1
|
Davies E, Lewin J, Field M. Am I a responsible drinker? The impact of message frame and drinker prototypes on perceptions of alcohol product information labels. Psychol Health 2024; 39:1005-1022. [PMID: 36190181 DOI: 10.1080/08870446.2022.2129055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/01/2022] [Accepted: 09/21/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND Current alcohol product labelling tends to include ambiguous messages such as 'drink responsibly'. Consumers who identify as responsible drinkers may not pay heed to health warning messages, believing that they are not the intended target. AIMS We aimed to determine how responses to responsible drinking labels would differ from responses to positively and negatively framed health messages. We also explored if prototype perceptions would moderate the message impact. METHODS A between groups, three arm (ambiguous, positive or negative messages) experiment recruited 465 participants. Outcomes were drinking intentions and label acceptability (novelty, believability, personal relevance, and potential to change behaviour). Measures of heavy and responsible drinker prototype perceptions were included for exploratory moderation analyses. RESULTS Positive and negative messages were rated significantly more likely to change behaviour than ambiguous messages. There was also a moderation effect: participants with stronger favourability and similarity to the responsible drinker prototype intended to drink more alcohol in the future after exposure to negatively framed labels, but not after exposure to ambiguous or positively framed labels. DISCUSSION Drink responsibly' messages are unlikely to lead to behaviour change. Incorporating theoretical moderators may have value in developing our understanding of the impact of alcohol product labelling.
Collapse
Affiliation(s)
- Emma Davies
- The Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Joel Lewin
- The Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Matt Field
- Department of Psychology, University of Sheffield, Sheffield, UK
| |
Collapse
|
2
|
Pettigrew S, Davies T, O'Brien P, Sträuli B, Petticrew M, Bowden J. The absence of mandatory pregnancy warning labels in online alcohol purchasing contexts. Drug Alcohol Rev 2024; 43:1178-1182. [PMID: 38501974 DOI: 10.1111/dar.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/20/2024]
Abstract
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.
Collapse
Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Tazman Davies
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Paula O'Brien
- Melbourne Law School, The University of Melbourne, Melbourne, Australia
| | - Bella Sträuli
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Mark Petticrew
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jacquie Bowden
- National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia
| |
Collapse
|
3
|
Lewin J, Field M, Davies E. Investigating the impact of 'dark nudges' on drinking intentions: A between groups, randomized and online experimental study. Br J Health Psychol 2024; 29:272-292. [PMID: 37839822 DOI: 10.1111/bjhp.12698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 08/25/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVES This study explored how 'dark nudges' (tactics used in alcohol industry-funded responsible drinking campaigns) affect drinking intentions, perceived source credibility and whether individual differences in perceptions of prototypical drinkers moderated these effects. DESIGN Two 2 × 2 between-groups online experimental studies. METHODS Study 1 (N = 164) presented three alcohol health messages per condition, comprising social norm (healthy/unhealthy ("dark nudge")) by frame (loss/gain). Study 2 (N = 229) presented one message per condition, comprising cancer causality (single cause/multiple causes (dark nudge)) by funding disclosure (disclosure/non-disclosure (dark nudge)). Outcomes were drinking intentions and perceived source credibility. Exploratory analyses considered prototype perceptions as a between-subjects moderator. RESULTS No significant effects of message frame, social norm, fundi or multiple cancer causality arguments on drinking intentions were found. In Study 2, in the dark nudge multiple cancer causality conditions, perceived source credibility was high when funding was undisclosed, but significantly lower when it was disclosed. Exploratory analyses suggested effects were moderated by prototype similarity. In Study 1, higher perceived similarity to a heavy drinker and lower perceived similarity to a responsible drinker were associated with higher drinking intentions in the unhealthy norm/gain frame condition, but lower drinking intentions in the other conditions. CONCLUSIONS Framing, social norm, funding disclosure and multiple causality manipulations as tested in this study did not exert a dark nudge effect on drinking intentions. However, the exploratory analyses suggest it could be hypothesised that the types of messages used in alcohol industry-funded responsible drinking campaigns may result in greater drinking intentions among those who identify more as heavy drinkers and less as responsible drinkers. Perceived prototype similarity may be an important moderator of the impact of alcohol health messages that warrants further research. Study 2 suggests disclosure of industry funding guides judgements of the credibility of sources of misleading messages about alcohol and cancer.
