Real-Time Exposure to Alcohol Content in Digital Media in Adolescents: Protocol for a Multi-burst Ecological Momentary Assessment Study (Preprint)

BACKGROUND Background: Digital media frequently contains positive portrayals of alcohol content, which has been shown to be associated with alcohol-related cognitions and behaviors. Because youth are heavy media consumers and have access to unsupervised, repeat viewing of media content on their personal mobile devices, it is critical to understand the frequency of encountering alcohol content in adolescents’ daily lives and how adolescents engage with the content. OBJECTIVE Objective: This paper describes the protocol for a study that examines exposure to digital media alcohol content in the natural environment among adolescents. METHODS Methods: Adolescents (n=302; 32% man, 19% non-binary, 51% woman; 26% Asian, 4% American Indian, 22% Black, 5% Other, 52% White; 26% Hispanic/Latinx; mean age 16.21 years, SD=0.77) enrolled in high school were recruited through social media to participate in a prospective study comprised of bursts of ecological momentary assessment (EMA) reports coupled with longer surveys. Video-conferenced group orientation sessions and online survey completion were followed by 21-day EMA reports involving scheduled reports in four blocks of time across the day as well as involving self-initiated media reports. Reports of exposure to alcohol content included descriptions of the media platform, indices of engagement, source characteristics, beliefs and perceived norms about content, context, and sponsored/branded content presence. The participants were asked to submit exposures to alcohol content in the media in the form of an image (screenshot, photo) or text description to be objectively coded. At each week’s end, the participants completed an online survey assessing alcohol use, norms about drinking, and affect. This protocol was conducted in three bursts, four months apart, over an 8-month period. RESULTS Results: EMA reports will be merged with coded image/text entries and weekly and baseline/follow-up survey data. Self-reported alcohol exposure will be explored descriptively and differences in media exposure across subgroups (e.g., gender, drinking status) will be tested. Event-level data will be compared with random prompt data using multilevel models to examine differences at times of exposure vs. non-exposure. Prospective associations between media alcohol content exposure and alcohol use will be explored over one-week and 4-month timeframes. Mediation of the association between media alcohol exposure and drinking will be tested to explore putative cognitive mechanisms. CONCLUSIONS Conclusions: By characterizing adolescents’ real-world exposure to alcohol content in the media, the study will provide critical information to develop and implement interventions to target youth behavior that are well-suited to delivery via mobile devices. Next steps are to conduct focus groups with a subset of the participants to understand their lived experience of in vivo exposure to media alcohol content and reactions to proposed intervention targets. The present study and subsequent qualitative work will launch a program of research to counter the effects of alcohol-related media exposure as it is experienced by adolescents in an effort to minimize underage alcohol involvement.