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Nearly Five Times Higher than We Think: How Much People Underestimate the Amount of Alcohol in Popular Movies and What Predicts Underestimation?

  • Institut für Therapie- und Gesundheitsforschung


Reducing alcohol use is challenging due to the volume of alcohol shown in media and the relationship between exposure and use. It is unclear to what degree people are aware of and able to estimate alcohol exposure in the media, such as in movies. In this study, 609 Australian adults estimated the amount of alcohol exposure in up to 10 of 102 popular movies they remembered best. They reported when they last saw each movie, their alcohol use, age, and gender. Participants underestimated the amount of alcohol in movies by an average of 35.39 times. Movies classified as featuring adult content (PG-13 or R) and movies with the greatest amount of alcohol were particularly underestimated. Individual’s age, gender, alcohol use, or when the movie was last viewed had no effect on underestimation. In conclusion, due to the severe underestimation, alcohol exposure should be more seriously reviewed by governmental and medial organizations.
International Journal of Mental Health and Addiction
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NearlyFive Times Higher thanWe Think: How Much People
Underestimate theAmount ofAlcohol inPopular Movies
andWhat Predicts Underestimation?
MareePatsouras1 · BenjaminC.Riordan1· MatthisMorgenstern2·
ReinerHanewinkel2· EmmanuelKuntsche1
Accepted: 21 December 2022
© The Author(s) 2022
Reducing alcohol use is challenging due to the volume of alcohol shown in media and the
relationship between exposure and use. It is unclear to what degree people are aware of
and able to estimate alcohol exposure in themedia, such as inmovies. In this study, 609
Australian adults estimated the amount of alcohol exposure in up to 10 of 102 popular
movies they remembered best. They reported when they last saw each movie, their alcohol
use, age, and gender. Participants underestimated the amount of alcohol in movies by an
average of 35.39 times. Movies classified as featuring adult content (PG-13 or R) and mov-
ies with the greatest amount of alcohol were particularly underestimated. Individual’s age,
gender, alcohol use, or when the movie was last viewed had no effect on underestimation.
In conclusion, due to the severe underestimation, alcohol exposure should be more seri-
ously reviewed by governmental and medial organizations.
Keywords Alcohol· Media· Memory· Dual process model· Exposure
Alcohol contributes to over three million deaths per year, and given the health and societal
costs of alcohol misuse, reducing alcohol use is an international priority (World Health
Organization, 2018). However, this is difficult due to alcohol’s omnipresence in media
(such as popular movies) and the link between alcohol exposure and alcohol use (Bigman
etal., 2020).
* Maree Patsouras
1 Centre forAlcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
2 Institute forTherapy andHealth Research, Kiel, Germany
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International Journal of Mental Health and Addiction
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The Link Between Alcohol Exposure andAlcohol Use
Alcohol exposure in popular movies is one of several elements in the environment that can
influence drinking behavior. Content analyses have found that alcohol is present in around
85–90% of movies (El-Khoury etal., 2019; Tickle etal., 2009). Compared to traditional
advertising, movies are perceived as entertainment, and alcohol messaging is not as explicit
(e.g., characters may drink without drawing attention to it; Dal Cin etal., 2009). Addition-
ally, movie exposure may be more persuasive as viewers may perceive movie characters as
super-peers, increasing identification if the character is evaluated similarly to themselves,
positively, or if they wish/want to be like them (Elmore etal., 2017; Morojele etal., 2018).
Most of the previous research has established the link between alcohol exposure in mov-
ies and drinking behavior (for an exception, see Stautz et al., 2016). For example, ado-
lescents exposed to the highest quartile of movie alcohol exposure were at increased risk
for every drinking milestone, including sipping (7% increased risk for every extra hour of
movie alcohol exposure), initiation (risk increased by 49% to 53% over 2years), consum-
ing a full alcoholic beverage (increased risk by 6% for each hour of movie alcohol expo-
sure), weekly drinking (2.4 times more likely), heavy episodic drinking (8% additional risk
per hour of movie alcohol exposure), and binge drinking (1.7 times more likely; Bigman
etal., 2020; Jackson et al., 2018; Waylen etal., 2015). Complementing this, exposure to
alcohol in popular media can limit the effectiveness of alcohol interventions (Boyle etal.,
Given research highlighting thatmovie alcohol exposure was related to increased alco-
hol consumption, reducing exposure may be an effective option to reduce alcohol-related
risk. However, it is currently unclear to what degree people are aware of alcohol exposure
in movies and how influential it is.
