Association between exposure to digital alcohol marketing and alcohol use: a systematic review and meta-analysis

Exposure to digital alcohol marketing content might be associated with pro-alcohol-related attitudes and behaviours, including the likelihood of initiating or sustaining the use of alcohol, especially among adolescents (aged <18 years) and young adults (aged 18-25 years). This study aimed to examine the relationship between exposure to digital alcohol marketing content and alcohol use outcomes.

Alcohol-related, digital media-related, and marketing-related search terms were entered into six online databases: PubMed, Web of Science, Scopus, PsycINFO, Embase, and Communication & Mass Media. Peer-reviewed articles written in English, published between Jan 1, 2004, and Feb 1, 2025, were included in the search. Studies that were included measured self-reported exposure to digital alcohol marketing content; used an unexposed control group; measured past 30-day alcohol use, binge drinking, or susceptibility to use alcohol among never users; and provided raw data to compute odds ratios (ORs) or reported ORs in the manuscript. When available, adjusted odds ratios were included; otherwise, unadjusted estimates were computed from raw data. A multilevel random-effects meta-analysis was used to estimate ORs and 95% CI, and heterogeneity (I²) was calculated for each alcohol use outcome. Study quality and publication bias were assessed. The study protocol was registered on the Open Science Framework.

The search identified 9913 articles. 96 articles were eligible for full-text review, of which 65 articles were removed based on the exclusion criteria. 31 studies were included in the final meta-analysis. The total sample size was 62 703 participants (32 314 [51·5%] female; 30 389 [48·5%] male, including 52 475 (83·7%) adolescents (aged 11-17 years) and 10 228 (16·3%) adults (aged ≥18 years). Participants exposed to digital alcohol marketing content, compared with those not exposed, had greater odds of reporting past 30-day alcohol use (19 studies, 46 361 participants; OR 1·75 [95% CI 1·39-2·20]; I²=91·0%), binge drinking (13 studies, 25 603 participants; 1·80 [1·22-2·67]; I²=95%), and susceptibility to use alcohol among never users (seven studies, 18 698 participants; 1·78 [1·29-2·46]; I²=88%).

Findings demonstrated an association between exposure to digital alcohol marketing content and alcohol-related behaviours. Future research is needed to clarify the temporal order between exposure to digital alcohol marketing content and alcohol-related behaviours.

The National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.