Alcohol marketing as a commercial determinant of health: daily diary insights from young women in Kampala

Alcohol marketing, as a commercial determinant of health, presents an emerging threat to global health and is of particular importance in low-resource settings. This study is composed of data from 'The Onward Project On Wellbeing and Adversity' (TOPOWA) project, a multicomponent prospective cohort study examining the mechanistic pathways of adverse mental health conditions among women aged 18 to 24 years living in the Kampala slums in Uganda. The cohort consists of 300 women recruited in 2023 from three study sites (i.e., Banda, Bwaise, and Makindye). In this study, we deployed an underutilized tool, daily diaries, for assessing the exposure to alcohol marketing and an alcohol-promoting environment among young women living in the urban slums of Kampala, Uganda to spur new research and action. At baseline, participants completed a 5-day daily diary and an interviewer-administered survey. Findings show that alcohol-related neighborhood features were most frequently reported, including bars (Mean = 3.88 days), people drinking alcohol (Mean = 3.75), alcohol selling points (Mean = 3.45) and alcohol ads on TV (Mean = 2.51). Women who were exposed to bars (PR = 1.31) and alcohol ads on billboards (PR = 1.14) in a day were more likely to report alcohol use. Similarly, those exposed to alcohol ads on billboards (PR = 1.76) and bars (PR = 2.02) every day were more likely to report alcohol use. Higher cumulative exposure to different alcohol-related features was associated with a greater likelihood of alcohol use, particularly in the group with the highest exposure level. These findings underscore a need to develop alcohol counter-marketing strategies and harm reduction approaches. Daily diaries proved to be a feasible strategy in capturing real-time exposure data, which could in turn support prevention measures and the evaluation of intervention strategies.