The Dual Process Model
Previous research has showed strong support for the exposure-behavior relationship, but
less is known about the mechanisms or theoretical perspective behind this effect. This
may be explained through the lens of the Dual Process Model (Strack & Deutsch, 2004),
which posits that exposure can lead to alcohol use through two distinct pathways, a slow
system (conscious, accessible, and intentional cognitions) and a fast system (automatic,
faster, unconscious cognitive processes; Larsen etal., 2012; Pieters etal., 2010; Strack &
Deutsch, 2004). Alcohol attitudes could be shaped or changed through both systems. Via
the slow system, repeated movie alcohol exposure may promote pro-alcohol beliefs by pro-
viding information about the role, normativity, acceptability, and positive consequences of
alcohol use (Dal Cin etal., 2009; Jackson etal., 2018; Koordeman etal., 2011a). Repeated
alcohol exposure in movies may elicit conditioned responses via the fast system of the
Dual Process Model, increasing alcohol use, without awareness via our slow, deliberate,
and intentional system. If individuals are mostly unaware of the amount of alcohol they
are exposed to in movies, this study can provide a new understanding for this theoretical
The first step is to show whether viewers are actually aware of and can correctly esti-
mate movie alcohol exposure events. It could be difficult to implement strategies to reduce
awareness (such as avoiding alcohol exposure) if individuals greatly underestimate alcohol
exposure. This may be particularly important for people undergoing alcohol treatment or
for parents wanting to limit the amount of alcohol their children are exposed to.
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This study investigated whether viewers can recall how many times they have seen alco-
hol in movies they remember well.
Which Factors Predict Movie Alcohol Exposure?
Although it is important to demonstrate whether people underestimate the amount of alco-
hol they are exposed to, it is also important to determine what factors might predict under-
estimation. By including information about the movie, (such as movie classification, the
amount of alcohol exposure, and when the movie was last viewed) and about the individual
(such as gender, age, and drinking habits), this could help identify where or what type of
people would most benefit from resources. Although this research question is exploratory,
there is reason to believe that people will underestimate alcohol exposure more in movies
aimed at children, that those who drink less will underestimate movie alcohol exposure
more than those who drink more, and that participants will be no more accurate estimating
movie alcohol exposure irrespective of when the movie was last viewed.
For example, movie classifications (which refer to both advisory and restricted catego-
ries) in Australia classify movies based on drug usage, themes, sex, language, violence,
and nudity, with no independent alcohol category (Australian Government, 2020). Based
on the USA classification, almost half of 81 (47%) General-rated movies (G) depict some
form of alcohol use (Thompson & Yokota, 2001). G and Parent-Guidance-Suggested (PG)
are movies mostlyaimed at children audiences, where all ages are either admissible or with
parental guidance (Motion Picture Association, 2022). Parent-Strongly-Cautioned (PG-13)
movies portray some content considered inappropriate for children and pre-teen audiences,
and Restricted (R) movies portray adult material (Motion Picture Association, 2022). Due
to the unexpectedly high amount of alcohol exposure events in G/PG-rated movies, it is
likely that individuals underestimate movie alcohol exposure more in movies for children
(G/PG) than those aimed towards an adult or mature audience (PG-13, R movies).
Similarly, the amount of alcohol that is remembered in popular movies may differ by
different drinking groups. People who drink more may be more likely to correctly estimate
alcohol exposure events, due to the unique cognitive impact alcohol cues has on memory
processing (Brown etal., 2016). For example, people who drink more may react differently
towards alcohol cues due to its increased salience and motivational importance (Brown
etal., 2016; Witteman etal., 2015). This could potentially coincide with increased aware-
ness of alcohol exposure in movies; those who drink may be more aware of alcohol when
it is presented in a popular movie. Additionally, previous research has highlighted strong
but inconsistent evidence investigating recall biases for alcohol use, yet no evidence has
investigated recalling estimates of movie alcohol exposure. Recall biases (underreporting
past alcohol use due to reduced, forgotten, or minimized salience) suggest that recall abil-
ity declines substantiality over time (Greenfield & Kerr, 2008). Previous research shows
that shorter recall periods provide less biased and more accurate consumption estimates
than longer recall periods; yet, longitudinal studies have incongruously indicated relatively
reliable relationships between concurrently reported and recalled consumption (Chu etal.,
2010; Ekholm, 2004; Gmel & Daeppen, 2007; Krenek etal., 2016; Kuntsche & Labhart,
2012; Liu etal., 1996; Merrill etal., 2020). While participants estimation of movie alcohol
exposure may be suspectable to recall errors, it may be likely that if participants are una-
ware of movie alcohol exposure, they underestimate regardless of the last recall period (the
last time participants saw the movie).
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Current Study
This study aims to determine whether (and to which amount) people are aware of alco-
hol exposure in popular movies. Our first and main hypothesis was that participants would
underestimate the amount of alcohol exposure in movies, and this hypothesis and the meth-
ods described below were pre-registered on the Open Science Framework (10. 17605/ OSF.
IO/ NQ9BT; any deviations from the pre-registered protocol are noted). Additionally, we
aimed to explore which factors predicted estimation (gender, age, alcohol use, movie clas-
sification, total alcohol exposure, and time since the movie was last viewed). Although we
pre-registered no hypotheses and the research question was largely exploratory, we antici-
pated that (i) participants would underestimate the amount of alcohol more in children’s
movies (classified as G/PG) than adult movies (PG-13, R), that (ii) people who drink more
will underestimate less (compared to those who drink less), and that (iii) participants will
be no more accurate estimating alcohol exposure in movies viewed recently or longer in
the past.
