Alcohol Warning Label Awareness and Attention: A Multi-method Study

A systematic review on the impact of alcohol warning labels

Findings on the effects of alcohol warning labels (AWLs) as a harm reduction tool have been mixed. This systematic review synthesized extant literature on the impact of AWLs on proxies of alcohol use. PsycINFO, Web of Science, PubMED, and MEDLINE databases and reference lists of eligible articles. Following PRISMA guidelines, 1,589 articles published prior to July 2020 were retrieved via database and 45 were via reference lists (961 following duplicate removal). Article titles and abstracts were screened, leaving the full text of 96 for review. The full-text review identified 77 articles meeting inclusion/exclusion criteria which are included here. Risk of bias among included studies was examined using the Evidence Project risk of bias tool. Findings fell into five categories of alcohol use proxies including knowledge/awareness, perceptions, attention, recall/recognition, attitudes/beliefs, and intentions/behavior. Real-world studies highlighted an increase in AWL awareness, alcohol-related risk perceptions (limited findings), and AWL recall/recognition post-AWL implementation; these findings have decreased over time. Conversely, findings from experimental studies were mixed. AWL content/formatting and participant sociodemographic factors also appear to influence the effectiveness of AWLs. Findings suggest conclusions differ based on the study methodology used, favoring real-world versus experimental studies. Future research should consider AWL content/formatting and participant sociodemographic factors as moderators. AWLs appear to be a promising approach for supporting more informed alcohol consumption and should be considered as one component in a comprehensive alcohol control strategy.

The effectiveness of alcohol label information for increasing knowledge and awareness: a rapid evidence review

BACKGROUND

Consumers have difficulty understanding alcoholic units and low risk drinking guidelines (LRDG). Labelling may improve comprehension. The aims of this rapid evidence review were to establish the effectiveness of on-bottle labelling for (i) improving comprehension of health risks; (ii) improving comprehension of unit and/or standard drink information and/or LRDG, and (iii) reducing self-reported intentions to drink/actual drinking.

METHODS

Electronic database searches were carried out (January 2008-November 2018 inclusive). Papers were included if they were: published in English; from an Organization for Economic Co-operation and Development country; an experimental/quasi-experimental design. Papers were assessed for quality using the Effective Public Health Practice Project Quality Assessment tool. Ten papers were included. Most studies were moderate quality (n = 7).

RESULTS

Five themes emerged: comprehension of health risks; self-reported drinking intentions; comprehension of unit/standard drink information and/or LRDG; outcome expectancies; and label attention. Labelling can improve awareness, particularly of health harms, but is unlikely to change behaviour. Improved comprehension was greatest for labels with unit information and LRDG.

CONCLUSIONS

Alcohol labelling can be effective in improving people's comprehension of the health risks involved in drinking alcohol enabling them to make informed consumption decisions, and perhaps thereby provide a route to changing behaviour. Thus, effective alcohol labelling is an intervention that can be added to the broader suite of policy options. That being said, the literature reviewed here suggests that the specific format of the label matters, so careful consideration must be given to the design and placement of labels.

Designing Effective Alcohol Warnings: Consumer Reactions to Icons and Health Topics

Introduction

New warning labels for alcohol could reduce alcohol-related health harms. This study examined consumer responses to alcohol warnings with different designs.

Methods

A national sample of 3,051 U.S. adults completed an online survey in August 2021. Participants were randomized to 1 of 4 warning topics (addiction, liver damage, early death, or colon cancer). Participants viewed 3 labels, presented in random order: 2 types of warning labels (text-only and icon) showing a newly developed warning message about their assigned topic and a text-only control label showing a neutral message. Participants rated each label on effectiveness at discouraging alcohol consumption (primary outcome) and attention (secondary outcome) using 1 to 5 Likert-type scales. Participants also rated warnings with different causal language variants (e.g., "increases risk of," "contributes to") and marker words (e.g., "WARNING," "SURGEON GENERAL WARNING").

Results

Both the text-only and icon warnings were perceived as more effective (Average Differential Effects [ADEs]=0.79 and 0.86, respectively) and more attention-grabbing (ADEs=0.43 and 0.69, respectively) than control labels (all ps<0.001). The icon warnings were rated as more effective and attention-grabbing than the text-only warnings (ADEs=0.07 and 0.27, respectively, both ps<0.001). Although all warning topics outperformed the control messages, warnings about addiction were rated as less effective and attention-grabbing than the other topics. A majority (60%) of participants selected "increases risk of" as the most discouraging causal variant and a plurality (47%) selected "SURGEON GENERAL WARNING" as the most discouraging marker word.

Conclusions

New alcohol warnings could discourage alcohol consumption, especially if warnings include icons.

