BACKGROUND: Exposure to digital alcohol marketing content might be associated with pro-alcohol-related attitudes and behaviours, including the likelihood of initiating or sustaining the use of alcohol, especially among adolescents (aged <18 years) and young adults (aged 18-25 years). This study aimed to examine the relationship between exposure to digital alcohol marketing content and alcohol use outcomes.

METHODS: Alcohol-related, digital media-related, and marketing-related search terms were entered into six online databases: PubMed, Web of Science, Scopus, PsycINFO, Embase, and Communication & Mass Media. Peer-reviewed articles written in English, published between Jan 1, 2004, and Feb 1, 2025, were included in the search. Studies that were included measured self-reported exposure to digital alcohol marketing content; used an unexposed control group; measured past 30-day alcohol use, binge drinking, or susceptibility to use alcohol among never users; and provided raw data to compute odds ratios (ORs) or reported ORs in the manuscript. When available, adjusted odds ratios were included; otherwise, unadjusted estimates were computed from raw data. A multilevel random-effects meta-analysis was used to estimate ORs and 95% CI, and heterogeneity (I) was calculated for each alcohol use outcome. Study quality and publication bias were assessed. The study protocol was registered on the Open Science Framework.

FINDINGS: bThe search identified 9913 articles. 96 articles were eligible for full-text review, of which 65 articles were removed based on the exclusion criteria. 31 studies were included in the final meta-analysis. The total sample size was 62 703 participants (32 314 [51·5%] female; 30 389 [48·5%] male, including 52 475 (83·7%) adolescents (aged 11-17 years) and 10 228 (16·3%) adults (aged ≥18 years). Participants exposed to digital alcohol marketing content, compared with those not exposed, had greater odds of reporting past 30-day alcohol use (19 studies, 46 361 participants; OR 1·75 [95% CI 1·39-2·20]; I=91·0%), binge drinking (13 studies, 25 603 participants; 1·80 [1·22-2·67]; I=95%), and susceptibility to use alcohol among never users (seven studies, 18 698 participants; 1·78 [1·29-2·46]; I=88%).

INTERPRETATION: Findings demonstrated an association between exposure to digital alcohol marketing content and alcohol-related behaviours. Future research is needed to clarify the temporal order between exposure to digital alcohol marketing content and alcohol-related behaviours.

FUNDING: The National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.