Participants were recruited in July 2021 via targeted social media advertisements on Face-
book and Instagram. Participants were eligible if they were residing in Australia, over
18 years old, and proficient in English. Participants were included in the analyses for
the first research question (do people underestimate movie alcohol exposure) if they had
provided any alcohol movie estimates (n = 609) and for the second (what factors predict
greater underestimation) if they provided both movie estimates and information about
their gender, age, and alcohol use (n = 395, 64.9% of the overall sample, mean age 44.08,
SD = 16.3, 52% female, 44% male and 4% other).
Movie Selection
The movie list included 102 movies (see the Supplementary material for a full alcohol
exposure list). Overall, ninety-seven movies were sourced from a previous study (ninety-
three were retained), where researchers watched and content analyzed each movie to pro-
vide an estimate of alcohol exposure (Hanewinkel etal., 2014). Hanewinkel etal. (2014)
defined alcohol exposure by counting when major or minor characters used or handled
alcohol, or when it was used in the background (counted after it first appeared on screen).
A total of 56% of the movies had previously been coded by researchers at the Dartmouth
Media Research Laboratory, and the remaining were coded by trained coders from six
study centers in Europe (Hanewinkel etal., 2014). Interrater reliability was calculated in
two ways: (a) by comparing the coding results between the European trainers and cod-
ers on training movies (ranging from r = 0.93 to r = 0.99) and (b) by comparing the Euro-
pean trainers and the original coders from Dartmouth Media Research Laboratory, in a
blinded random sample of movies (r = 0.87; Hanewinkel etal., 2014). For more informa-
tion, please view the original article (Hanewinkel etal., 2014). Twelve more recent movies
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(nine were retained) were also coded for the purposes of this study using the same criteria
as Hanewinkel etal. (2014). This study selected only the most popular movies in Australia
based on the Screen Australia rankings (Australian government agency, reporting the top
50 grossing movies in the Australian box office for each year; Screen Australia, 2018).
Firstly, it was checked whether the previously coded movie was included in the ranking for
the year it was released, and movies were then randomly selected (Screen Australia, 2018).
This ensured the movie was popular and likely viewed by many Australians.
The newly coded movies were chosen based on Screen Australia rankings from 2015
to 2020, choosing the top two highest grossing movies released for each year and ran-
domly choosing the rest to fill each classification. This was conducted by one researcher
on the team (M.P). On average, the 102 movies contained 42.95 alcohol exposure events
(SD = 48.57, median = 28). One deviation from the pre-registered outcomes is that we
removed 7 movies because they were animated movies and did not include any prominent
human characters (e.g., Cars 2, the Lion King). This reduced the total amount of movies
from 109 (previously and newly coded) to 102 (see Fig.1 in the Supplementary material
for additional information about the movie selection process).
Gender Participants reported whether they identified as male, female, non-binary, or
rather not say (recoded in data analysis to male, female, or other).
Age Participants selected from seven categories, ranging from 1 (18–24) to 7 (75years or
older). To calculate mean age, midpoints of categories were used with the highest category
of 75 plus being recoded to 79.5 (75 + half to the adjunct category; Kuntsche etal., 2007,
Estimation of Alcohol Exposure in Movies Participants were asked to select up to 10 mov-
ies (from the 102 movies on the list) they remembered the best. Participants were asked to
estimate how many times alcohol was visible in each chosen movie, on a nine-point scale
from 1 (0) to 9 (200 +). Estimates were recoded by calculating the means for each response
option (with the 200 + option scored as half to the adjunct category (being 249.5; Kuntsche
etal., 2007; Kuntsche et al., 2008). Given that one movie had a higher number of expo-
sure events than the top category (i.e., Inglorious Bastards with 617 alcohol events), we
recoded this movie to 249.5. To calculate the difference (i.e., the under or overestimation),
the actual exposure of alcohol in the movie was subtracted from the participants’ estimated
Time Since the Movie Was Last Seen Participants were asked to rate how long ago they
saw each selected movie the last time, on an 8-point scale, from 1 (in the last 2months) to 8
(12 and more years ago). All categories were recoded in months since last watched by using
midpoints of categories with the last category being recoded to 180 (= 12years*12months
per year + 36 (half to the adjunct category; Kuntsche etal., 2007, 2008)).
Classification The movie classification that participants selected and estimated was
included. Movie classification (G/PG, PG-13, and R) was previously coded by Hanewinkel
etal. (2014), according to the Motion Picture Association (the USA version; Motion Pic-
ture Association, 2022). The newly coded movies were classified using the same system.
As in previous research (Dal Cin etal., 2008; Stoolmiller etal., 2012; Wills etal., 2009),
G and PG movies were combined into a single category. G/PG movies represented the
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International Journal of Mental Health and Addiction
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movies appropriate for children, and PG-13 and R movies represented adult/mature mov-
ies (see TableS1 in the Supplementary material for additional details on the classification
guide for Australia in comparison to the USA’s rating system).
