Place-based characteristics, alcohol advertising, and adolescent alcohol use behaviors in Taiwan: A mixed methods approach Open Access

Abstract

An emerging line of research indicates that place-based characteristics and alcohol advertising are associated with underage drinking. Few studies have examined this relationship in non-Western contexts. In this dissertation, quantitative and qualitative methods were used to examine relationships of place-based characteristics and alcohol advertising to underage drinking in Taipei, Taiwan. The quantitative phase used a longitudinal school-based study to capture individual-level characteristics and administrative data and Google Street View virtual audit data to capture district-level characteristics. The qualitative phase involved 8 focus group discussions on alcohol marketing and alcohol access among vocational high school students in Taipei, Taiwan. The first paper examined the associations of place-based characteristics and alcohol advertising to adolescent alcohol initiation and continuation. For alcohol-naïve adolescents, lower district-level economic disadvantage, greater spatial access to betel nut kiosks, and exposure to television-based alcohol advertising were associated with alcohol initiation. For alcohol-experienced adolescents, greater spatial access of off-premises alcohol outlets, and lower access to metro rapid transportation and to temples were associated with alcohol continuation. The second paper investigated the associations of place-based characteristics and alcohol advertising to drinking intentions. Greater spatial access to on-premises alcohol outlets was more strongly associated with drinking intentions for boys than girls, while greater spatial access to off-premises alcohol outlets was more strongly associated with drinking intentions for girls than boys. Greater exposure to television-based alcohol advertising more strongly predicted drinking intentions for girls than boys. Greater exposure to non-television-based alcohol advertising more strongly predicted drinking intentions for boys than girls. The third paper used qualitative methods to explore Taiwanese adolescents' perspectives on alcohol marketing for alcopops and regular beer, and analyzed how these marketing efforts influence adolescents' drinking experience. Packaging design and television alcohol advertising were the marketing strategies that influence adolescents' choice of alcopops vs. regular beer. This dissertation extended previous research on the association of place-based characteristics and alcohol advertising to adolescent alcohol use in a non-Western context. The findings may inform interventions to reduce underage drinking, suggesting that district-level and policy-level efforts are important to restrict alcohol access, strengthen local resources, and exposure to global alcohol marketing to youth.

Table of Contents

Chapter 1: Introductory Literature Review

Introduction 1

Adolescent Alcohol Use as a Significant Public Health Problem 2

Place-based Determinants of Adolescent Alcohol Use 4

Place-based Social Environments 5

Place-based Alcohol Access Environments 6

Place-based Institutional Resource Environments 8

Gender Differences in the Effects of Place-based Risk Factors 10

Alcohol Advertising 10

Gender Differences in the Impact of Alcohol Advertising 11

Taiwan as an Emerging Alcohol Market 12

Gaps in the Literature Conceptual Model and Theoretical Framework 13

Conceptual Model and Theoretical Framework 15

Significance of the Research 16

References 19

Chapter 2: Residential environments, alcohol advertising, and initiation and persistence of alcohol consumption among adolescents in urban Taiwan: A prospective multilevel study

Abstract 33

Introduction 35

Methods 42

Results 49

Discussion 51

References 62

Chapter 3: The social ecology of intention to drink among urban Taiwanese adolescents: A multilevel examination of place and alcohol advertising effects

Abstract 70

Introduction 72

Methods 76

Results 83

Discussion 85

References 96

Chapter 4: A comparison of choices of alcopops and choices of regular beer: A focus group study among urban Taiwanese adolescents

Abstract 105

Introduction 107

Methods 110

Results 113

Discussion 120

References 126

Chapter 5: Summary and Conclusion 132

Evaluation of the dissertation research 137

Implications for Research and Practice 139

Conclusion 145

References 146

About this Dissertation

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Behavioral Sciences and Health Education
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
Keyword	Google Street View Alcopops Alcohol use Alcohol advertising Multilevel methods Focus groups Place-based characteristics Adolescents Packaging
Committee Chair / Thesis Advisor	Cooper, Hannah, Emory University
Committee Members	Windle, Michael, Emory University Crawford, Natalie , Emory University Haardoerfer, Regine, Emory University Chen, Chuan-Yu, National Yang Ming University

Last modified

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	Place-based characteristics, alcohol advertising, and adolescent alcohol use behaviors in Taiwan: A mixed methods approach ()	2018-08-28 11:07:33 -0400	Press to Select an action Download

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions