Youth Cognitive Responses to Alcohol Promotional Messaging: A Systematic Review

OBJECTIVE: This review examines the research of the effects of alcohol advertising on the cognitive mechanisms that precede underage alcohol use. METHOD: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed 22 studies (1988–2016) selected from 22,040 articles. The final sample assessed cognitive responses of youth younger than the legal purchase age who were exposed to alcohol advertisements from television or magazines. RESULTS: The studies were predominantly cross-sectional (59.1%), used convenience sampling (63.6%), had 74 to 3,521 participants, and were from six countries. The most common methods and applied theories for assessing advertising effects on cognitions were linear methods based on priming and modeling theories, and structural equation modeling based on information-processing models. Overall, advertising content appealed to youth, particularly advertisements that emphasized lifestyles of drinkers rather than the product quality. Youth exposed to alcohol advertisements were more likely to associate positive and arousing effects with alcohol, and in some studies effects were modified by sex, alcohol use, and age. Residual confounding and selection bias were a concern in the majority of studies. CONCLUSIONS: Exposure to alcohol advertising may affect underage perceptions of risks and rewards of alcohol use. Nevertheless, the ability to draw causal conclusions is limited because of study designs. Future studies should use nonlinear methods to assess the association between advertising and cognitions and avoid measuring alcohol advertising as a uniform and dose-response exposure among diverse populations. Future research would be strengthened by applying consistent theoretical frameworks, improving control for confounding bias, and using validated cognitive outcome measures.