Alcohol Use Alcohol use was assessed with the Alcohol Use Disorders Identification
Test–Consumption (AUDIT-C; Bush etal., 1998) that consists of three items: frequency
of drinking (rated on a 5-point scale, ranging from 1 (never) to 5 (4 or more times a week),
typical drinking quantity, (scored on a 6-point scale from 1 (none) to 6 (10 or more), and
frequency of binge drinking (scaled on a 5-point scale ranging from 1 (never) to 5 (daily or
almost daily). Total scores were computed by summing all three sub-scales (minimum = 0,
maximum = 12, Cronbach’s alpha = .76). Scores of 3 and 4 is an indicator of hazardous
drinking for women and men, respectively (Fischer etal., 2021). To help with standard
drink estimates, participants were shown a diagram depicting unit content and standard
drink sizes for different alcoholic beverages.
Participants were recruited through social media advertising to take part in a 15-min online
survey hosted on Question Pro (QuestionPro, 2022). Participants who clicked the link in
the advertisement were directed to the consent form, where they were informed that the
study was about the “themes, acceptability, and ratings in movies.” Limited disclosure was
used to ensure that participants would not deduce the true aim and bias their estimates of
alcohol content in movies. All participants who provided consent then were asked to select
up to 10 movies from the movie list of 102 movies that they remembered best. To avoid the
tendency that participants may systematically chose movies on top of the list, two versions
of the survey were administered with the order of movies presented reversed (otherwise
surveys were identical). For each movie selected, participants then rated how long ago they
saw each movie the last time and provided estimates for the amount of alcohol exposure in
all chosen movies. Participants also provided smoking, violence, and swearing estimates to
disguise that the true focus was on alcohol. Finally, participants completed the AUDIT-C
and demographic information. After completion, participants received a debriefing state-
ment outlining the survey’s real purpose. Participants were offered a prize entry to win
one of five $50 e-vouchers. All methods were approved by the La Trobe University Human
Research Ethics Committee (HEC21089).
Analysis Strategy
To determine whether participants underestimated alcohol exposure in movies, an inter-
cept-only multi-level model was estimated using the lme4 package in the R statistical
software (Bates et al., 2015; The R Foundation, 2021). Note that although we initially
pre-registered a one-sample t-test on the Open Science Framework, the intercept-only
multi-level model allows us to account for multiple observations per participant and was
preferred. In order to determine which factors predict greater underestimation in movies,
an additional multi-level model was estimated with the difference score as the outcome
variable and gender, age, alcohol use, when the movie was last viewed, classification,
and the total frequency of alcohol in the movie as predictors. Dummy codes were used
for the gender variable (with females as the reference), classification variable (with G/PG
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classifications as the reference), and for the movies with themost alcohol exposure (where
1 = movies with one standard deviation above the mean for exposure, otherwise 0).
On average, the participants saw the movies just over 3years ago and had an AUDIT-C
score of 2.8 (SD = 2.4; slightly under the AUDIT-C cutoff for hazardous drinking of 3 and
4 for women and men, respectively). Using the AUDIT-C cutoffs, 19.0% of men in the
study and 19.7% of women were drinking hazardously. Additionally, the 609 participants
rated on average 7.0 movies resulting in 4251 movie alcohol estimates and rated a mix
of G/PG (20%), PG-13 (43%), and R-rated movies (37%). On average, participants
estimated that alcohol exposure occurred 9.3 times in the movies (SD = 23.4). However,
alcohol was actually shown in these movies 44.6 times (SD = 54.6) on average. Therefore,
participants underestimated the amount of alcohol by 35.4 alcohol exposure events per
movie on average (SD = 23.4; see Table 1 for estimate breakdowns by gender, age, and
movie classification). An intercept-only multi-level model found that this underestimation
was statistically significantly different from zero (intercept = 35.3, 95% confidence
interval = − 37.4, − 33.3, p < 0.001).
What Predicts Greater Underestimation?
As seen in Table 2, participants were also more likely to underestimate the amount of
alcohol in PG-13 and R-rated movies compared to G/PG movies. Additionally, movies with
the most alcohol exposure were underestimated more than other movies. Neither gender,
time since when the movie was last viewed, age, nor participants’ alcohol use (AUDIT-C
scores) impacted alcohol estimates.