Improving the effectiveness of pregnancy warning labels displayed on alcohol containers: a French eye-tracking study

OBJECTIVES

Every year, foetal alcohol spectrum disorders impact 1 in 100 live births in France. France is one of the few countries with mandated labelling that must include a pregnancy warning. However, as the regulation passed with minimal specifications regarding the size and colour of the ensuing pictogram, the current pregnancy warning labels (PWLs) is often barely visible. This study investigated the potential influence of the PWL design on women's attention and alcohol product choice.

STUDY DESIGN

The study used a within-subject experiment, with participants exposed to four PWL conditions.

METHODS

An eye-tracking method was adopted. Eye movement was used as a proxy for measuring visual attention. In total, 4752 observations were collected (99 participants × 48 wine bottles) among women of childbearing age.

RESULTS

The results show that almost none of the participants paid attention to the current French PWL. However, the findings also indicate that a larger colourful PWL, with a combined text and pictogram, attracts far more attention, and that participants chose the bottles of wine displaying this type of PWL less frequently.

CONCLUSIONS

The study indicates that the current French PWL is insufficient to draw women's attention and suggests improvements to the PWL design to help increase its effectiveness.

Evaluation of Flour Safety Messages on Commercially Available Packages: An Eye-Tracking Study

Wheat flour and baking mix have been associated with foodborne outbreaks and recalls, yet many consumers are unaware of the repercussions of consuming raw flour products. The objective of this study was to evaluate the accessibility of flour safety messages on commercially available packages and to identify consumer barriers to processing these messages. Eye-tracking technology was used to track the eye movements of 47 participants to assess their time to fixation (TTF) on the flour safety messages on 10 commercial packages. Notifications that were longer than one sentence were considered “long” messages, while notifications that consisted of only one sentence were considered short (S1–S5 and L1–L5). Only two participants (4.3%) found messages on all 10 packages. Highly accessible messages did not result in a high preference of presentation among participants. Most of the participants (98%) found the message on the S4 package, which correlated with the lowest TTF of 7.08 s. However, only 15% of those who found the S4 message chose it as their preferred message. Many participants who were interviewed said that they preferred messages that identified the reasoning for the warnings. They also preferred the messages that were well separated from other content on the package. Flour safety messages on the current packages are not effective to convey information and change consumer behavior. More science-based messaging strategies need to be developed to provide guidance for flour safety communication.

Alcohol Health Warning Labels: A Rapid Review with Action Recommendations

A rapid review of research on health warning labels located on alcohol containers (AWLs) was conducted. Using five search engines (Embase, Medline, Pubmed, Scopus, Psyinfo), 2975 non-duplicate citations were identified between the inception date of the search engine and April 2021. Of those, 382 articles were examined and retrieved. We selected 122 research papers for analysis and narrative information extraction, focusing on population foci, study design, and main outcomes. Research included public opinion studies, surveys of post-AWL implementation, on-line and in-person experiments and real-world quasi-experiments. Many studies focused on the effects of the 1989 United States Alcoholic Beverage Labeling Act on perceptions, intentions and behavior. Others focused on Australia, Canada, the United Kingdom, England or Scotland, Italy and France. There was substantial variation in the design of the studies, ranging from small-scale focus groups to on-line surveys with large samples. Over time, evidence has been emerging on label design components, such as large size, combination of text and image, and specific health messaging, that is likely to have some desired impact on knowledge, awareness of risk and even the drinking behavior of those who see the AWLs. This body of evidence provides guidance to policy-makers, and national and regional authorities, and recommendations are offered for discussion and consideration.

Stable Gaze Tracking with Filtering Based on Internet of Things

Gaze tracking is basic research in the era of the Internet of Things. This study attempts to improve the performance of gaze tracking in an active infrared source gaze-tracking system. Owing to unavoidable noise interference, the estimated points of regard (PORs) tend to fluctuate within a certain range. To reduce the fluctuation range and obtain more stable results, we introduced a Kalman filter (KF) to filter the gaze parameters. Considering that the effect of filtering is relevant to the motion state of the gaze, we design the measurement noise that varies with the speed of the gaze. In addition, we used a correlation filter-based tracking method to quickly locate the pupil, instead of the detection method. Experiments indicated that the variance of the estimation error decreased by 73.83%, the size of the extracted pupil image decreased by 93.75%, and the extraction speed increased by 1.84 times. We also comprehensively discussed the advantages and disadvantages of the proposed method, which provides a reference for related research. It must be pointed out that the proposed algorithm can also be adopted in any eye camera-based gaze tracker.

