preliminary qualitative findings add to a growing body of literature suggesting that positive expectancies about alcohol and permissive norms around adolescent drinking are likely mechanisms (Jackson et al., 2018). However, longitudinal studies of these pathways are lacking. Our results also highlight the need to study the potential role of individual-level moderators of the effects of exposure to alcohol content in the media on cognitions and behaviors, such as the strength of one’s attitudes toward alcohol use or their susceptibility to social influence.

Data about how adolescents perceive alcohol depictions in social and entertainment media might also be informative for adolescent media literacy training and media-specific parent interventions (e.g., Corcoran et al., 2022; Gabrielli et al., 2018), which have been associated with youth perceptions about substances (Greene et al., 2020; Primack et al., 2014; Slater et al., 1996) and substance use outcomes (Cox et al., 2018; Pinkleton et al., 2007). Notably, adaptations to future use of media literacy trainings to include a focus on portrayals on social media is warranted. For example, the extent to which media portrays positive consequences of drinking more so than negative consequences, in contrast to the balance with which these are experienced in real life, could be discussed with adolescents and their parents. This may be particularly highlighted for social media, which our findings indicate is perceived as more realistic and presents alcohol use in a more positive light than entertainment media.

Limitations

We completed debriefing forms at the end of each focus group, one goal of which was to determine whether content saturation was reached (Morse, 1995), and continued conducting groups until no new information was learned. The size of our focus groups was smaller on average than typical focus groups; however, (1) guidance for running focus groups via videoconferencing has suggested smaller group size (Tuttas, 2015) and (2) the pandemic led to unusually challenging recruitment of youth for research. In addition to being small overall, our sample overrepresented females, 11^th/12^th (vs 9^th/10^th) graders, and participants who were White or Asian, and thus resulted in an inability to conduct subgroup analyses. It is possible that different themes would develop in a sample with more representative demographic characteristics, or that themes may differ by subgroups. We encourage future qualitative studies on media influences on alcohol use to recruit larger and more diverse samples with particular emphases on gender identity and race/ethnicity.

Parental consent was required for adolescents under age 18 in this study, which may have resulted in important differences between the younger and older participants. Additionally, data were collected in Spring of 2021, during which the COVID-19 pandemic may have continued to impact the lives of adolescents. Teen media use spiked during the pandemic (Marciano et al., 2021)which may have served to enhance our ability to understand media-related beliefs and behavior, but it is possible that different themes would develop if the data were collected today, or prior to the pandemic. Moreover, while lifetime drinking was not assessed, the majority of our sample did not endorse alcohol use in the prior three months, suggesting that our results may be biased toward non- and infrequent drinkers. However, exposure to alcohol content in the media should theoretically influence initiation and progression of drinking, making nondrinkers, who are developmentally at risk for alcohol uptake, an ideal sample for the present study. Future research should be conducted to identify how exposure to and perceptions of alcohol-related content in the media may differ as a function of prior experience with alcohol use and consequences.

Critical realism paradigm and template style thematic analyses were utilized to analyze the study data, and as such it is possible that using a different paradigm/theory along with a different analytic approach would have changed the study findings. Further, this qualitative investigation did not consider many of the nuances of media alcohol exposure that may differentially influence alcohol-related cognitions, such as exactly who posted social media content, the extent to which others had interacted with (e.g., liked, commented on) a post, or the relatability of the social media poster or entertainment media character. Each of these could be better examined in subsequent studies.

Conclusion

In sum, the present study indicates that alcohol portrayals in the media are pervasive, and that these portrayals impact adolescent behavior, social norms, and expectancies about alcohol. This study also supports the need for more research specifically examining alcohol portrayals on social media, which may be even more influential than traditional forms of media, and for research understanding the mechanisms by which alcohol exposure in the media impacts adolescent behavior over time.

Public Health Significance Statement:

The study indicates that adolescents’ have extensive awareness of alcohol portrayals in both entertainment and social media, and perceive that such portrayals impact adolescents’ alcohol use behavior, social norms related to alcohol use, and expected effects of alcohol. Despite common exposure to media portrayals of alcohol, adolescents noted individual differences in perceptions of alcohol exposures as well as platform-specific differences. Knowing adolescents are very aware of alcohol portrayals in the media suggests the importance of countering alcohol-promoting content, ideally within platforms where it is encountered, as a tool to lower positive drinking expectancies and early drinking initiation.