Collapse
Affiliation(s)
- Joel Lewin
- The Centre for Psychological Research, Oxford Brookes University, Oxford, UK
- Oxford Institute of Clinical Psychology Training and Research, The University of Oxford, Oxford, UK
| | - Matt Field
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Emma Davies
- The Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| |
Collapse
|
4
|
López-Olmedo N, Muciño-Sandoval K, Canto-Osorio F, Vargas-Flores A, Quiroz-Reyes A, Sabines A, Malo-Serrano M, Bautista-Arredondo S, Colchero MA, Barrientos-Gutiérrez T. Warning labels on alcoholic beverage containers: a pilot randomized experiment among young adults in Mexico. BMC Public Health 2023; 23:1156. [PMID: 37322503 PMCID: PMC10268389 DOI: 10.1186/s12889-023-16069-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Little is known about the potential impacts of visible and up-to-date health warning labels on alcoholic beverage containers on a range of outcomes in low- and middle-income countries. We conducted an experimental study to test the potential impacts of visible health warning labels (on the principal panel of the package) on thinking about health risks, product attractiveness, visual avoidance, and intention to change alcohol use among students in Mexico aged 18-30 years. METHODS A double-blind, parallel-group, online randomized trial was conducted from November 2021 to January 2022 in 11 states in Mexico. In the control group, participants were presented with the image of a conventional beer can with a fictional design and brand. In the intervention groups, the participants observed pictograms with a red font and white backgrounds (health warning label in red-HWL red) or with a black font and yellow backgrounds (health warning label in yellow-HWL yellow), located at the top, covering around one-third of the beer can. We used Poisson regression models -unadjusted and adjusted for covariates- to assess differences in the outcomes across study groups. RESULTS Using intention-to-treat analysis (n = 610), we found more participants in groups HWL red and HWL yellow thought about the health risks from drinking beer compared to the control group [Prevalence Ratio (PR) = 1.43, CI95%:1.05,1.93 for HWL red; PR = 1.25, CI95%: 0.91, 1.71 for HWL yellow]. A lower percentage of young adults in the interventions vs control group considered the product attractive (PR 0.74, 95%CI 0.51, 1.06 for HWL red; PR 0.56, 95%CI 0.38, 0.83 for HWL yellow). Although not statistically significant, a lower percentage of participants in the intervention groups considered buying or consuming the product than the control group. Results were similar when models were adjusted for covariates. CONCLUSIONS Visible health warning labels could lead individuals to think about the health risks of alcohol, reducing the attractiveness of the product and decreasing the intention to purchase and consume alcohol. Further studies will be required to determine which pictograms or images and legends are most contextually relevant for the country. TRIAL REGISTRATION The protocol of this study was retrospectively registered on 03/01/2023: ISRCTN10494244.
