Punto de Equilibrio

2.2.2.1 Passive exposure studies (i.e., studies on exposure to user-generated online

alcohol-related content)

An Australian study examined young Australians’ (n=60; aged 18-21 years) perceptions of the relationship between alcohol and SNS (Jones et al., 2017). Personal interviews, focus group discussions, and written commentaries on self-examination of topics relating to

alcohol were used to collect data. Many participants reported having been regularly exposed to peer-generated alcohol posting on SNS. They also acknowledged the effect of such content (e.g., images) on their drinking behaviours, with content largely associating alcohol with success, pleasure, and strength.

A thematic analysis of focus group interviews conducted among UK adolescents suggested that involvement with SNS alcohol-related postings predicts normalisation of excessive consumption and potentially risky drinking behaviours among young people (Purves et al., 2014). SNS content analysis suggested that alcohol brands used alcohol-related content posted on their SNS pages to initiate conversations among SNS users and between brands and SNS users. This helped users co-produce content. SNS content analysis also

suggested that images and language were consciously chosen by brands to relate their content to users’ cultures, real-life, and leisure activities. This enabled brands to generate responses from the users consistent with the brands’ objectives and appeared to be

designed to appeal to niche groups. For example, images relating to brand packaging were found to be a trigger for brand preference between genders. While females appeared to prefer brightly-coloured and new products, males preferred simpler and popular products. A longitudinal study was conducted among 1,434 10th-grade students in five Southern California high schools (Huang et al., 2014). The aim of the study was to identify

associations between participants’ friends posting their own pictures of drinking or smoking, on Facebook and MySpace and the likelihood of increasing or maintaining their

(participants’) smoking and drinking levels at time 2. A significant association was found between exposure to peers’ posting their own pictures of smoking on Facebook and MySpace and own smoking levels at time 2 (p = .004). However, exposure to peers’ SNS postings of drinking was not significantly related to own alcohol use at time 2 (p = .807) (Huang et al., 2014).

Niland et al. (2014) conducted seven Facebook go-along focus group interviews with young European New Zealanders aged 18-25 years. Participants were asked to show their

Facebook profiles and discuss their everyday online drinking and social networking practices, such as their exposure to peers’ alcohol-related content posted on Facebook. Participants’ drinking photos, such as those taken at alcohol-related events and bars and clubs and posted on Facebook, were found to be a dominant feature of their discussions and online social networking activities. The authors concluded that finding online drinking content pleasurable and socially desirable could predict normalisation of alcohol use and reinforce cultures of drinking among young adults (Niland et al., 2014).

A US study examined the relationship between exposure to peers’ alcohol-related content posted on SNS (Facebook, Snapchat, and Instagram) during the initial six weeks of college and second semester drinking among 408 first year college students (Boyle et al., 2016). Exposure during the initial weeks of college was found to be an important predictor of drinking six months later across demographic groups (p<.01), with a stronger predictive relationship identified among males.

Another longitudinal study was conducted among 658 US high school students (Nesi et al., 2017). This study assessed the relationship between adolescents’ exposure to peers' SNS postings of alcohol, “alcohol-favourable peer injunctive norms” (e.g., online self-presentation that appear to be approving of alcohol among peers), and drinking behaviours (initiation of drinking, becoming drunk, and heavy episodic drinking). The associations were assessed at baseline and one year later. Peer injunctive norms significantly predicted the relationship between exposure to friends' SNS postings of alcohol and all drinking behaviours at Time 2 (all p<.05).

2.2.2.2 Active exposure studies (i.e., studies on participants’ involvement with online

alcohol marketing)

Critchlow et al. (2017) explored the relationship between engagement with user-generated online alcohol content (including social media posts) and higher-risk drinking among 18-25 year olds (n = 405) in the UK via an online cross-sectional survey. A stronger association was identified between engagement with user-generated online alcohol content and higher- risk drinking (AOR = 1.64) compared with awareness of user-generated online alcohol content and higher-risk drinking (AOR = 1.19). The association between awareness and participation was found to be significant for both males (AOR = 1.84, p<.05) and white British participants (AOR = 1.90, p<.01) compared with other demographic groups (Critchlow et al., 2017).

