The new normal? An examination of the portrayal of alcohol use on TV programs popular among youth, 2002-2012

Background: Alcohol use continues to cause serious harm among youth in the U.S. Exposure to alcohol in the media is one of the vectors associated with alcohol use initiation and increased use. During a time when young people in the U.S. spend the large majority of their media-use time with TV content, it is critical to understand the alcohol-use messages to which they are exposed. Furthermore, it is important to explore how they may be influenced by these messages and how the messages may be changing over time. It has been almost 30 years since a study has looked at patterns of alcohol use on TV over a 10-year period. Objectives: The objectives of this research are to: (1) develop a methodology to capture 10 years of alcohol-use portrayals on TV programs most popular among youth; (2) document the alcohol portrayals on TV programs most popular among youth between 2002 and 2012; (3) explore the theoretical underpinnings of the relationship between exposure to TV portrayals of alcohol use and behavior change within an environment of normalized alcohol use. Methods: We used Nielsen data to identify the top five most viewed TV programs by 12-20 year-olds in the U.S. for each year between 2002 and 2012. Through an iterative process, we created a pilot coding scheme to capture elements of drinking behavior and the drinking environment by character, in a random sample of 50 TV episodes, five from each year. For our next study we modified our coding scheme to include coding by scene as well as by character, and increased our sample size to 15 episodes per year for a total of 150 episodes. We used Social Cognitive Theory and Transportation Theory to connect viewer exposure to alcohol use on TV with potential modeling of this behavior in real life. Results: We were able to capture all alcohol-related content on TV programs popular among youth between 2002 and 2012, both by character and by scene. The majority of episodes (n = 125, 83%) contained at least one reference to alcohol. There was a significant increase in all three major measures of the frequency of alcohol on TV: the total number of references to alcohol per hour (β = 3.45, 95% CIs [0.625, 6.28]); the number of alcohol appearances (verbal and visual) per hour (β = 0.824, 95% CIs [0.115, 1.53]), and the number of alcohol acts per hour (β = 2.62, 95% CIs [0.339, 4.92]). As another measure of the normalization of alcohol use, we found that the top reasons characters consumed alcohol were to be sociable, for celebration or for no reason except to keep occupied. Conclusions: TV programs popular among youth present alcohol use as a normal, everyday activity. As viewers are transported into the storylines of TV programs, and seek out “super peers” on TV as role models, high rates of consumption by these characters have great potential to influence viewer drinking behavior. Patterns of drinking based on the modeling of this normalized use may prove harmful to developing brains and bodies. Researchers and public health professionals should pursue opportunities to work with the creative community to reduce or eliminate unnecessary portrayals of alcohol use on TV. As has been done in the past, more realistic portrayals of alcohol use may help reduce the risks current modeling poses for youth