There has been a notable decline in alcohol consumption among young adults in recent years, specifically in European countries, Australia and in the USA (Larm et al. 2018). In the UK, there is a decreasing trend of underage drinking: only 38% of 11-15 year olds reported having consumed alcohol- containing beverages in 2015, down from 61% in 2003 (Bhattachayra, 2016). Reductions are also observable among older age groups, the proportion of 16-17 year olds and 16-24 year olds who reported drinking alcohol fell from 88% to 65% and from 90% to 78% respectively between 2001 and 2016 (Oldham et al, 2018). According to the 2013 National Drug Strategy Household Survey (NDSHS) in Australia, there has been a steep decline in weekly risky drinking among young adults aged 18 to 24 (31.5% in 2010 down to 22.1% in 2013) (Pennay 2015). The trend is relatively consistent across all races, genders, socio- economic and demographic groups, and is thus unrelated to these factors.

There are many possible reasons for why youth drinking could be in decline. One explanation is that stricter law enforcements on the minimum age of alcohol purchase have made alcoholic beverages less accessible to underage adolescents (Bhattachayra, 2016). Alternatively, some researchers suggest that better education could underpin the decline in youth drinking and that health promotion strategies and workshops in schools have made alcohol seem less appealing to adolescents (Pennay, 2015). One of the most cited explanations for the decline in youth drinking is that the increasing trend of non-drinking is due to a rise in new technology causing a shift in adolescent leisure and social activities to online platforms such as social networking websites (Wise, 2018).

This review aims to explore the third hypothesis, with particular focus on the relationship between social media usage and the decline in alcohol consumption among adolescents. It has been suggested that social networking websites provide a digital platform for young adults to socialize on (Wise, 2018), thus reducing the need to physically meet up.

On the contrary, Austin (2000) suggests a link between social media and an increase in adolescent alcohol consumption, due to positive affective responses and positive drinking expectancies caused by portrayals of alcohol on advertisements found on social media. Similarly, Chen (2002) believes that online displays of alcohol consumption in the form of posts on social media by adolescents are associated with increased drinking among their peers, due to peer influence mechanisms. In these cases, social media usage may actually lead to an increase in alcohol consumption among adolescents.

This systematic review evaluates recent research conducted in this field and serves to explore whether social media usage is associated with an increase or decrease in alcohol consumption among young adults aged 11 to 24.

 METHODS:

The standard protocol given in Preferred Reporting Items for Systematic Reviews & Meta- Analysis (PRISMA) (see Fig. 1) was used in the article selection process.

Using MEDLINE via Ovid as our primary database, we first derived our free-text terms focusing our search on three separate categories of terms; ‘social media’, ‘young adults’ and ‘alcohol’ respectively. The MeSH heading terms were then derived from these free-text terms, using MEDLINE’s search engine. With a search strategy that included all our search terms, a systematic search for journal articles was conducted from the years 1976 to 2018, resulting in a total of 2464 records. It should be noted that the scope of the initial search was intentionally broad to include a wide range of journal articles that could potentially advise the discussion or introduction sections of the systematic review.

Preliminary scrutiny of the titles was conducted after eliminating duplicate records. 87 records remained post-title screening. During abstract assessment, we focused on including journal articles that were relevant and eligible for the review, in terms of: (1) sample size target age range 11 to 24; (2) focus on social media, rather than other uses of the Internet; (3) date of study.

Studies that explored the mechanisms and impacts of alcohol advertisements and marketing to adolescents via social media platforms were excluded, as the focus of such studies deviate from our research question. Additionally, articles that observed a change in attitude towards alcohol drinking, rather than a change in the actual consumption of alcohol were excluded from our search. 21 studies were retained post-abstract screening and only 12 studies remained after full-text analysis.

These criteria were strictly applied in order to greatly narrow down the list of journal articles found into a manageable number. Due to practical constraints, quality checks were not conducted for this review.

The use of qualitative narrative synthesis was applied to combine the results of various studies, due to the heterogeneity among the study designs across the journal articles.

 RESULTS:

The twelve studies examined each had different sample age groupings, all within the 11-24 years old age range. Six of the studies were conducted in the United States, two from Norway, one from England, Sweden and Australia respectively, and one from both Korea and the United States (cross-cultural study).

The present study sought to analyse a common suggestion in literature, that the increased trend of non-drinking among adolescents can be attributed to the increase in time spent on Social Networking Sites (SNS) (Larm, 2018). However, contrary to this, out of the twelve studies included in this review, eleven linked increased SNS usage to alcohol-related behaviors amongst young people.

Nesi (2017) investigated that an increase in time spent on social networking sites led to increased chances of alcohol initiation (ie. consuming alcohol for the first time), as well as decreased alcohol abstinence. The risk for alcohol initiation generally peaks at adolescence (Jackson, 2014), and an early onset of alcohol drinking can potentially lead to physical and mental health issues, and even addiction in the long run. According to Bandura (2001), this can be explained using the theory of planned behaviour and social cognitive theory, which explain that an individual’s drinking behaviour is based on peer perceptions of drinking norms, and their understanding of the role alcohol serves in college life.

Boyle (2018) found that the perception of peer approval for risky drinking behaviour was, to a large extent, based on the amount of social reinforcement SNS posts containing alcohol- related content received in the form of retweets on Twitter and likes on Instagram and Facebook. Amongst non-drinkers, exposure to alcohol-related posts on social media platforms led to increased perceptions of acceptability around drinking (Hoffman, 2017).Experimental evidence supports the idea that exposure to SNS posts portraying alcohol consumption led to an increase in willingness to drink (Litt, 2011). However, Nesi (2017) found that this effect was found to be applicable only to alcohol inexperienced first-year university students, and hence explains an increase in alcohol initiation among first-year students.