Table 1 Descriptive summary
means for true alcohol exposure,
participants’ estimations, and
the difference, by gender, age
(median split), and movie
Variable True alcohol
Total 44.6 9.3 − 35.4
Female 49.7 11.2 − 38.1
Male 46.2 8.5 − 37.7
Other 47.9 6.7 − 41.1
Age (median split)
Under 39.5years 39.2 7.7 − 31.5
39.5years and over 52.8 11.4 − 41.1
G/PG 16.3 2.1 − 13.9
PG-13 43.2 7.4 − 35.2
R 71.2 17.7 − 53.1
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The aims of this study were to investigate participants’ estimation of alcohol exposure
in popular movies and what factors contributed to greater underestimation. The results
revealed that participants greatly underestimated the amount of alcohol in movies, and that
PG-13 and R-movie classification and amount of alcohol exposure accounted for greater
Although it was expected that participants would underestimate the amount of alcohol in
movies, the magnitude of their underestimation was striking, as the actual average alcohol
exposure in movies was nearly five times higher than the participants’ average estimation
of alcohol events. This highlights that despite the high contents of alcohol, even in chil-
dren’s movies, participants underestimate its prevalence. Potentially, among our Australian
sample, and given that alcohol use in Western societies is embedded as a form of sociabil-
ity, alcohol may be so normalized and tolerated that it may be perceived as ordinary and
unremarkable (Kuntsche etal., 2021). This study has showed that underestimating alcohol
use may unwittingly expose viewers to increased alcohol-related risk, occurring without
their knowledge. Thus, individuals (or parents of children) cannot implement strategies to
reduce their exposure to alcohol or to decrease their related risk if they underestimate its
exposure amounts. Furthermore, alcohol underestimation may be harmful because repeated
alcohol exposure in movies may elicit conditioned responses, e.g., via the fast system of the
Dual Process Model (Strack & Deutsch, 2004), increasing alcohol use without awareness.
Increasing awareness of alcohol exposure events via the slow system of the Dual Process
Model (such as informing people about underestimation and the consequences of alcohol
exposure) can enable informed decision-making before viewing movies.
For our second exploratory hypothesis (what predicts underestimation), we
found some interesting and unexpected findings, i.e., all three of our individual-
level predictors (gender, age, and alcohol use) were non-significant. This highlights
how common and generalized the underestimation of alcohol exposure was among
our participants. We believe that the social normalization of alcohol, and the sheer
volume of alcohol exposure in movies, led our participants to be less aware of its
presence and this occurred regardless of their age, gender, or alcohol use. We speculate
that as alcohol is so normal and socially accepted, movie alcohol exposure may
Table 2 Model for different factors predicting greater underestimation
B, unstandardized regression coefficient; CI, confidence interval; 1movies with the most alcohol exposure
(where 1 = movies with one standard deviation above the mean for exposure, otherwise 0)
Predictors B (95% CI) p
Intercept − 4.02 (− 11.18; 3.14) .271
Gender (male vs female) − 2.80 (− 7.22; 1.63) .215
Gender (other vs female) − 3.39 (− 15.26; 8.49) .576
Age − 0.12 (− 0.26; 0.01) .075
Alcohol use (audit score) − 0.46 (− 1.37; 0.44) .317
Classification (PG-13 vs G/PG) − 8.59 (− 12.85; − 4.33) < 0.001
Classification (R vs G/PG) − 7.90 (− 12.48; − 3.32) < 0.001
Time since last viewed − 0.02 (− 0.06; 0.02) .407
High exposure1 − 117.55 (− 121.84; − 13.26) < 0.001
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not evoke the same reaction or be as memorable as other more salient events (i.e., than
drug exposure or violence would). This may have serious implications for specific
sub-populations; for example, for alcohol use, people who drank more alcohol did not
recall alcohol any better than those who did not drink or drank less. Thus, whilepeople
drinking heavily can make a conscious effort to avoid drinking establishments or choose
non-alcoholic drinks, unfortunately, they will be just as poor (as people drinking at
lower levels) at avoiding alcohol-related media, which potentially could induce craving,
as seen in previous research investigating alcohol-dependent patients and alcohol
advertisements (Witteman etal., 2015).
Interestingly, we found no significant differences for the estimation for gender, despite
prior experimental research showing that males may be particularly suspectable to alcohol
imagery (Koordeman etal., 2011a, b). Our findings may show no differences because it
was based on estimating alcohol exposure, rather than the outcome of increased drinking.
While it was mainly exploratory, participants underestimated alcohol exposure more in
adult audience/mature movies (PG-13 or R) than in children’s movies (G/PG). It appears
that while participants believed that there was more alcohol in PG-13 and R movies, they
still believed that there were very few alcohol presentations in all classification movies.
One possible explanation is that participants underestimated PG-13 and R-rated movies
more than G/PG-rated movies because PG-13 and R movies typically had more alcohol
Consistently, participants were significantly more likely to underestimate alcohol in
movies containing more alcohol exposure. One possible explanation is that participants
may have an average or norm of alcohol exposure they expect to be in movies; that is,
they expect a certain amount in PG-13 movies and even more for R movies. However, as
they are unaware of the true exposure amounts, and given that the true exposure is much
higher, this creates the large discrepancy. Previous research has established clear links
between alcohol exposure and use (Bigman etal., 2020; Jackson etal., 2018; Waylen etal.,
2015), and this study has contributed by highlighting that participants even underestimate
exposure in adult movies, highlighting their unawareness of the very high prevalence.
Therefore, it is important to include alcohol as its own category during classification
decisions, which is currently not the case in Australian movie classifications (Australian
Government, 2020). This could help alert or increase participant awareness of alcohol
exposure in movies.
