Immediate effects of alcohol marketing communications and media portrayals on consumption and cognition: a systematic review and meta-analysis of experimental studies
Kaidy Stautz, Kyle G. Brown, Sarah E. King, Ian Shemilt and Theresa M. Marteau*
Abstract
Background: Restricting marketing of alcoholic products is purported to be a cost-effective intervention to reduce alcohol consumption. The strength of evidence supporting this claim is contested. This systematic review aimed to assess immediate effects of exposure to alcohol marketing on alcoholic beverage consumption and related cognitions.
Methods: Electronic searches of nine databases, supplemented with reference list searches and forward citation tracking, were used to identify randomised, experimental studies assessing immediate effects of exposure to alcohol marketing communications on objective alcohol consumption (primary outcome), explicit or implicit alcohol-related cognitions, or selection without purchasing (secondary outcomes). Study limitations were assessed using the Cochrane Risk of Bias tool. Random and fixed effects meta-analyses were conducted to estimate effect sizes.
Results: Twenty four studies met the eligibility criteria. A meta-analysis integrating seven studies (758 participants, all students) found that viewing alcohol advertisements increased immediate alcohol consumption relative to viewing non-alcohol advertisements (SMD = 0.20, 95 % CI = 0.05, 0.34). A meta-analysis integrating six studies (631 participants, all students) did not find that viewing alcohol portrayals in television programmes or films increased consumption (SMD = 0.16, 95 % CI = minus;0.05, 0.37). Meta-analyses of secondary outcome data found that exposure to alcohol portrayals increased explicit alcohol-related cognitions, but did not find that exposure to alcohol advertisements influenced explicit or implicit alcohol-related cognitions. Confidence in results is diminished by underpowered analyses and unclear risk of bias.
Conclusions: Viewing alcohol advertisements (but not alcohol portrayals) may increase immediate alcohol consumption by small amounts, equivalent to between 0.39 and 2.67 alcohol units for males and between 0.25 and 1.69 units for females. The generalizability of this finding beyond students and to other marketing channels remains to be established.
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Background Alcohol marketing is a prominent feature of an lsquo;alcogenicrsquo; environment - an environment that reflects and promotes a culture of alcohol use [1]. Alcohol marketing communications have been identified as a potential target for public health intervention due to their proposed |
influence on harmful patterns of alcohol consumption [2, 3]. The alcohol industryrsquo;s position is that marketing raises awareness of certain brands or products, but does not cause overall increased consumption [4, 5]. Findings from three published systematic reviews are discordant with the industryrsquo;s position [6–8]. These reviews investigated relationships between exposure to |
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* Correspondence: tm388@cam.ac.uk Kaidy Stautz and Kyle G. Brown are joint first authors. Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK |
various forms of alcohol marketing and alcohol consumption among young people. Their findings were based on
copy; 2016 Stautz et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
syntheses of overlapping but not identical sets of primary studies. Two of the reviews synthesised evidence from longitudinal cohort studies only [6, 7], whilst the third also incorporated evidence from cross-sectional studies [8]. All three concluded that exposure to alcohol marketing has a dose-dependent association with initiation of alcohol use and increased alcohol consumption.
Due to their focus on people below the legal drinking age these reviews did not include experimental studies, in which participants are randomised to be exposed either to alcohol marketing or a control stimulus, with alcohol consumption objectively measured post-exposure. Whilst the authors of one review [7] note that such studies lack ecological validity (i.e. their settings and procedures may not reflect the complex nature of real-world advertising exposure), experimental studies have several advantages. They allow for a high degree of control over marketing exposure and, with successful randomisation, minimise the potential for confounding of effects by unmeasured variables – a limitation of some longitudinal studies as acknowledged by previous review authors [6–8]. Further, objective measurement of alcohol consumption has benefits over self-report measures used in longitudinal studies, which are prone to influence by participant and contextual characteristics [9]. In synthesising observational or experimental research, there is therefore a trade-off between greater ecological validity and greater internal validity with reduced risk of bias. We are unaware of any systematic attempt to date to synthesise the results of experimental studies on this topic. We therefore conducted the systematic review reported here, to assess evidence from randomised, experimental studies for the im
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