Online social networking also showed an impact on young people who were already drinkers whereby social media use was associated with an increase in consumption (Pegg,2018), as well as an increased tendency of risky drinking (Groth, 2017).

Social norms are defined as “the collective understanding and awareness of preferred, appropriate behavior within a social group” (Yang, 2018). Scholars have proven the roles of descriptive norms (ie. an individual’s perception of the prevalence of a behaviour) as well as injunctive norms (ie. an individual’s perception of the social acceptance of a behaviour) in shaping behaviour, and in this case, influencing one’s binge drinking intentions. A study by Yang (2018) showed that an increase in exposure to social media posts involving alcohol drinking was associated with higher social acceptability (e.g. injunctive norms) of risky drinking behaviours. Thus, descriptive and injunctive norms were able to positively predict young people’s binge drinking tendencies.

Additionally, the association between exposure to alcohol- related content and consumption was stronger when participants reported higher Online Social Identity (OSI), according to a study by Pegg (2018). Young people often develop social identities through various online platforms. This, in turn, has a huge influence on drinking behaviours during adolescence, as young people tend to align their behaviours and drinking habits to that of their friends and peers online, driven by peer pressure and the need for social inclusion (Reicher, 2010). Using social identity and group behaviour theory, adhering to social norms within a group setting is a significant factor necessary to prove and show group membership (Pegg, 2018). Therefore, in this case, young people who are exposed to posts and photographs of their friends consuming alcohol may be influenced to drink more in order to feel a sense of acceptance and inclusion within a group.

Many studies showed that the positive association between social media use and consumption was present in both males and females (Curtis, 2018). Larm (2018) examined gender differences and found that the association between social media use and decreased odds of non-drinking was particularly robust amongst females, although the association was there in both males and females.

The focus of the papers was mixed: most were largely based on social media, while some were focused on wider Internet use. One particular study conducted by Larm (2018) explored the effect that online gaming had on alcohol use. It was concluded that online gaming on weekends was associated with a decrease in alcohol use, whereas online gaming on weekdays did not affect alcohol consumption levels at all. This makes sense, because young people tend to consume alcoholic beverages on weekends rather than on weekdays (Jensen, 2018).

 DISCUSSION:

The aim of this review is to evaluate the evidence that increased social media use could be an explanation for recent trends of decreased drinking in young people (Oldham, 2018). We found little to no support for this explanation. Indeed, all of the studies showed that an increase in time spent on SNS was closely associated with an increase in consumption (Curtis, 2018) as well as risky and binge drinking (Yang, 2018). Similarly, time spent online led to an increased likelihood of alcohol initiation (Nesi, 2017) and a significant decrease in the proportion of abstainers (Wise, 2018).

Although the association between social media use and alcohol consumption were largely consistent for both genders there was some evidence that the association between online networking and decreased probability of non-drinking was more robust for females than males (Larm, 2018). This was supported by data from the Youth Activity Participation Survey of Western Australia (2017) which demonstrated that the positive association between alcohol use and SNS use was found to be more robust among females than males (Pegg, 2018).

There has been much debate between researchers on the ways in which social media can affect alcohol consumption amongst young people. One explanation which has been offered is that the increase in photographs and stories being shared online have resulted in a lasting legacy to alcohol consumption which could affect the employability of young people long term. This could mean that young people are less likely to engage in alcohol consumption. However, it seems that young people are aware of these factors but rather than cutting down on their alcohol consumption instead use more private forums to share alcohol related content such as SNS. This is supported by the findings of Jenson, Hussong and Baik (2018) who found that young people prefer to discuss alcohol and alcohol related events over private messaging than over social media. Larm (2018) provides another explanation for how social media could influence alcohol consumption and highlighted the idea that online conversations via SNS may be a platform where adolescents are exposed to positive alcohol perceptions and preferences from their peers, as well as alcohol advertisements, in the absence of parental guidance and scrutiny. This may potentially encourage the prioritization of interactions with peers over parental communication, thus diminishing the protective effect of parental supervision and monitoring.

One limitation of the current study is that due to practical constraints and the subsequent narrow framing of the search we do not consider online marketing by the alcohol industry and the influence this could have on young people’s drinking. Social media platforms are a common avenue for alcohol companies to engage in intensive marketing, thus increasing their potential to alter binge drinking beliefs (injunctive and descriptive norms) that exist among young people. Such services provided by SNS increases the perception of accessibility of alcoholic drinks, making it more likely for young people to attempt to obtain them. This is supported by the findings of Hoffman (2017), who found that 15.5% of the study sample reported using microblogging services, such as Snapchat and Twitter, to receive certain updates on alcoholic beverages, while 5.6% of participants have previously used coupons for discounts in the purchase of alcoholic beverages. Again, due to practical constraints, only one database (MEDLINE) was used for this systematic review, future reviews should widen the scope to other relevant databases to ensure that relevant papers are not missed.

 CONCLUSION:

In general, the increased tendency of non-drinking cannot be said to be directly attributed to the rise in social media use among young people. Contrary to previous belief, the use of social media is associated with an increase in the likelihood of young people initiating alcohol consumption and is associated with a higher level of consumption and risky drinking amongst young drinkers. However, there could be some evidence that online socialization can have certain public health benefits for young people. The British Pregnancy Advisory Service (BPAS) (2018) report states that the increase in time spent online and decrease in general alcohol consumption among young adults has led to a 55% decline in teenage pregnancy rates. As such the upturn in online socialization could have significant positive public health implications for young adults. More research is required to understand how the move towards online socialization has displaced more traditional forms of socialization and how this impacts wider youth behaviour more generally.

 Published 14-08-2020

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