Participants underestimate alcohol exposure regardless of the last time they viewed
the movie. This result was inconsistent with the recall bias literature, which suggested
that shorter periods between an event and retrospective reporting improved accuracy and
relatively reliable longitudinal associations (Chu et al., 2010; Ekholm, 2004; Gmel &
Daeppen, 2007; Krenek et al., 2016; Kuntsche & Labhart, 2012; Liu etal., 1996; Merrill
etal., 2020). The results of this study may have differed from previous research as it instead
investigated recall of alcohol exposure in movies, instead of retrospective assessments for
alcohol consumption. Our study emphasized that participants’ estimate of alcohol exposure
was not degraded by recall biases, nor did it improve, suggesting no significant differences
between participants estimating recently and over a decade ago. This highlights that instead
of being impacted by recall biases, participants generally underestimate alcohol exposure
in movies, regardless of when the movie was last viewed. This circumvented the potential
limitation of recall biases implicating potential results, as the predictor was non-significant
in the final model.
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To increase participant awareness of alcohol exposure, warnings could be placed before
movies or on ticketing websites before purchasing. Our results could inform treatment
and recovery decisions by including recommendations of safe movies (with low alcohol)
alongside treatment; similar to the public websites presenting smoking exposure, new web-
sites could be created to account for low alcohol or alcohol-free movies (Rauchfreie-filme,
Increasing people’s awareness of alcohol exposure in movies (andits impact) may help
viewers make conscious and informed decisions before they expose themselves to movies
with high alcohol. In relation to movie regulations, Australia’s Classification Board could
independently include alcohol in its classification decisions, or provide more contextual
information on websites or before watching the movie. This could include examples of
binge drinking, alcohol dependence, the age of the characters drinking, or if alcohol was
generally framed as being positive or negative (Australian Government, 2015, 2020).
Limitations andFuture Research
One limitation of our study is the use of a convenience sample of Australian adults,
which may have limited generalizability and may not be representative of all Australian
adults. Another limitation is that we focused on movies exclusively. Future research
should include other media sources, to examine if underestimation is specific to movies
or generalized across media forms (e.g., social media, alcohol advertising). Testing
whether this effect holds over multiple media sources may be important for policy
(like reducing advertising) or treatment (incorporating social media breaks as part of
We found that participants underestimated the amount of movie alcohol exposure by a near
factor of five and that amount of alcohol exposure and movie classification accounted for
greater underestimation. These results have important implications; people (e.g., parents
of children) cannot implement strategies to reduce their exposure to alcohol and decrease
their related risk (of alcohol consumption) if they underestimate how much alcohol is in a
given movie. Thus, alcohol exposure should be reviewed by governmental organizations,
such as being included in movie classifications.
Supplementary Information The online version contains supplementary material available at https:// doi.
org/ 10. 1007/ s11469- 022- 00998-5.
Data Availability The data underlying this article cannot be shared due to the ethical approval stating that
only the research team will have access to the data.
Participant reimbursement was funded by the School of Psychology and Public Health, La Trobe University. All
procedures followed were in accordance with the ethical standards of the responsible committee on human exper-
imentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed
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Conflict of Interest The authors declare no competing interests.
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Mexican American adolescents report high rates of alcohol consumption as well as media use. Viewing alcohol images in the media is associated with increased alcohol consumption; however, to date, this association has not been examined across different ethnic groups in the United States. To bridge this gap, we examined the association between viewing alcohol use images in PG-13-rated movies and alcohol initiation in Mexican-heritage adolescents. A cohort of 1,154 Mexican-heritage youth, average age 14 years, was followed for 2 years; in 2008–2009, participants reported alcohol use in the past 30 days and again in 2010–2011. Exposure to alcohol use images in PG-13-rated movies was estimated from 50 movies randomly selected from a pool of 250 of the top box office hits in the United States using previously validated methods. A series of generalized linear models, adjusting for age, gender, peer and family alcohol use, family functioning, anxiety, sensation-seeking tendency, and acculturation were completed. Multiple imputation was utilized to address missing data. Overall, N = 652 participants reported no alcohol use in 2008–2009; by 2010–2011, 33.6% (n = 219) had initiated alcohol use. Adjusted models indicated an independent association between exposure to alcohol use images in PG-13-rated movies and alcohol initiation (comparing quartiles 3 to 1: RR =1.53; 95% CI [1.11, 2.10]). The findings emphasize that the relationship between viewing alcohol use scenes in American films and alcohol initiation holds among Mexican-heritage adolescents and underscore the need to limit adolescents' exposure to such powerful images in PG-13-rated movies.