How health warning labels on wine and vodka bottles influence perceived risk, rejection, and acceptance

Background

Wine consumption has a particular place in the culture of many European countries, and beliefs that wine offers health benefits are widespread. High consumption of wine and other alcoholic beverages among many Europeans correlates with alcohol-related accidents and disease burdens. Health warning labels (HWLs) on alcohol containers have been increasingly recommended to deter consumers from drinking. However, findings on the impact of HWLs on consumers’ behavior have been mixed. Moreover, many European consumers have been found to reject the use of warning labels as a policy intervention, especially for wine, perhaps due to its cultural and economic importance.

Methods

An online study with a between-subjects design was conducted in Switzerland (N = 506) to assess whether HWLs can influence the perceived risk associated with drinking wine and vodka, a beverage insignificant to Swiss culture. Participants were presented an image of either a wine or vodka bottle with or without an HWL presenting a liver cancer warning statement. They were then asked to indicate their perceived risk of regularly consuming the depicted beverage. Acceptance and rejection of HWLs were also assessed.

Results

The perceived risk of vodka consumption exceeded the corresponding risk for wine but was unaffected by an HWL. Perceived health benefits were the main, negative predictor of perceived consumption risk. Participants mainly rejected HWLs due to their perceived effectiveness, perceived positive health effects, social norms, and individualistic values.

Conclusions

Perceived risk is an important determinant of drinking behavior, and our results suggest that HWLs may be unable to alter risk perceptions. Furthermore, a strong belief in the health benefits of alcohol consumption, particularly wine consumption, reduce risk perceptions and may be unaffected by HWLs.

Communicating Air Quality Index Information: Effects of Different Styles on Individuals' Risk Perception and Precaution Intention

Air Quality Index (AQI) is information about atmospheric pollutants, which is essential for governments to inform the public about the current air quality and potential health risks. By analyzing the AQIs from 11 countries (regions), we discovered considerable variations in the design of AQI information, which may open up room for unintended interpretation from the public. Therefore, as an attempt to address the inefficiency of some common styles of AQI information in promoting the public's precaution against bad air and better design such information, an online experiment with a 2 (descriptor: neutral vs. negatively valenced) × 2 (target groups in AQI warning messages: vague vs. specific) factorial design was conducted to test the effects of such information on individuals' risk perception and precaution intention. The results indicated that AQI information with a neutral descriptor was associated with lower self-risk perception and precaution intention levels than with a negatively valenced one. Among the individuals not included in the at-risk groups, those who read the warning messages with vague target groups had a higher third-person perception toward smog risk than those targeting specific population groups. Practical and theoretical implications are discussed.

Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review

Alcohol is toxic to human health. In addition to providing nutritional information, labels on alcohol products can be used to communicate warnings on alcohol-related harms to consumers. This scoping review examined novel or enhanced health warning labels to assess the current state of the research and the key studied characteristics of labels, along with their impact on the studied outcomes. Four databases (Web of Science, MEDLINE, PsycInfo, CINAHL) were searched between January 2010 and April 2021, and 27 papers were included in the review. The results found that most studies were undertaken in English-speaking populations, with the majority conducted online or in the laboratory setting as opposed to the real world. Seventy percent of the papers included at least one cancer-related message, in most instances referring either to cancer in general or to bowel cancer. Evidence from the only real-world long-term labelling intervention demonstrated that alcohol health warning labels designed to be visible and contain novel and specific information have the potential to be part of an effective labelling strategy. Alcohol health warning labels should be seen as tools to raise awareness on alcohol-related risks, being part of wider alcohol policy approaches.

Differences between Gamblers and Non-Gamblers on Sports Betting Websites

Online sports gambling is a popular recreational activity. Using the Theory of Planned Behaviour as the theoretical foundation, the aim of this study was to examine for differences between gamblers and non-gamblers in terms of their attitudes, subjective norms and perceived behavioral control towards online sports gambling. 173 male students from a tertiary educational institution were recruited for this study of which 56 respondents (32%) were gamblers. A series of regression analysis revealed differences between gamblers and non-gamblers. While subjective norms and perceived behavioural control were significant predictors of gambling intentions for the gamblers group, only attitude was a significant predictor for the non-gamblers group. Further analysis showed that subjective norms had a larger effect on the gamblers group in comparison to the non-gamblers group. Physiological data from an eye tracker provided further empirical evidence that there were differences between gamblers and non-gamblers. Gamblers, perhaps because they are more familiar with gambling websites, take less time to process information. The findings from this study suggests that there are differences between gamblers and non-gamblers. To prevent problem gambling, there is a need to develop different communication messages for gamblers and non-gamblers.

