HIGHLIGHTS
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Youth exposure to alcohol marketing is a risk factor for underage drinking.
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Adolescents completed the 2021 YouthStyles national online survey.
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More than half of the U.S. adolescents reported being exposed to alcohol marketing.
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Hispanic youth had greater odds than Whites of reported alcohol marketing exposure.
Keywords: Alcohol marketing, digital marketing, race/ethnicity, youth, marketing exposure
Abstract
Introduction
Youth exposure to alcohol marketing is a risk factor for underage drinking. In the U.S., research documents the impact of youth exposure to alcohol marketing through traditional media (e.g., TV, radio) on underage drinking, with less known about digital alcohol marketing exposure. This study aims to examine adolescents’ self-reported exposure to alcohol marketing on various types of media, including the internet, by their demographic characteristics.
Methods
Data were from the 2021 YouthStyles survey administered by Porter Novelli. Adolescents aged 12–17 years (N=833) completed this national online survey. Two multivariable logistic regression models were conducted in October 2022–April 2023 to examine exposure to alcohol marketing on 2 categories of media (watching TV, streaming videos, or going to the movies or browsing the internet). Models included race/ethnicity, age, gender, and past-week number of hours using the media category being assessed.
Results
More than half of the U.S. adolescents reported being sometimes or often exposed to alcohol marketing. Hispanic adolescents had approximately 1.6 greater adjusted odds than non-Hispanic White adolescents of reporting sometimes or often being exposed to alcohol marketing while watching TV, streaming videos, or going to the movies and while browsing the internet. As adolescents’ age increased, self-reported alcohol marketing exposure also increased for both media categories assessed.
Conclusions
Monitoring alcohol marketing exposure, including exposure on the internet, can inform efforts for reducing racial/ethnic disparities in underage drinking risk factors.
INTRODUCTION
Excessive alcohol use is responsible for about 4,000 deaths annually among people aged <21 years in the U.S.1 Youth exposure to alcohol marketing is associated with earlier initiation of alcohol use and increased consumption among youth who drink.2 Research in the U.S. has focused primarily on youth exposure to alcohol marketing through traditional media (e.g., TV, radio, magazines), with less known about exposure through digital media.3 Although a recent systematic review on digital alcohol marketing found an association between youth engaging with digital alcohol marketing and alcohol use, most of the data were from outside of the U.S.4 Because alcohol marketing is increasingly digital, such as on the internet and social media,4 digital marketing can enable alcohol companies to learn more information about the audience and optimize the content and placement of advertisements.5 In addition, research on marketing of alcohol or other health-risk products suggests that there might be differences in exposure by racial/ethnic groups. For example, people who are Hispanic might be disproportionately exposed.6,7 Therefore, this study aimed to examine self-reported exposure to alcohol marketing among adolescents in the U.S. context. The study also assessed youth alcohol marketing exposure by media type, including the internet, and by adolescents’ characteristics.
METHODS
Study Sample
Data were from the 2021 YouthStyles survey administered by Porter Novelli Public Services (Washington, DC) as part of SummerStyles, an internet panel survey among adults (aged ≥18 years).8 Participants were sampled from Ipsos's Knowledge Panel, an online database of eligible non-institutionalized adults in the U.S. Panel members with at least 1 adolescent child aged 12–17 years were invited to participate in the YouthStyles survey. For households with multiple adolescent children, 1 child was randomly selected to respond to the survey. The youth data were weighted to match the Current Population Survey proportions. Overall, 833 adolescents (aged 12–17 years, mean of 14 years) completed this national survey (response rate: 47.6%).
Measures
Adolescents were asked the following question about the type of media consumed and the hours used in the past week: During the past week, about how much time did you spend doing each of the following? 1) watching TV, streaming videos (such as Netflix, Hulu, YouTube, or Amazon Prime) or going to the movies; 2) browsing the internet. Those who reported using these media types were then asked about how often they see or hear advertisements or promotions for alcohol while using those media (Appendix 1, available online). Response options included never, sometimes, and often; alcohol marketing exposure was defined as responses of sometimes or often. Those who reported not using the media types assessed were considered as not being exposed to alcohol marketing.
