Author ORCID Identifier

https://orcid.org/0000-0002-9480-8574

Date of Award

Spring 5-13-2022

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Karen Nielsen

Second Advisor

Monica Swahn

Third Advisor

Lucy Popova

Abstract

Background: Although the “gender gap” in alcohol consumption is narrowing, research continues to find that men drink at higher rates and more heavily than women. Men also report higher levels of alcohol marketing exposure, which is associated with earlier drinking initiation. Additionally, there is evidence that youth who are more exposed to alcohol advertisements are at higher risk of drinking and harmful drinking behaviors. However, much of this research has focused on high-income and Western nations, and far less research has been conducted to address these issues in low-resource settings, particularly across sub-Saharan Africa, where the marketing of alcohol is far less regulated. Given the associations between gender, alcohol marketing exposure, and drinking, and the impact of alcohol marketing on young people, this study seeks to compare these associations between two distinct cultural and political contexts: Uganda and the United States (U.S.).

Methods: This study is a secondary data analysis of a survey distributed in March 2021 to young adults ages 18 to 25 in Uganda and the U.S. We limited our analyses to respondents who identified as either male or female. Our final sample size was 587, with 295 respondents from Uganda and 292 from the U.S. For this study, we selected 17 questions regarding drinking status, alcohol marketing exposure, gender, and country. The main outcomes we examined were high recent alcohol marketing exposure (reporting seeing 3 or more alcohol ads during the past week) and hazardous drinking (scoring 8 or more on the Alcohol Use Disorders Identification Test (AUDIT)). We conducted a moderation analysis for each outcome to examine the interaction between gender and country, and we additionally considered high recent alcohol marketing exposure and all possible pairwise interactions when predicting hazardous drinking. In addition, we considered models containing four questions indicating various types of alcohol marketing exposure (radio/podcasts/music streaming services, television, magazines/newspapers, and social media), both individually and as a sum score, as predictors of hazardous drinking. Data analysis was completed using SAS 9.4.

Results: Ugandans, compared with Americans, had 132% higher odds of reporting seeing 3+ advertisements for alcohol during the last week when controlling for gender (AOR = 2.32, 95% CI = [1.65, 3.27]). Ugandans also had higher odds of reporting high alcohol marketing exposure when watching TV (AOR = 2.65, [1.74, 4.04]), when looking at magazines/newspapers (AOR = 1.63, [1.15, 2.29]), and when listening to radio/podcasts/music streaming services (AOR = 3.13, [2.16, 4.53]). Despite reporting greater alcohol marketing exposure, however, Ugandans had lower odds of hazardous drinking when controlling for gender (AOR = .547, [.37, .81]). This finding persisted when separately controlling for high recent alcohol marketing exposure and the 4 alcohol marketing exposure types. No significant interaction effects were found in our models. Gender was not significantly associated with high levels of recent alcohol marketing exposure when controlling for other variables.

Conclusion: Despite reporting greater exposure to alcohol advertisements, Ugandans had lower odds of hazardous drinking when controlling for gender, indicating the need for further research looking at potential mediators, such as income. Gender was not significantly associated with high levels of recent marketing exposure when controlling for other variables, indicating that in our sample, males and females are being exposed to alcohol marketing at similar rates.

DOI

https://doi.org/10.57709/28964758

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