Non-alcoholic (zero-alcohol) beer as surrogate marketing: misidentification and self-reported alcohol desire in a national survey in Thailand

The global growth of non-alcoholic (zero-alcohol/alcohol-free) beer and its potential role in surrogate marketing (brand extension) are increasingly debated, yet evidence from low- and middle-income countries, including Thailand, remains scarce. We examined the prevalence of non-alcoholic beer exposure, misidentification, and self-reported desire to drink alcohol of a corresponding brand among exposed participants. We conducted a secondary analysis of a national cross-sectional survey of 6,459 Thai residents aged ≥ 15 years in December 2022. Participants were shown images of non-alcoholic beers and asked about exposure within the past 3 months. Misidentification was assessed by drink identification, and desire to drink alcohol of the corresponding brand was rated for each product seen, using a 0–5 ordinal rating scale. Associations among sociodemographic characteristics, drinking status, product misidentification, and self-reported desire were evaluated using logistic regression and cumulative link models. Overall, 32.2% of participants reported exposure to non-alcoholic beers, rising to 40.1% among current drinkers. Among the 2,080 exposed participants, more than four in five (85.3%) misidentified at least one product as alcoholic beer, and about half (51.2%) reported some degree of desire for the alcoholic beverage of at least one corresponding brand. Exposure was more common among participants with higher educational attainment, Bangkok residents, former drinkers, and frequent drinkers. Among exposed participants, misidentifying non-alcoholic beer as alcoholic beer was associated with higher self-reported desire, although in product-specific analyses this association was evident for Heineken 0.0 but not for Asahi 0.00. Higher reported desire was also observed among lower-income participants, former drinkers, and current drinkers, particularly those drinking frequently. Non-alcoholic beer products with branding and packaging similar to alcoholic beer were widely misidentified as alcoholic beer. Among participants reporting prior exposure, approximately half reported some desire for the alcoholic beverage of at least one corresponding brand, and misidentification as alcoholic beer was associated with higher reported desire, although this association differed between the two products examined. These findings support consideration of clearer labelling, packaging, and marketing rules that visually distinguish non-alcoholic beer from its alcoholic counterparts and limit surrogate marketing, while recognising that the cross-sectional design precludes causal inference.