Normalisation of alcohol drinking due to exposure to alcohol marketing in young adults : a prospective study with ecological momentary assessment

Abstract

The normalisation of alcohol consumption has significantly influenced social attitudes, rendering drinking typical, acceptable, and even desirable behaviour. This prospective cohort study aimed to investigate how exposure to alcohol marketing contributes to normalisation beliefs of drinking, including perceived descriptive and injunctive norms, as well as positive drinking expectancy among young adults in Hong Kong by using ecological momentary assessment (EMA) for 21 consecutive days, reporting their exposure to alcohol advertisements and their drinking behaviours. The study evaluated changes in the perceptions and drinking behaviours resulting from exposure to alcohol marketing. The study involved 371 participants aged 18 to 35, with a mean age of 26.82 (SD = 4.86). Approximately one-third of the participants were male. Notably, over 55% initiated their first drink before age 18, with more than 5% having their first drink before age 11. The findings revealed that exposure to alcohol marketing during the EMA period was not associated with any normalisation beliefs of drinking and alcohol consumption. The perception of social approval at follow-up was associated with drinking frequency (r = 0.145, p < 0.01) and drinking amounts (r = 0.152, p < 0.01) during the EMA period, as well as the age of initiation of drinking (r = -0.18, p < 0.01). Both alcohol consumption outcomes during the EMA period (drinking frequency and drinking amounts) were negatively associated with age (r = -0.091, p < 0.05; r = -0.107, p < 0.01) and PHQ-4 score at baseline (r = -0.077, p < 0.05; r = -0.077, p < 0.05). Positive Expectancy of Drinking at follow-up was associated with getting drunk within the EMA period (r: -0.122; p < 0.01). Male participants tended to drink more frequently and more amounts of alcohol. The study also assessed the compliance of alcohol marketing with the Generic Code of Practice on Television Advertising Standards, which previously focused solely on television broadcasting, and the General Guidelines on the Prohibition of Sale or Supply of Intoxicating Liquor to Minors in the Course of Business in Hong Kong. Content analysis revealed frequent violations across various media, with marketing often portraying alcoholic beverages as similar to non-alcoholic products. Advertisements labelled drinks as “light” or low in alcohol content and featured colourful imagery, including fruits and cartoons, to attract consumers. Such marketing strategies framed drinking as a desirable lifestyle choice essential for social success and popularity. These findings provide crucial evidence for policymakers and healthcare providers to consider implementing stricter controls on alcohol advertising. The potential impact of these measures is significant, as they could help mitigate the impact of alcohol marketing and promote healthier drinking behaviours in society. Future research should explore the mediating factors and longitudinal effect between alcohol marketing, drinking norms, and consumption behaviours and validate the measurement tools for normalisation beliefs.