Collapse
Affiliation(s)
- Nancy López-Olmedo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Karla Muciño-Sandoval
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Francisco Canto-Osorio
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Adriana Vargas-Flores
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Alai Quiroz-Reyes
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Arturo Sabines
- Pan American Health Organization in Mexico, Mexico City, Mexico
| | | | - Sergio Bautista-Arredondo
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - MArantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | |
Collapse
|
5
|
Booth L, McCausland T, Keric D, Kennington K, Stevens-Cutler J, Scott L, Pettigrew S. Evaluating an alcohol harm-reduction campaign advising drinkers of the alcohol-cancer link. Addict Behav 2023; 145:107760. [PMID: 37269794 DOI: 10.1016/j.addbeh.2023.107760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/27/2023] [Accepted: 05/24/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Public awareness of the alcohol-cancer link is low. Provision of this information could reduce alcohol consumption and related harms. The Spread campaign is a multi-media education campaign implemented in Western Australia to inform people about the carcinogenic properties of alcohol and associated harms. The aims of the present study were to (i) examine attitudinal and behavioural outcomes of the Spread campaign and (ii) identify demographic and drinking status factors associated with enactment of harm-reduction behaviours resulting from exposure. METHOD A cross sectional survey of Western Australian drinkers (consumed alcohol at least a few times in the previous 12 months, n = 760) examined campaign recognition, campaign perceptions, and behaviours resulting from campaign exposure. Chi-square analyses and a generalised linear model were used to identify demographic and alcohol-related factors associated with behavioural outcomes. RESULTS Around two-thirds of respondents recognised the campaign (65%), and of these, 22% reported successfully reducing how often or how much they drank due to seeing the campaign. Three quarters (73%) of all respondents considered the campaign message about the alcohol-cancer link to be believable. Respondents drinking at levels above the Australian guideline were less likely to have positive perceptions of the campaign than those complying with the guideline, but were more likely to report enacting the assessed harm-reduction behaviours as a result of campaign exposure. DISCUSSION AND CONCLUSION The results suggest that provision of information about the alcohol-cancer link has the potential to motivate reduced alcohol consumption. Implementing such campaigns could constitute an effective alcohol harm-reduction strategy.
Collapse
Affiliation(s)
- Leon Booth
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW 2042, Australia.
| | - Tahnee McCausland
- Mental Health Commission, Western Australian Government, 1/1 Nash St, Perth, WA 6000, Australia.
| | - Danica Keric
- Cancer Council Western Australia, Level 1/420 Bagot Road, Subiaco, WA 6008, Australia.
| | - Kelly Kennington
- Mental Health Commission, Western Australian Government, 1/1 Nash St, Perth, WA 6000, Australia.
| | - James Stevens-Cutler
- Mental Health Commission, Western Australian Government, 1/1 Nash St, Perth, WA 6000, Australia.
| | - Lucy Scott
- Mental Health Commission, Western Australian Government, 1/1 Nash St, Perth, WA 6000, Australia.
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW 2042, Australia.
| |
Collapse
|
6
|
Newall PWS, Rockloff M, Hing N, Thorne H, Russell AMT, Browne M, Armstrong T. Designing Improved Safer Gambling Messages for Race and Sports Betting: What can be Learned from Other Gambling Formats and the Broader Public Health Literature? J Gambl Stud 2023; 39:913-928. [PMID: 36961657 PMCID: PMC10175478 DOI: 10.1007/s10899-023-10203-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 03/25/2023]
Abstract
Safer gambling messages are one potential input to a public health approach toward reducing gambling-related harm, and yet there is no strong evidence supporting current messages such as "gamble responsibly" or "keep the fun in the game". Furthermore, sports betting is increasing in popularity in multiple jurisdictions, such as Australia and the US, increasing the need to design effective messaging campaigns for race and sports betting. Compared to other gambling formats, such as electronic gambling machines, the level of potential skill involved in race and sports betting may raise unique issues regarding the design of effective messages. This review first highlights research from the related public health domains of alcohol and tobacco. Then, five potential areas for further messaging-based research in race and sports betting are discussed: teaching safer gambling practices, correcting gambling misperceptions, boosting conscious decision making, norm-based messages, and emotional messages. A broad approach to message design is encouraged, given the potential for individual differences in message receptivity, and for frequently-repeated messages to be ignored or cause negative psychological reactance.
Collapse
Affiliation(s)
- Philip W S Newall
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, UK.