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Background: A complete ban on alcohol advertisements has been proposed for South Africa (SA), but there has been limited local research on the association between exposure to alcohol advertisements and alcohol consumption. Objectives: To examine the role of demographic factors, exposure to alcohol marketing and liking of alcohol advertisements in predicting use of alcohol in the past 6 months among older adolescents in Tshwane, Gauteng Province, SA. Methods: Participants comprised the adolescent sub-sample (N=869) of the International Alcohol Control study survey that was conducted in SA. They consisted of 408 males and 461 females aged 16 and 17 years who took part in structured interviews on their alcohol consumption and various alcohol-related attitudes and behaviours. A multiple survey logistic regression analysis of the dependent variable alcohol use in the past 6 months on the independent variables age, gender, educational status, socioeconomic status, exposure to alcohol brand marketing and liking of alcohol advertisements was used. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Results: The prevalence of drinking in the past 6 months was 10.6% (95% CI 5.9 - 18.3). The number of modes of alcohol brand/product advertising to which the adolescents were exposed was positively associated with alcohol use in the past 6 months. An additional mode of alcohol brand/product advertising exposure led to a relative increase of 1.13 (95% CI 1.01 - 1.28) in the odds of alcohol use in the past 6 months (e.g. a participant who was exposed to advertisements via seven different channels was 2.08 times more likely to have used alcohol in the past 6 months than a participant with exposure via a single channel). Having a strong dislike of alcohol advertisements was associated negatively (protective) with alcohol use in the past 6 months, with the odds ratio being 0.35 (95% CI 0.19 - 0.64). Having only a moderate dislike or a liking of alcohol advertisements was positively associated with alcohol use in the past 6 months among the study participants (OR 2.90 and 2.84, respectively). Age, gender, educational status and socioeconomic status were not independently associated with alcohol consumption. Conclusions: Exposure to alcohol marketing and not being strongly averse to advertisements of alcohol brands and products were associated with alcohol use among adolescents. The results have implications for policies on alcohol marketing in SA.
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Adolescents' media environment offers information about who uses substances and what happens as a result-how youth interpret these messages likely determines their impact on normative beliefs about alcohol and tobacco use. The Message Interpretation Processing (MIP) theory predicts that substance use norms are influenced by cognitions associated with the interpretation of media messages. This cross-sectional study examined whether high school adolescents' (n = 817, 48 % female, 64 % white) media-related cognitions (i.e., similarity, realism, desirability, identification) were related to their perceptions of substance use norms. Results revealed that adolescents' media-related cognitions explained a significant amount of variance in perceived social approval for and estimated prevalence of peer alcohol and tobacco use, above and beyond previous use and demographic covariates. Compared to prevalence norms, social approval norms were more closely related to adolescents' media-related cognitions. Results suggest that critical thinking about media messages can inhibit normative perceptions that are likely to increase adolescents' interest in alcohol and tobacco use.
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Background Restricting marketing of alcoholic products is purported to be a cost-effective intervention to reduce alcohol consumption. The strength of evidence supporting this claim is contested. This systematic review aimed to assess immediate effects of exposure to alcohol marketing on alcoholic beverage consumption and related cognitions. Methods Electronic searches of nine databases, supplemented with reference list searches and forward citation tracking, were used to identify randomised, experimental studies assessing immediate effects of exposure to alcohol marketing communications on objective alcohol consumption (primary outcome), explicit or implicit alcohol-related cognitions, or selection without purchasing (secondary outcomes). Study limitations were assessed using the Cochrane Risk of Bias tool. Random and fixed effects meta-analyses were conducted to estimate effect sizes. ResultsTwenty four studies met the eligibility criteria. A meta-analysis integrating seven studies (758 participants, all students) found that viewing alcohol advertisements increased immediate alcohol consumption relative to viewing non-alcohol advertisements (SMD = 0.20, 95 % CI = 0.05, 0.34). A meta-analysis integrating six studies (631 participants, all students) did not find that viewing alcohol portrayals in television programmes or films increased consumption (SMD = 0.16, 95 % CI = −0.05, 0.37). Meta-analyses of secondary outcome data found that exposure to alcohol portrayals increased explicit alcohol-related cognitions, but did not find that exposure to alcohol advertisements influenced explicit or implicit alcohol-related cognitions. Confidence in results is diminished by underpowered analyses and unclear risk of bias. Conclusions Viewing alcohol advertisements (but not alcohol portrayals) may increase immediate alcohol consumption by small amounts, equivalent to between 0.39 and 2.67 alcohol units for males and between 0.25 and 1.69 units for females. The generalizability of this finding beyond students and to other marketing channels remains to be established.
BACKROUND Research suggests that the social media platforms popular on college campuses may reflect, reinforce, and even exacerbate heavy drinking practices among students. The present study was designed to directly examine: (1) whether exposure to alcohol-related content on social media diminishes the efficacy of a traditional web-based personalized normative feedback (PNF) alcohol intervention among first-year drinkers; and (2) if social media inspired features and digital game mechanics can be integrated into a PNF intervention to combat social media-based alcohol influence and increase efficacy. METHOD Alcohol experienced first-year college students (N = 223) completed a pre-survey that assessed exposure to alcohol-related content and social media and were randomized to 1 of 3 web-based alcohol PNF conditions (traditional, gamified only, or social media inspired gamified). One month later, participants’ alcohol consumption was reassessed. RESULTS Among participants who received traditional PNF, social media-based alcohol exposure interacted with pre-intervention drinking such that traditional PNF was less effective in reducing drinking among heavier drinkers reporting greater exposure to alcohol-related social media content. Further, when regression models compared the efficacy of all three conditions, the social media inspired gamified PNF condition was significantly more effective in reducing drinking than was traditional PNF among moderate and heavy drinkers reporting greater exposure to alcohol on social media. CONCLUSION Although additional research is needed, these findings suggest that representing the population of students on whom normative statistics are based with social media-like user avatars and profiles may enhance the degree to which alcohol PNF is relatable and believable among high-risk students.
