In the YouTube universe, alcohol is funny, drinkers are attractive, consequences minimal

Results will be published in the March 2015 online-only issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Several studies have linked watching movies containing alcohol abuse in them with actual alcohol-related behaviors," explained Brian A. Primack, associate professor of medicine and pediatrics at the University of Pittsburgh and corresponding author for the study. "These initial studies were cross-sectional, so it was hard to determine if exposures influenced the behaviors or if people who drank alcohol were drawn to alcohol-related media exposures. However, more recent longitudinal studies have suggested that media exposures can be influential."

Yet YouTube, said Primack, hasn't been studied in this context and with a high degree of rigor. "YouTube is an important medium to study for a couple of reasons," he said. "If you want to learn about something in general, you will often 'Google' it. However, more individuals are now going straight to YouTube for their searches, because it provides written information, visual information, and group discussion, all together. Also, because YouTube was bought by Google in 2006, you will often get YouTube links when you make a general Google search."

Brooke Molina, professor of psychiatry and psychology, and director of the Youth and Family Research Program at the University of Pittsburgh, called this study unique and praised its careful coding strategy. "The care that was taken to ensure that content was reliably coded increases confidence in this new study," she said.

"Our codebook is very detailed," added Primack. "For example, it defines exactly what we mean by something potentially subjective like 'positive portrayal' or 'humor,' and it provides clear examples for coders." He and his colleagues systematically captured the 70 most relevant and popular videos on YouTube related to alcohol intoxication. They subsequently created 42 codes in six categories: video characteristics, character socio-demographics, alcohol depiction, degree of alcohol use, characteristics associated with alcohol, and consequences of alcohol.

"The 70 videos were each about four minutes long," said Primack. "Combined, these videos had been viewed about a third of a billion times. They tended to involve males more than females, and almost half (44%) referred to a specific brand name of alcohol. While active intoxication was frequently shown (86%), only a few (7%) referred to alcohol dependence or withdrawal. There were more 'likes' when humor was present versus when it was not, and more 'positive sentiment' when a brand name was mentioned, when liquor was mentioned, and when there was 'attractiveness' present. However, there was less positive sentiment when negative emotional or physical consequences from alcohol use were shown."

"I find it particularly important that liquor is featured most often in frequently viewed videos containing heavy drinking," said Molina. "Given the high alcohol content of liquor, and the poor ability of young people to regulate their alcohol content in a knowledgeable and skilled way, this means that young people may be at increasing risk for dangerous drinking."

"We are not sure why hard liquor was commonly represented, especially because beer is more frequently consumed in the U.S., and the vast majority of videos came from the U.S.," commented Primack. "It may be because liquor has a high alcohol content, and so users may find it more edgy and interesting to post and/or view material related to this."

Both Primack and Molina believe that YouTube might also be used to educate viewers about the realities of alcohol.

"It would be valuable for public health advocates to post such material," said Primack. "It is interesting that none of the videos we analyzed were developed for this purpose, which could help 'even out' the types of portrayals so that commonly viewed videos would more accurately manifest the true consequences of alcohol use. It seems like a missed opportunity, because there can be a relatively low expense involved in creating and posting videos for YouTube. For example, remember that the ALS Foundation scored a huge triumph in bringing in money and notoriety to their organization through the 'Ice Bucket Challenge,' which involved very little in terms of initial investment."

"I found it useful to know that videos containing alcohol references were liked less when injuries or intoxication were involved," added Molina. "This is very good news as it suggests there may be ways to incorporate both humor, to attract viewers, and negative consequences of heavy drinking, to educate viewers. However, prevention messages may need to be increasingly creative and market-savvy to have an effect."

A future line of research may address the volume of brand-related information and imagery present on YouTube, said Primack. "There were a total of 55 alcohol brand-name references in only 70 videos," he said. "Because there were several different brand-name references in some videos, this equated to 44 percent of all videos having a brand-name reference. This is important because brand-name references are known to be particularly potent in terms of encouraging drinking. Even if these references were not placed by the industry, they can still function as advertising."

Primack also cautioned readers to be familiar with how skewed information on the Internet tends to be with regard to alcohol. "Young people especially can be very impressionable," he said. "When they see alcohol linked with humor, attractiveness, and positive consequences, they tend to simply take these associations at face value. Instead, that average reader may find value in more actively and critically analyzing the types of messages they see. If that average reader is a parent or a teacher, he or she may wish to actively teach that type of critical analysis, sometimes called 'media literacy,' to his or her children."