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, 400 Kent St, Sydney, NSW, 2000, Australia.
| | - Matthew Rockloff
- Experimental Gambling Research Laboratory, School of Human, Medical, and Applied Sciences, CQUniversity, University Drive, Bundaberg, QLD, 4670, Australia
| | - Nerilee Hing
- Experimental Gambling Research Laboratory, School of Human, Medical, and Applied Sciences, CQUniversity, University Drive, Bundaberg, QLD, 4670, Australia
| | - Hannah Thorne
- Experimental Gambling Research Laboratory, School of Human, Medical, and Applied Sciences, CQUniversity, 44 Greenhill Rd, Wayville, SA, 5034, Australia
| | - Alex M T Russell
- Experimental Gambling Research Laboratory, School of Health, Medical and Applied Sciences, CQUniversity, 400 Kent St, Sydney, NSW, 2000, Australia
| | - Matthew Browne
- Experimental Gambling Research Laboratory, School of Human, Medical, and Applied Sciences, CQUniversity, University Drive, Bundaberg, QLD, 4670, Australia
| | - Tess Armstrong
- Experimental Gambling Research Laboratory, School of Human, Medical, and Applied Sciences, CQUniversity, 44 Greenhill Rd, Wayville, SA, 5034, Australia
| |
Collapse
|
7
|
Grummon AH, Ruggles PR, Greenfield TK, Hall MG. Designing Effective Alcohol Warnings: Consumer Reactions to Icons and Health Topics. Am J Prev Med 2023; 64:157-166. [PMID: 37575887 PMCID: PMC10421534 DOI: 10.1016/j.amepre.2022.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
Collapse
Affiliation(s)
- Anna H. Grummon
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Phoebe R. Ruggles
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Marissa G. Hall
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
- Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
8
|
Giesbrecht N, Reisdorfer E, Rios I. Alcohol Health Warning Labels: A Rapid Review with Action Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11676. [PMID: 36141951 PMCID: PMC9517222 DOI: 10.3390/ijerph191811676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
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.
Collapse
Affiliation(s)
- Norman Giesbrecht
- Centre for Addiction and Mental Health, 33 Ursulla Franklin St., Toronto, ON M5S 2S1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada
| | | | | |
Collapse
|
9
|
Kokole D, Anderson P, Jané-Llopis E. Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review. Nutrients 2021; 13:3065. [PMID: 34578942 PMCID: PMC8469468 DOI: 10.3390/nu13093065] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 01/16/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, POB 616, 6200 MD Maastricht, The Netherlands; (P.A.); (E.J.-L.)
- ESADE Business School, University Ramon Llull, Avenida de Pedralbes, 60-62, 08034 Barcelona, Spain
- Institute for Mental Health Policy Research, CAMH, 33 Russell Street, Toronto, ON M5S 2S1, Canada
| |
Collapse
|
10
|
Dimova ED, Mitchell D. Rapid literature review on the impact of health messaging and product information on alcohol labelling. DRUGS: EDUCATION, PREVENTION AND POLICY 2021. [DOI: 10.1080/09687637.2021.1932754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Elena D. Dimova
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Danielle Mitchell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| |
Collapse
|
11
|
Asrani SK, Mellinger J, Arab JP, Shah VS. Reducing the Global Burden of Alcohol-Associated Liver Disease: A Blueprint for Action. Hepatology 2021; 73:2039-2050. [PMID: 32986883 PMCID: PMC9361217 DOI: 10.1002/hep.31583] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/18/2020] [Accepted: 09/08/2020] [Indexed: 12/12/2022]
Abstract
