Global comparisons of responses to alcohol health information labels: A cross sectional study of people who drink alcohol from 29 countries

The absence of mandatory pregnancy warning labels in online alcohol purchasing contexts

INTRODUCTION

As people increasingly migrate to online shopping platforms, hard-won improvements in requirements for consumer information provision at the point of sale are being eroded. An example is the alcohol pregnancy warning label for packaged alcoholic beverages that has been recently introduced in Australia and New Zealand. The aim of the present study was to assess the extent to which the pregnancy warning was visible at the online point of sale when the requirement became mandatory in August 2023.

METHODS

Data for alcohol products sold on the websites of the two largest alcohol retailers in Australia were web-scraped from 1 to 3 August 2023. The captured data for 8343 alcoholic beverages were inspected to determine whether the pregnancy warning was visible.

RESULTS

Virtually no products (0.1%) had the mandatory warning visible on the main sales page, and only 7% enabled visibility of the warning via optional product image rotation functionality.

DISCUSSION AND CONCLUSIONS

The almost complete absence of the mandatory pregnancy warnings on the main product pages of major alcohol retailers' websites highlights the regulatory problems posed by the emerging shift to online shopping. The very low prevalence of visible pregnancy warnings is likely to be an overestimate of the extent to which consumers would be exposed to warnings due to images being counted as being present regardless of their quality or readability. New regulation is needed to ensure that mandatory information requirements for harmful products are applied to online shopping contexts.

Impact of health warning labels and calorie labels on selection and purchasing of alcoholic and non-alcoholic drinks: A randomized controlled trial

AIMS

To estimate the impact on selection and actual purchasing of (a) health warning labels (text-only and image-and-text) on alcoholic drinks and (b) calorie labels on alcoholic and non-alcoholic drinks.

DESIGN

Parallel-groups randomised controlled trial.

SETTING

Drinks were selected in a simulated online supermarket, before being purchased in an actual online supermarket.

PARTICIPANTS

Adults in England and Wales who regularly consumed and purchased beer or wine online (n = 651). Six hundred and eight participants completed the study and were included in the primary analysis.

INTERVENTIONS

Participants were randomized to one of six groups in a between-subjects three [health warning labels (HWLs) (i): image-and-text HWL; (ii) text-only HWL; (iii) no HWL] × 2 (calorie labels: present versus absent) factorial design (n per group 103-113).

MEASUREMENTS

The primary outcome measure was the number of alcohol units selected (with intention to purchase); secondary outcomes included alcohol units purchased and calories selected and purchased. There was no time limit for selection. For purchasing, participants were directed to purchase their drinks immediately (although they were allowed up to 2 weeks to do so).

FINDINGS

There was no evidence of main effects for either (a) HWLs or (b) calorie labels on the number of alcohol units selected (HWLs: F(2,599)  = 0.406, P = 0.666; calorie labels: F(1,599)  = 0.002, P = 0.961). There was also no evidence of an interaction between HWLs and calorie labels, and no evidence of an overall difference on any secondary outcomes. In pre-specified subgroup analyses comparing the 'calorie label only' group (n = 101) with the 'no label' group (n = 104) there was no evidence that calorie labels reduced the number of calories selected (unadjusted means: 1913 calories versus 2203, P = 0.643). Among the 75% of participants who went on to purchase drinks, those in the 'calorie label only' group (n = 74) purchased fewer calories than those in the 'no label' group (n = 79) (unadjusted means: 1532 versus 2090, P = 0.028).

CONCLUSIONS

There was no evidence that health warning labels reduced the number of alcohol units selected or purchased in an online retail context. There was some evidence suggesting that calorie labels on alcoholic and non-alcoholic drinks may reduce calories purchased from both types of drinks.

How Do Young Adult Drinkers React to Varied Alcohol Warning Formats and Contents? An Exploratory Study in France

Research on alcohol warnings has increased in the last decade, providing key evidence to governments on warning format and contents. The bulk of this research, however, has been conducted in Anglosphere countries, whereas fewer studies have focused on other countries which have high per capita alcohol consumption, and where the high social acceptability of drinking is liable to affect how people accept and react to prevention measures. Since France has one of the highest per capita alcohol consumption rates in the world according to the World Health Organization (WHO), we therefore explore how young adults in France react to warnings on alcoholic beverage advertisements. We conducted 25 in-depth interviews, in 2017, with 18-25-year-old drinkers in France. Respondents were asked open-ended questions on the perceived impact of various warning contents (i.e., on health risk, social-cost risk, and on short- vs. long-term risk) and formats (text only vs. larger text combined with colored pictograms). Warnings that targeted youth-relevant risks (i.e., road accidents or sexual assault) were considered to be the most meaningful and credible, although warnings communicating longer term risks (i.e., brain, cancer) were also thought to be influential. Less familiar risks, such as marketing manipulation and calorie intake, elicited the most negative reactions. Larger text-and-pictogram warnings were considered to be the most effective format in capturing attention and increasing awareness. Regardless of format and content, however, these warnings were not perceived as effective for decreasing alcohol consumption.