Peer-Reviewed Publication; EUREKALERT
Corresponding Author: James D. Sargent, MD, Dartmouth Geisel School of Medicine, Rubin 8, Dartmouth Cancer Center, One Medical Center Drive, Lebanon, NH 03756 (james.d.sargent@dartmouth.edu).
Key Points
Question Is alcohol marketing exposure associated with subsequent increases in youth drinking?
Findings This systematic review and meta-analysis of 19 cohorts (82 498 participants from 10 high-income countries) found that alcohol marketing exposure was associated with a small increase in the risk of initiating drinking and binge drinking among youth that was unlikely due to chance; 86% of estimated relative risks were positive, consistent across countries, marketing measures, and drinking levels.
Meaning A large body of evidence shows that alcohol marketing exposure is associated with increased risk of youth drinking; confirmatory research is needed among youth in low- and middle-income countries.
Importance Alcohol marketing is ubiquitous. Although numerous longitudinal studies have examined its association with youth drinking, few have been synthesized in a meta-analysis.
Objective To quantify the longitudinal association between alcohol marketing exposure and youth drinking.
Data Sources MEDLINE, Scopus, and PsycInfo from inception to September 2, 2025.
Study Selection Longitudinal population-based studies assessing marketing exposure and drinking in youth younger than 25 years.
Data Extraction and Synthesis Data were extracted independently and in duplicate. The Risk of Bias in Nonrandomized Studies—of Exposures (ROBINS-E) tool was used to assess risk of bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess evidence certainty.
Main Outcomes and Measures Exposures included television advertising, other channel (eg, online) advertising, alcohol portrayals in entertainment media (brand placement), promotional activities, branded merchandise ownership, advertisement or brand liking, and composite exposure measures. Continuous exposures were scaled to reflect low-to-high comparisons, odds ratios were converted to relative risks (RRs), and multilevel meta-analysis was conducted to obtain pooled RRs. Subgroups were compared by exposure type, outcome, and risk of bias. Results were narratively synthesized where meta-analysis was not possible.
Results A total of 19 cohorts were identified (10 high-income countries; 23 publications; 94 RRs; n = 82 498). All studies were judged to be at risk of bias for self-report outcome assessment. There was an increased risk of youth drinking with high vs low advertising exposure (RR, 1.50 [95% CI, 1.37-1.63]), with moderate certainty of evidence (upgraded due to evidence of dose response). Narrative synthesis suggested that changes in attitudes and cognitions mediated the association. In subgroup analyses, exposure to television advertising was found to have the strongest association with drinking.
Conclusions and Relevance The results of this systematic review and meta-analysis show an association between alcohol marketing exposure and drinking outcomes across a variety of exposure types. Additional research is needed using single exposure measures that capture multiple marketing channels, to better address risk of bias, and to include studies from low- to middle-income countries, where alcohol marketing is expanding.