Statistical Analysis
Weighted percentage of respondents’ characteristics and exposure to alcohol marketing by gender and race/ethnicity were estimated. Separate multivariable logistic regression models that included race/ethnicity, age, gender, and past-week number of hours using the media category being assessed were used to examine alcohol marketing exposure on 2 media categories: while watching TV, streaming videos, or going to the movies or while browsing the internet. AORs were calculated with 95% CIs. Statistical significance was determined as p<0.05. Data for these analyses were weighted using adolescent population weights. Analyses were conducted October 2022–April 2023.
RESULTS
Approximately half (51.7%) of the adolescents were non-Hispanic White; 25.0% were Hispanic; 12.7% were non-Hispanic Black; 4.4% were in ≥2 racial groups; and 6.2% were categorized as other, non-Hispanic (Table 1). In the past week, 53.0% of the adolescents reported spending ≥5 hours watching TV, streaming videos, or going to the movies, and 52.8% reported spending ≥5 hours browsing the internet. Approximately 5%–6% did not use these media types. Fifty-three percent of adolescents reported alcohol marketing exposure while watching TV, streaming videos, or going to the movies, and 51.3% reported alcohol marketing exposure while browsing the internet. Weighted percentages of alcohol marketing exposure by gender and race/ethnicity by media categories are in Figure 1.
Table 1.
Respondents’ Characteristics, Media Consumption, and Exposure to Alcohol Marketing, YouthStyles, 2021
| Characteristics | Unweighted n | Weighted percentage (%) |
|---|---|---|
| Race/ethnicity | ||
| Non-Hispanic White | 543 | 51.7 |
| Non-Hispanic Black | 58 | 12.7 |
| Hispanic (any race) | 137 | 25.0 |
| ≥2 races, non-Hispanic | 45 | 4.4 |
| Other, non-Hispanic | 49 | 6.2 |
| Gender | ||
| Boys | 421 | 50.9 |
| Girls | 412 | 49.1 |
| Number of hours in the past week watching TV, streaming videos, or going to the movies | ||
| 0 | 42 | 5.0 |
| 1–4 | 337 | 42.1 |
| 5–10 | 268 | 31.3 |
| ≥11 | 185 | 21.7 |
| Number of hours in the past week browsing the internet | ||
| 0 | 37 | 5.7 |
| 1–4 | 346 | 41.5 |
| 5–10 | 260 | 31.0 |
| ≥11 | 188 | 21.8 |
| Exposure to alcohol marketing while watching TV, streaming videos, or going to the moviesa | ||
| Never | 390 | 47.0 |
| Sometimes or often | 440 | 53.0 |
| Exposure to alcohol marketing while browsing the interneta | ||
| Never | 392 | 48.8 |
| Sometimes or often | 439 | 51.3 |
Measured by the question, How often do you see or hear advertisements or promotions for alcohol when doing each of the following? (1) Watching TV, streaming videos (such as Netflix, Hulu, YouTube, or Amazon Prime), or going to the movies or (2) browsing the internet. The response options were asked of people who reported using the media type being assessed. Those who reported not using the specific media type being assessed were considered as not exposed.
Figure 1.
Weighted percentages of exposure to alcohol marketing by gender and race/ethnicity by media category, YouthStyles, 2021.
Self-reported exposure to alcohol marketing varied by adolescents’ characteristics, after controlling for other factors (Table 2). Hispanic adolescents had approximately 1.6 greater odds than non-Hispanic White adolescents of reporting alcohol marketing exposure while watching TV, streaming videos, or going to the movies (95% CI=1.10, 2.21) and while browsing the internet (95% CI=1.25, 2.30). In addition, as adolescents’ age increased by 1 year, there was a 1.2 increase in the odds of self-reported alcohol marketing exposure for both media categories.
Table 2.