At least in Western societies, alcohol consumption is part and parcel of celebrations and social gatherings. Social norms around alcohol use - when, for whom and how much drinking is appropriate or not - assist us in navigating social interactions and help us to manage even unfamiliar situations by providing general behavioral guidance. However, when discussing drinking norms, one should keep in mind that, as social beings, individuals belong to more than one group and that norms and consequence of alcohol consumption shift depending on the context, who we are with and even the time of the day. Already young children form ideas around adult drinking norms and develop these further as they age. These childhood perceptions of social norms around alcohol are likely to influence the development of drinking patterns later in life. Shifting alcohol-related norms towards less risky and harmful drinking is a two-decade old approach in the intervention and prevention of heavy alcohol use. Two concepts, the Social Norms Approach, predominantly used in the context of college and University students, and the more recent approach on changing collective norms in drinking sub-cultures via community interventions merit particular attention.
Objective: The aim of this study was to compare data on both alcohol use and alcohol-related consequences between intensive longitudinal data collection and the retrospective Timeline Followback (TLFB) interview. Method: Heavy drinking college students (n = 96; 52% women) completed daily reports across a 28-day period to assess alcohol use and positive and negative consequences of drinking. They returned to the lab at the end of this period to complete a TLFB assessing behavior over those same 28 days. First, t tests were used to compare variables aggregated across the full 28 days at the between-person level. Next, hierarchical linear modeling was used to examine within-person differences between methods for each variable in weekly and daily increments. Results: Many alcohol use and consequence variables were significantly different when derived from self-reports during TLFB versus daily reports. In contrast to prior work, we found that higher estimates of drinking were reported retrospectively on the TLFB than on the daily reports. In addition, discrepancies were greater on some variables for heavier drinkers and when more time had elapsed between the end of the daily reporting period and TLFB collection. Conclusions: Recall of drinking behavior during TLFB and daily reports may differ in systematic ways, with discrepancies varying based on participant and methodological characteristics.
Children and adolescents are increasingly exposed to various types of media. The power of film to shape attitudes and behaviors has been widely accepted in a number of different contexts. The goal of this study was to analyze the representation of illicit drugs and alcohol in movies recently released in the United States and available to an under-18 audience. A research team reviewed the content of all available G, PG, PG-13, and R-rated feature films released in the United States in April 2016. A standardized coding instrument was developed. It focused on the following parameters: nature of the substance, its implicit or explicit depiction, setting of use, characteristics of the user (age, gender, and role in movie), motivations behind use, and consequences of use. A descriptive evaluation of the variables and Fisher’s exact analysis of covariates and scene outcomes were carried at the bivariate level. Five out of thirty-three movies did not depict any substance use. Most scenes involved explicit alcohol use, usually by a male adult who was a secondary character. Comedy and action movies were more likely to display rewarding consequences for substance use. Scenes with social and sexual motivations for use were significantly more likely to have rewarding outcomes. Recent Hollywood movie productions accessible to under-18 audiences are likely to contain scenes with psychoactive substance use. More research is needed to understand the association between exposure to substance use through film and the shaping of relevant attitudes and behaviors in young audiences.
Background: Exposure to alcohol content in movies has been shown to be associated with adolescent use of alcohol, including earlier onset. This study examined the influence of movie alcohol exposure on subsequent alcohol onset, considering the social context (whether the movie was viewed with a friend or parent). We examined whether media's influence holds across a spectrum of early drinking milestones: sipping (but not consuming a full drink of) alcohol, consuming a full drink of alcohol, and engaging in heavy episodic drinking (HED). Methods: Data were taken from a sample of 882 middle school youth (52% female; 24% non-White) enrolled in an ongoing study on alcohol initiation and progression. Exposure to alcohol content in films was measured using a method that combines content analysis and random assignment of movie titles to youth surveys. The hazard of initiating alcohol use (sip, full drink, HED) as a function of exposure was estimated using survival analysis. Associations were adjusted for demographic, personality, and social influence factors known to be associated with both movie exposure and alcohol use. Results: Exposure to alcohol content was common. Hours of exposure prospectively predicted earlier onset of alcohol involvement across all outcomes. Viewing movies with friends appeared to augment the media exposure effect, in contrast to viewing movies with parents, which was not a significant predictor of initiation. Conclusions: Exposure to alcohol in films is involved in the entry into early stages of alcohol involvement. Findings support further investigation into the role of the media in underage drinking, especially in the context of consuming media with friends and peers. Limiting media exposure and/or stronger Federal Trade Commission oversight of movie ratings should be a priority for preventing underage drinking.