Alcohol-associated liver disease (ALD) is a major driver of global liver related morbidity and mortality. There are 2.4 billion drinkers (950 million heavy drinkers) and the lifetime prevalence of any alcohol use disorder (AUD) is 5.1%-8.6%. In 2017, global prevalence of alcohol-associated compensated and decompensated cirrhosis was 23.6 million and 2.5 million, respectively. Combined, alcohol-associated cirrhosis and liver cancer account for 1% of all deaths worldwide with this burden expected to increase. Solutions for this growing epidemic must be multi-faceted and focused on both population and patient-level interventions. Reductions in ALD-related morbidity and mortality require solutions that focus on early identification and intervention, reducing alcohol consumption at the population level (taxation, reduced availability and restricted promotion), and solutions tailored to local socioeconomic realities (unrecorded alcohol consumption, focused youth education). Simple screening tools and algorithms can be applied at the population level to identify alcohol misuse, diagnose ALD using non-invasive serum and imaging markers, and risk-stratify higher-risk ALD/AUD patients. Novel methods of healthcare delivery and platforms are needed (telehealth, outreach, use of non-healthcare providers, partnerships between primary and specialty care/tertiary hospitals) to proactively mitigate the global burden of ALD. An integrated approach that combines medical and AUD treatment is needed at the individual level to have the highest impact. Future needs include (1) improving quality of ALD data and standardizing care, (2) supporting innovative healthcare delivery platforms that can treat both ALD and AUD, (3) stronger and concerted advocacy by professional hepatology organizations, and (4) advancing implementation of digital interventions.
Collapse
Affiliation(s)
- Sumeet K Asrani
- Baylor University Medical Center, Dallas, TX, United States,Corresponding Author and reprint requests Sumeet K Asrani MD MSc, Baylor University Medical Center, Dallas Texas, 2148208500
| | - Jessica Mellinger
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Juan P Arab
- Depto. Gastroenterología y Hepatología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Vijay S Shah
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| |
Collapse
|
12
|
Schubert E, Smith E, Brydevall M, Lynch C, Ringin E, Dixon H, Kashima Y, Wakefield M, Bode S. General and specific graphic health warning labels reduce willingness to consume sugar-sweetened beverages. Appetite 2021; 161:105141. [PMID: 33524439 DOI: 10.1016/j.appet.2021.105141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/05/2020] [Accepted: 01/22/2021] [Indexed: 11/25/2022]
Abstract
Sugar-sweetened beverage (SSB) consumption is associated with obesity and other severe negative health consequences. The present study examined the effectiveness of two types of health warning labels (HWLs) in modulating dietary choices for SSBs: specific HWLs, presenting health consequences associated with consuming SSBs, and general HWLs, presenting health consequences of an unhealthy diet and obesity. While electroencephalography (EEG) was recorded, 63 participants completed a computer-based task in which they were first randomly allocated to view either SBB-specific, general, or non-warning control HWLs. They then viewed images of a range of SSB products, varying on perceived healthiness and tastiness, and rated their willingness to consume (WTC) each one. Linear mixed-effect model analyses revealed that general and specific HWLs both decreased WTC SSBs perceived as tasty, compared to the control condition. For general HWLs, this effect was reduced for SSBs perceived to be healthy, suggesting that specific HWLs may be more effective at reducing SSB consumption. The EEG data showed that SSBs considered unhealthy elicited greater N1 amplitudes, and tasty SSBs elicited greater late positive potential (LPP) amplitudes, possibly reflecting attentional allocation and craving responses, respectively. However, no strong differences between HWL types were found. Taken together, the results suggest that graphic HWLs, both general and specific, have the potential to reduce SSB consumption, but they do not strongly modulate craving-related neural responses to SSBs.