An Australian study explored the association between participants’ alcohol-identities on Facebook in terms of self- and other-generated alcohol-related content and alcohol

consumption and problems among a sample of 158 17-24 year old Australians (Ridout et al., 2012). Alcohol-identity on Facebook was found to be significantly associated with all

measures of alcohol consumption for both males and females (Alcohol Use Disorders Identification Test – alcohol consumption (AUDIT-C) p<.01; Graduated-Frequency measure – standard drinks consumed (GF-C) p<.01; Graduated-Frequency measure – binge drinking

(GF-B) p<.01); alcohol dependence/consequences (Alcohol Use Disorders Identification Test – alcohol problems (AUDIT-P) p<.01; Rutgers Alcohol Problem Index (RAPI) p<.01; and, the College Behaviour Checklist (CBC): p<.01)).

The relationship between Internet-based alcohol marketing and alcohol use among 9,038 school students was explored in a cross-country survey conducted in Germany, Italy, the Netherlands, and Poland (de Bruijn et al., 2016). For participants from all these countries, passive exposure to online alcohol marketing (e.g., having seen online alcohol-related content) was significantly associated with increased odds of drinking initiation (OR = 1.6, p<.001). Similarly, exposure to online marketing (e.g., ever received promotional emails) was a predictor of binge drinking in the past 30 days (OR = 1.05, p<.05). Significant associations were also identified between drinking initiation and active engagement with online alcohol marketing (e.g., searched for information on alcoholic beverages (OR = 1.14, p<.001), downloaded alcohol-branded screensaver (OR = 1.12, p<.001), and used alcohol- branded social media page (OR = 1.06, p<.05)). Further, participation with online alcohol content (e.g., searched for information on alcoholic beverages (OR = 1.11, p<.001),

downloaded alcohol-branded screensaver (OR = 1.12, p<.001), and used alcohol-branded social media page (OR = 1.06, p<.001)) was found to be a significant predictor of past 30 days binge drinking.

The association between interaction with SNS alcohol-related content and drinking among young 1,001 Australians was investigated via an online survey (Carrotte et al., 2016). Interaction with SNS alcohol-related content was significantly associated with self-reported risky drinking (OR = 2.1, p<.001). Higher levels of risky drinking were identified among older age groups, Australian born respondents, those spending more on recreational activities, illegal drugs users, and those started drinking at an early age.

Pumper & Moreno (2013) investigated the longitudinal association between and Facebook postings of alcohol-related content and drinking, before starting the first year at college

(Time 1) and at the end of first year (Time 2) among 315 first-year US college students. The eligible participants were those deemed “high-risk alcohol users”. Participants’ Facebook accounts were also examined for identifying the references to alcohol use and high-risk alcohol use at both Time 1 and Time 2. A mean increase in both attitude and intention scores towards alcohol was identified at Time 2 compared with Time 1 (4.0 and 4.0 versus 4.6 and 4.9) among high-risk alcohol users. Further, a greater proportion of high-risk alcohol users displayed more references to high-risk alcohol use at Time 2 compared with Time 1 (52% versus 5%) (Pumper & Moreno, 2013).

A Belgian study conducted among 1,006 late adolescents assessed the reciprocity of alcohol-related postings on SNS and binge drinking at T1 (baseline) and T2 (one year later) (Geusens & Beullens, 2017). Results indicated that alcohol-related postings at baseline were associated with binge drinking one year later (p<.05) and vice-versa (p<.05). Gender

differences were identified for these associations: 1) girls reported less binge drinking at T2 (p<.001) but not at T1 (p = .06) than boys and 2) the frequency of SNS alcohol-related postings were less compared with boys both at baseline (p = .08) and follow-up (p = .13). A US longitudinal study investigated the association between baseline exposure to and engagement with online alcohol-related content (assessed as scores on positive responses to exposure and engagement and called “Internet receptivity scores”) and underage alcohol use at 1-year follow-up using computer-assisted telephone and web-based surveys

(McClure et al., 2016). While significant associations were found between scores and binge drinking one year later (score of 1: OR = 1.77, p<.0001; score of 2: OR = 2.15, p<.0001), no such relationship was found in the context of baseline drinking.