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

Chen, Yen-Tyng (2016)
Dissertation (162 pages)
Committee Chair / Thesis Adviser: Cooper, Hannah
Committee Members: Windle, Michael ; Haardoerfer, Regine ; Crawford, Natalie ; Chen, Chuan-Yu (National Yang Ming University);
Research Fields: Health Sciences, Public Health
Keywords: Adolescents; Alcohol use; Multilevel methods; Place-based characteristics; Alcohol advertising; Google Street View; Alcopops; Focus groups; Packaging
Program: Laney Graduate School, Behavioral Sciences and Health Education
Permanent url: http://pid.emory.edu/ark:/25593/rg7n2

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

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