Characterizing In Vivo Exposure to Alcohol Content in the Media: Media Platform, Engagement, and Associations With Attitudes

BACKGROUND: Alcohol-related content in media is overwhelmingly presented positively, and exposure to this content is linked to adolescent drinking. Yet, less is known about how often adolescents encounter alcohol content via media, how exposure varies across platforms, and how adolescents typically engage with such content. We used ecological momentary assessment (EMA) methods to collect detailed, real-time data about alcohol-related content encountered across a variety of digital media sources. METHODS: High school students recruited through social media (N = 302; mean age = 16.2; 63.9% female sex) completed three 21-day EMA bursts spaced 4 months apart. Participants reported alcohol-related content encountered via scheduled and self-initiated smartphone surveys, yielding 55,352 total reports, including 8792 with alcohol content. We fit multilevel models to evaluate momentary associations between exposure to alcohol content and cognitive outcomes (personal attitudes, perceived peer norms, beliefs that content promotes alcohol use). RESULTS: Nearly all participants (99.3%) reported exposure to alcohol-related content during the monitoring period. The most common sources were Instagram (32.4% of alcohol reports), TikTok (18.1%), and YouTube (7.8%). About one-third of exposures originated from influencers; nearly half of YouTube and Instagram exposures involved industry sources. In-depth engagement (e.g., commenting) with content was rare, although engagement requiring minimal effort ("liking") was endorsed for 25.6% of content reports. Encountering alcohol content on Instagram and Snapchat was associated with personal disapproval of the content; there were few associations with perceived peer norms. Engagement significantly predicted more cognitions favoring alcohol. CONCLUSIONS: Adolescents frequently encounter alcohol content across diverse platforms, often from influencers and industry. Much of the content was believed to promote alcohol use. Although behavioral engagement was limited, exposure was linked to attitudes toward content encountered on some platforms. Greater understanding of components and contexts to be targeted for just-in-time interventions delivered in proximity to in vivo exposures can reduce risk for early alcohol engagement.