Associations Between Digital Alcohol Marketing and Alcohol-related Behaviours: A Systematic Review of Quantitative Studies

Background Digital alcohol marketing has evolved rapidly with the growth of social media. Modern digital environments are driven by user-generated content UGC relating to peer-to-peer sharing, liking, and commenting on alcohol brands, which blurs the line between commercial promotion and authentic social interaction. This systematic review synthesises recent research on the association between digital alcohol marketing and alcohol-related outcomes, while examining the dual roles of UGC and health warnings as empirical countermeasures. Methods Following PRISMA guidelines, eight electronic databases (PubMed, Web of Science, Scopus, JSTOR, PsycINFO, Medline, Taylor & Francis Online, ScienceDirect) were systematically searched for quantitative studies published between 2017 and late 2024. Studies were included if they investigated exposure to, and/or engagement with, alcohol marketing in digital contexts, as were studies which examined the role of user-generated messaging and health warnings in alcohol ads. Eligible outcomes were alcohol-related beliefs, attitudes, intentions, and behaviours. Results Eighteen quantitative studies met inclusion criteria (10 cross-sectional, 7 experimental, 1 longitudinal). Positive associations with alcohol-related outcomes were reported across all 14 studies (77.8%) assessing exposure to (33.3%, n = 6) and/or engagement with (44.4%, n = 8) digital alcohol marketing, leading to increased drinking frequency and drinking intentions. Across the 6 studies (33.3%) examining UGC and health warnings (with 2 experimental studies overlapping with engagement), emerging evidence demonstrates that while pro-drinking UGC increases ad persuasiveness and normative influence, health warnings lessen the effects of digital alcohol marketing on attitudes and consumption. Conclusions Quantitative evidence demonstrates a consistent link between digital alcohol marketing and alcohol-related behaviours across exposure and engagement dimensions. Alcohol control policies must address digital marketing channels, regulate user-generated promotions, and mandate prominent health warnings across online environments. Although positive associations between digital marketing and alcohol-related outcomes predominate, evidence regarding optimal warning designs and platform-specific effects remains limited. Furthermore, the literature remains dominated by US-based research, with a critical shortage of studies conducted in European settings or among older adult populations.