The Role of Alcohol-Related Media Exposure on Rural Thai Adolescents’ Drinking Intention: A Structural Equation Modeling Approach

Background: Alcohol-related media exposure is strongly associated with adolescents’ psychosocial factors, but the mechanisms underlying drinking intention and potential sex differences remain unclear. Objectives: This cross-sectional study examined the associations between alcohol-related media exposure and rural Thai adolescents’ drinking intention, focusing on psychosocial mediators—perceived drinking norms, attitudes, and perceived behavioral control—and the moderating role of biological sex. Methods: A total of 474 rural Thai adolescents (mean [±SD] age: 14.54 ± 0.92; 50.63% male) from 8 public district schools in Chiang Mai Province, Thailand, completed a self-administered survey. Data were analyzed using structural equation modeling with weighted least squares and variance-adjusted estimator. Results: Attention to pro-drinking messages was significantly associated with adolescents’ perceived drinking norms (β = 0.76, P < .001), attitudes (β = 0.72, P < .001), and perceived behavioral control (β = −0.66, P < .001), which in turn were associated with greater drinking intention. Mediation effects were similar across sexes, but the negative effect of exposure on perceived behavioral control was stronger for males (β male = −0.76 vs β female = −0.58). Conclusion: Pro-drinking message attention was strongly associated with adolescents’ drinking intention, mainly through perceived drinking norms and perceived behavioral control. Nurse-led prevention should enhance media literacy and strengthen adolescents’ control over alcohol use.