Health warning labels on alcohol bottles are often evaluated as a behaviour change intervention, but they can play many other roles beyond behaviour change, especially in the shorter term. One of them is raising awareness of the harms associated with alcohol – most prominently cancer as one of the lesser known risks. Reaching this aim can be considered as a relatively low-hanging fruit, but there is surprisingly little research into the extent to which the cancer warnings could increase cancer knowledge.
Our research thus explored how different warning messages on alcoholic beverages containers impact Europeans’ understanding of the link between alcohol and cancer. Additionally, we were interested in how these labels were perceived. Spoiler alert: there is big room for improvement of Europeans’ knowledge, and health warning labels can achieve that!
What we did
We conducted an online survey experiment looking into the impact of different kinds of health warnings on alcohol labels in a sample of almost 20,000 participants from 14 European countries. Our study tested three types of messages:
- One that talked about drinking responsibly, as commonly used by the alcohol industry.
- Another that mentioned general health risks from alcohol.
- And the last one specifically warning about the risk of alcohol causing cancer, including breast and colon cancer.
The cancer warning was tested in different variants – one including a pictogram, and one including a graphic image of a cancer patient to see if that made the message more impactful.
We then looked at whether those warnings increase knowledge, and how participants react to them – do they find them relevant and acceptable, or would they rather avoid them?
We were also interested if the effects were universal across the countries, as well as across other demographic variables such as gender, age and education.
What we found
We found that cancer warnings, regardless of whether they contained only text, or additionally included a pictogram or a graphic image, significantly increased people’s knowledge that alcohol can cause cancer. Around one-third of those who saw these warnings showed a clear increase in understanding (while almost half was already aware of the link between alcohol and cancer, and thus could not further increase their knowledge). This effect was consistent across different countries and demographic groups, suggesting that labels can be a universal tool for informing consumers about the health risks of alcohol.
The participants also considered that compared to responsibility and general health harm message, all three types of cancer message were more relevant to them, more likely to deter them from alcohol consumption, and more likely to encourage discussion of risks with family and friends. While all messages had similar acceptability, the cancer message with graphic image was least acceptable and also elicited the highest avoidance.
We also discovered that cancer messages were better received by women, whereas men were more content with the status quo – either no health message or a responsibility message.
Why this matters
Alcohol causes significant harm to the drinker and people around them, but in most European countries this is not reflected when we look at the attractively designed bottles and cans. Our study shows that specific cancer warning labels on alcoholic beverages can really make a difference in how much people know about the risks of drinking, and that many Europeans are ready and willing to hear this message. There could be a risk of going too far and scaring people by including graphic images, as our study shows this will be perceived as less acceptable.
Policymakers should thus seriously consider health warnings as a requirement to help protect public health. This could help people make better-informed decisions about their drinking habits and potentially lower the risk of alcohol-related burden in the longer term.
Written by Dr Daniela Correia and Dr Daša Kokole, Alcohol, Illicit Drugs and Prison Health, Special Initiative on NCDs and Innovation, WHO Regional Office for Europe.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.