Youth Exposure to Alcohol Marketing by Adolescent Characteristics and Category of Media, YouthStyles, 2021
| Characteristics | AORa (95% CI) |
|
|---|---|---|
| Watching TV, streaming videos, or going to movies | Browsing the internet | |
| Race/ethnicity | ||
| Non-Hispanic White | 1.00 (ref) | 1.00 (ref) |
| Non-Hispanic Black | 1.33 (0.85, 2.11) | 1.41 (0.90, 2.21) |
| Hispanic (any race) | 1.55 (1.10, 2.21) | 1.61 (1.25, 2.30) |
| ≥2 races, non-Hispanic | 1.55 (0.77, 3.24) | 0.93 (0.45, 1.91) |
| Other, non-Hispanic | 0.84 (0.46, 1.51) | 1.16 (0.63, 2.15) |
| Gender | ||
| Boys | 1.00 (ref) | 1.00 (ref) |
| Girls | 1.15 (0.86, 1.54) | 0.87 (0.66, 1.17) |
| Ageb | 1.21 (1.11, 1.31) | 1.19 (1.09, 1.30) |
| Number of hours media used in the past week | ||
| 1–4 | 1.00 (ref) | 1.00 (ref) |
| 5–10 | 1.20 (0.86, 1.67) | 1.07 (0.77, 1.49) |
| ≥11 | 0.97 (0.67, 1.40) | 1.05 (0.72, 1.53) |
Note: Boldface indicates statistical significance (p<0.05).
Regression models included respondents’ race/ethnicity, age, gender, and number of hours in the past week using the category of media being assessed.
Age was included as a continuous variable, so a 1-unit increase pertains to each year of increasing age.
DISCUSSION
In this study, more than half of the adolescents reported alcohol marketing exposure while watching TV, streaming videos, or going to the movies. This corroborates other research, such as on the magnitude of alcohol marketing exposure on cable TV.9 One study showed that during 2018–2019, youth were exposed 23.9 billion times to alcohol advertising on cable TV, and about 454 million advertising exposures were ones that did not comply with the voluntary guidelines.9 In the U.S., alcohol marketing is primarily self-regulated, which has been found to lack effectiveness for protecting certain populations, including youth.10,11
In addition, more than half of the adolescents reported being exposed to alcohol marketing while browsing the internet. Digital alcohol marketing brings unique considerations compared with other marketing platforms. For example, it allows for more interactive engagement with the audience being marketed to, and marketing can occur in various forms, including directly from companies or indirectly from peers or influencers—all of which can contribute to the normalization of alcohol consumption among youth.12
This study identified a disparity in alcohol marketing exposure by adolescents’ race/ethnicity. Hispanic adolescents were more likely to report such exposure for both media categories assessed than non-Hispanic White adolescents. These results are consistent with those of previous studies. For example, one study found that Hispanic youth in the Los Angeles, California, area were exposed to nearly twice the amount of alcohol advertisements on TV, print, radio, outdoors, and online as non-Hispanic White youth.13 These findings suggest that alcohol advertisements may be designed to appeal to certain subpopulation groups, which could have public health implications, given that youth exposure to alcohol use images or alcohol marketing is associated with alcohol initiation and increases in drinking.2
Limitations
Self-reported alcohol marketing exposure among youth may be subject to recall and social desirability biases. In addition, the extent to which alcohol marketing exposure while using social media apps was considered in responses pertaining to browsing the internet is unknown, as is whether drinking scenes in movies were considered as promotion. Finally, the sample size for this study precluded analyses assessing the relationship between alcohol marketing exposure and alcohol use.
CONCLUSIONS
More than half of U.S. adolescents reported sometimes or often being exposed to alcohol marketing while watching TV, streaming videos, or going to the movies or while browsing the internet, which could increase the risk of underage drinking.2 In addition, Hispanic adolescents had increased odds of reporting alcohol marketing exposure compared with their non-Hispanic White counterparts. In light of these study findings and the U.S. Surgeon General's recent advisory on potential harms associated with youth using social media,14 monitoring exposure to alcohol marketing, including digitally, can inform potential strategies to reduce exposure and racial/ethnic disparities in this risk factor for underage drinking. Policies regulating and limiting youth exposure to alcohol marketing in the U.S., along with consideration of evidence-based policies that increase the price of alcohol and reduce its availability overall, could further reduce alcohol use among youth.10
CRediT authorship contribution statement
Lei Zhang: Conceptualization, Formal analysis, Writing – original draft. Marissa B. Esser: Conceptualization, Writing – review & editing.
Acknowledgments
ACKNOWLEDGMENTS
The authors acknowledge those at Porter Novelli for regularly administering the survey analyzed in this study.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Funding: none.
Declaration of interest: none.
Footnotes
Supplementary material associated with this article can be found in the online version at doi:10.1016/j.focus.2024.100243.
