Examining the causal association between alcohol marketing and alcohol-related attitudes and consumption: A longitudinal cohort study with adults in the United Kingdom

Background

Harmful alcohol use is associated with myriad health and social harms which, in turn, generate a substantial economic burden. In the United Kingdom (UK), there were 9,461 deaths from alcohol-specific causes in 2021, the highest number on record. It is therefore important to continually examine drivers of alcohol use and identify evidence-based opportunities to limit and prevent such harm. Multiple evidence reviews have concluded that exposure to alcohol marketing is positively associated with alcohol use, including among young people. Alcohol marketing refers to all the activities used to increase the visibility and salience of alcohol products and brands. This includes, but is not limited to, advertising, sponsorship, packaging, price offers, point-of-sale display, and digital marketing. To limit the role that marketing plays in driving consumption, several European countries have introduced statutory controls to restrict where and how often alcohol can be marketed and what it is permitted to say (e.g., France, Ireland, Norway). In the UK, alcohol marketing continues to be largely self-regulated, although the Scottish Government has recently consulted on introducing statutory restrictions.

To date, there is limited robust empirical evidence about the reach and impact of alcohol marketing among consumers in the UK, which presents a key barrier to developing evidence-based policies to reduce harm. Of the limited studies which do exist in the UK, most focus on those under the minimum legal purchasing age (<18 years) and are based on cross-sectional designs that cannot infer causal relationships between marketing and consumption. A predominant focus on young people in both the UK and international literature also leaves a crucial gap in our understanding of how marketing influences adults. This is important given that adults are the primary targets for alcohol marketing communications and the source of most alcohol sales and consumption. This means there is also limited understanding about the impact of alcohol marketing on vulnerable adult groups (e.g., higher-risk drinkers or those looking to reduce consumption) and whether alcohol marketing exposure and influence varies among subgroups (e.g., by socioeconomic status or age). Most research has also only examined an impact on consumption, which underestimates the vital role that alcohol marketing plays in shaping key antecedents to consumption, such as normative beliefs, brand salience, and drinking motives.

Aims

This study will establish robust and comprehensive evidence about the reach and influence of alcohol marketing among adults in the UK. Specifically, it will examine:

1. Awareness of, and engagement with, a range of alcohol marketing activities.
2. The extent to which alcohol marketing exposure influences both alcohol use (e.g., frequency of drinking, frequency of heavy episodic drinking etc) and psychological factors which are key antecedents of alcohol use (e.g., normative beliefs, drinking motives, outcome expectancies, brand salience etc).
3. How the reach and influence of alcohol marketing varies across subgroups (e.g., age, gender, socioeconomic status, level of drinking risk etc).

Methods

Design: A two-wave longitudinal study using self-report surveys, an established method of investigating the causal relationship between alcohol marketing and consumption among young people.

Sample: We will recruit a cohort of adults (18+) living in the UK using non-probability online market research panels (e.g., YouGov’s panel of one million UK adults). We will recruit 6,000 participants at baseline and achieve a 65% retention rate at follow-up (n=3,900 full completers). We have used this approach in previous longitudinal studies examining gambling during COVID-19 and the impact of tobacco control measures in the UK, including a demonstrable ability to obtain high retention rates.

Measures: We will design a bespoke online survey (~15 minutes) to capture the main domains outlined in the aims. This will include a suite of measures to capture awareness of, and engagement with, a variety of alcohol marketing activities, as well as data on alcohol use, consumption patterns, related attitudes (e.g., drinking motives, outcome expectancies, norms, brand salience), and perceptions of current/potential alcohol marketing policies. To strengthen our ability to examine a causal impact of marketing, we will also measure other contextual factors that may also explain changes in alcohol use and attitudes between waves (e.g., changes in personal circumstances). The survey will be developed and refined through a literature review, bespoke public-patient involvement groups, a project advisory group (see policy relevance section), and cognitive testing to ensure the validity of survey measures.

Analysis: This will be conducted in two stages to ensure timely policy insight. Once the baseline data are collected, we will report where (and how often) adults recall being exposed to a variety of alcohol marketing activities, how exposure varies among key subgroups (overall and for specific marketing activities), and the cross-sectional associations between alcohol marketing exposure, alcohol use, and alcohol-related attitudes. Once follow-up data are collected, we will examine to what extent changes in exposure to alcohol marketing between waves (overall and for specific activities) are predictive of changes in key consumption and attitudinal outcomes, controlling for confounders and covariates.