Effect of alcohol label designs with different pictorial representations of alcohol content and health warnings on knowledge and understanding of low-risk drinking guidelines: a randomized controlled trial

BACKGROUND AND AIMS

The UK low-risk drinking guidelines (LRDG) recommend not regularly drinking more than 14 units of alcohol per week. We tested the effect of different pictorial representations of alcohol content, some with a health warning, on knowledge of the LRDG and understanding of how many drinks it equates to.

DESIGN

Parallel randomized controlled trial.

SETTING

On-line, 25 January-1 February 2019.

PARTICIPANTS

Participants (n = 7516) were English, aged over 18 years and drink alcohol.

INTERVENTIONS

The control group saw existing industry-standard labels; six intervention groups saw designs based on: food labels (serving or serving and container), pictographs (servings or containers), pie charts (servings) or risk gradients. A total of 500 participants (~70 per condition) saw a health warning under the design.

MEASUREMENTS

Primary outcomes: (i) knowledge: proportion who answered that the LRDG is 14 units; and (ii) understanding: how many servings/containers of beverages one can drink before reaching 14 units (10 questions, average distance from correct answer).

FINDINGS

In the control group, 21.5% knew the LRDG; proportions were higher in intervention groups (all P < 0.001). The three best-performing designs had the LRDG in a separate statement, beneath the pictograph container: 51.1% [adjusted odds ratio (aOR) = 3.74, 95% confidence interval (CI) = 3.08-4.54], pictograph serving 48.8% (aOR = 4.11, 95% CI = 3.39-4.99) and pie-chart serving, 47.5% (aOR = 3.57, 95% CI = 2.93-4.34). Participants underestimated how many servings they could drink: control mean = -4.64, standard deviation (SD) = 3.43; intervention groups were more accurate (all P < 0.001), best performing was pictograph serving (mean = -0.93, SD = 3.43). Participants overestimated how many containers they could drink: control mean = 0.09, SD = 1.02; intervention groups overestimated even more (all P < 0.007), worst-performing was food label serving (mean = 1.10, SD = 1.27). Participants judged the alcohol content of beers more accurately than wine or spirits. The inclusion of a health warning had no statistically significant effect on any measure.

CONCLUSIONS

Labels with enhanced pictorial representations of alcohol content improved knowledge and understanding of the UK's low-risk drinking guidelines compared with industry-standard labels; health warnings did not improve knowledge or understanding of low-risk drinking guidelines. Designs that improved knowledge most had the low-risk drinking guidelines in a separate statement located beneath the graphics.

Social Advertising Effectiveness in Driving Action: A Study of Positive, Negative and Coactive Appeals on Social Media

Background: Social media offers a cost-effective and wide-reaching advertising platform for marketers. Objectively testing the effectiveness of social media advertising remains difficult due to a lack of guiding frameworks and applicable behavioral measures. This study examines advertising appeals’ effectiveness in driving engagement and actions on and beyond social media platforms. Method: In an experiment, positive, negative and coactive ads were shared on social media and promoted for a week. The three ads were controlled in an A/B testing experiment to ensure applicable comparison. Measures used included impressions, likes, shares and clicks following the multi-actor social media engagement framework. Data were extracted using Facebook ads manager and website data. Significance was tested through a series of chi-square tests. Results: The promoted ads reached over 21,000 users. Significant effect was found for appeal type on engagement and behavioral actions. The findings support the use of negative advertising appeals over positive and coactive appeals. Conclusion: Practically, in the charity and environment context, advertisers aiming to drive engagement on social media as well as behavioral actions beyond social media should consider negative advertising appeals. Theoretically, this study demonstrates the value of using the multi-actor social media engagement framework to test advertising appeal effectiveness. Further, this study proposes an extension to evaluate behavioral outcomes.

Risk communication in cyberspace: a brief review of the information-processing and mental models approaches

Effective risk communication in cyberspace is critical for users to understand the potential security risks and make secure decisions. Two approaches to risk communication originating from psychology, the human information-processing approach and the mental-models approach, have been widely applied in other research fields of risk communication. The human information-processing approach characterizes the human as a communication system, with risk-communication information from a source delivered to the receiver, who processes the information via various stages. The mental-models approach emphasizes the importance of understanding experts' and non-experts' mental models, comparing these models, and drafting and evaluating risk-communication messages. With an overview of these two approaches and their applications, the goal of this paper is to provide insights for future use of these approaches in cybersecurity.

Commentary on 'Communicating Messages About Drinking': Using the 'Big Legal Guns' to Block Alcohol Health Warning Labels

Like the tobacco industry, the alcohol industry, with the support of governments in alcohol exporting nations, is looking to international trade and investment law as a means to oppose health warning labels on alcohol. The threat of such litigation, let alone its commencement, has the potential to deter all but the most resolute governments from implementing health warning labeling.