Appendix. Supplementary materials
REFERENCES
- 1.Alcohol-Related Disease Impact (ARDI). Centers for Disease Control and Prevention. www.cdc.gov/ARDI. Updated 2024. Accessed May 2, 2024.
- 2.Sargent JD, Babor TF. The relationship between exposure to alcohol marketing and underage drinking is causal. J Stud Alcohol Drugs Suppl. 2020;Sup19(suppl 19):113–124. 10.15288/jsads.2020.s19.113. [DOI] [PMC free article] [PubMed]
- 3.Jernigan D, Noel J, Landon J, Thornton N, Lobstein T. Alcohol marketing and youth alcohol consumption: a systematic review of longitudinal studies published since 2008. Addiction. 2017;112(suppl 1):7–20. doi: 10.1111/add.13591. [DOI] [PubMed] [Google Scholar]
- 4.Noel JK, Sammartino CJ, Rosenthal SR. Exposure to digital alcohol marketing and alcohol use: a systematic review. J Stud Alcohol Drugs Suppl. 2020;Sup19(suppl 19):57–67. 10.15288/jsads.2020.s19.57. [DOI] [PMC free article] [PubMed]
- 5.Carah N, Brodmerkel S. Alcohol marketing in the era of digital media platforms. J Stud Alcohol Drugs. 2021;82(1):18–27. doi: 10.15288/jsad.2021.82.18. [DOI] [PubMed] [Google Scholar]
- 6.DuPont-Reyes MJ, Hernandez-Munoz JJ, Tang L. TV advertising, corporate power, and Latino health disparities. Am J Prev Med. 2022;63(4):496–504. doi: 10.1016/j.amepre.2022.04.017. [DOI] [PubMed] [Google Scholar]
- 7.Zahid N, Pulvera R, Madsen KA, Lee MM, Ibarra-Castro A, Falbe J. Socioeconomic disparities in outdoor branded advertising in San Francisco and Oakland, California. Prev Med Rep. 2022;27 doi: 10.1016/j.pmedr.2022.101796. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.ConsumerStyles & YouthStyles. Porter Novelli Styles. https://styles.porternovelli.com/consumer-youthstyles/. Updated 2024. Accessed May 9, 2024.
- 9.Alger C, Berklein F, Sparks A, Kupersmith C, Ross CS. Abt Associates; Rockville, MD: 2022. Alcohol advertising compliance on cable television July-December (Q3-Q4), 2019.https://www.abtassociates.com/files/Projects/PDFs/2022/Alcohol%20Advertising%20Compliance%20on%20Cable%20TV_Q3-4_09-23-20%20sxf%20(002).pdf Accessed July 20, 2023. [Google Scholar]
- 10.Babor TF, Casswell S, Graham K, et al. 3rd ed. Oxford University Press; Oxford, United Kingdom: 2022. Alcohol: No Ordinary Commodity.https://global.oup.com/academic/product/alcohol-no-ordinary-commodity-9780192844484?cc=us&lang=en& Accessed May 29, 2024. [Google Scholar]
- 11.Esser MB, Jernigan DH. Policy approaches for regulating alcohol marketing in a global context: a public health perspective. Annu Rev Public Health. 2018;39(1):385–401. doi: 10.1146/annurev-publhealth-040617-014711. [DOI] [PubMed] [Google Scholar]
- 12.Lobstein T, Landon J, Thornton N, Jernigan D. The commercial use of digital media to market alcohol products: a narrative review. Addiction. 2017;112(suppl 1):21–27. doi: 10.1111/add.13493. [DOI] [PubMed] [Google Scholar]
- 13.Collins RL, Martino SC, Kovalchik SA, Becker KM, Shadel WG, D'Amico EJ. Alcohol advertising exposure among middle school-age youth: an assessment across all media and venues. J Stud Alcohol Drugs. 2016;77(3):384–392. doi: 10.15288/jsad.2016.77.384. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Office of the Surgeon General . Office of the Surgeon General; Rockville, MD: 2023. Social media and youth mental health: the U.S. Surgeon General’s advisory.https://www.hhs.gov/sites/default/files/sg-youth-mental-health-social-media-advisory.pdf Accessed May 29, 2024. [Google Scholar]
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