Collapse
Affiliation(s)
- Elektra Schubert
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Emma Smith
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Maja Brydevall
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Carmen Lynch
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Elysha Ringin
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Helen Dixon
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Australia
| | - Yoshihisa Kashima
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Australia
| | - Stefan Bode
- Melbourne School of Psychological Sciences, The University of Melbourne, Australia.
| |
Collapse
|
13
|
Clarke N, Pechey E, Mantzari E, Blackwell AKM, De-Loyde K, Morris RW, Munafò MR, Marteau TM, Hollands GJ. Impact of health warning labels communicating the risk of cancer on alcohol selection: an online experimental study. Addiction 2021; 116:41-52. [PMID: 32267588 DOI: 10.1111/add.15072] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/25/2019] [Accepted: 04/01/2020] [Indexed: 01/08/2023]
Abstract
AIMS Evidence from tobacco research suggests that health warning labels (HWLs) depicting the adverse consequences of consumption change smoking behaviours, with image-and-text (also known as 'pictorial' or 'graphic') HWLs most effective. There is an absence of evidence concerning the potential impact of HWLs placed on alcohol products on selection of those products. This study aimed to obtain a preliminary assessment of the possible impact of (i) image-and-text, (ii) text-only, and (iii) image-only HWLs on selection of alcoholic versus non-alcoholic drinks. DESIGN A between-subjects randomised experiment with a 2 (image: present versus absent) × 2 (text: present versus absent) factorial design. SETTING The study was conducted on the online survey platform Qualtrics. PARTICIPANTS Participants (n = 6024) were adults over the age of 18 who consumed beer or wine regularly (i.e. at least once a week), recruited through a market research agency. INTERVENTIONS Participants were randomised to one of four groups varying in the HWL displayed on the packaging of alcoholic drinks: (i) image-and-text HWL; (ii) text-only HWL; (iii) image-only HWL; and (iv) no HWL. HWLs depicted bowel cancer, breast cancer and liver cancer, which were each displayed twice across six alcoholic drinks. Each group viewed six alcoholic and six non-alcoholic drinks and selected one drink that they would like to consume. MEASUREMENTS The primary outcome was the proportion of participants selecting an alcoholic versus a non-alcoholic drink. FINDINGS Alcoholic drink selection was lower for all HWL types compared with no HWL (image-and-text: 56%; image-only: 49%; text-only: 61%; no HWL: 77%), with selection lowest for HWLs that included an image. Image-and-text HWLs reduced the odds of selecting an alcoholic drink compared with text-only HWLs (OR = 0.80, 95% CI = 0.69, 0.92), but increased the odds of selecting an alcoholic drink compared with image-only HWLs (OR = 1.34, 95% CI = 1.16, 1.55). CONCLUSIONS Health warning labels communicating the increased risk of cancers associated with alcohol consumption reduced selection of alcoholic versus non-alcoholic drinks in a hypothetical choice task in an online setting; labels displaying images had the largest effect. Their impact in laboratory and real-world field settings using physical products awaits investigation.
Collapse
Affiliation(s)
- Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Anna K M Blackwell
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | | | - Marcus R Munafò
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| |
Collapse
|
14
|
Hobin E, Weerasinghe A, Vallance K, Hammond D, McGavock J, Greenfield TK, Schoueri-Mychasiw N, Paradis C, Stockwell T. Testing Alcohol Labels as a Tool to Communicate Cancer Risk to Drinkers: A Real-World Quasi-Experimental Study. J Stud Alcohol Drugs 2020. [PMID: 32359056 PMCID: PMC7201213 DOI: 10.15288/jsad.2020.81.249] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: This study tested the initial and continued effects of cancer warning labels on drinkers’ recall and knowledge that alcohol can cause cancer. Method: A quasi-experiment was conducted to examine changes in the intervention versus comparison site for three outcomes: unprompted and prompted recall of the cancer warning, and knowledge that alcohol can cause cancer. The intervention site applied cancer warning labels to alcohol containers in its liquor store for 1 month, and the two liquor stores in the comparison site did not apply cancer labels. In total, 2,049 unique cohort participants (1,056 male) were recruited at liquor stores in the intervention and comparison sites to participate in surveys 4 months before labels were applied and 2 and 6 months after the cancer label was halted because of alcohol industry interference. Generalized estimating equations tested differences in outcomes between sites over time adjusting for socio-demographics and other covariates. Results: Two months after the cancer label, unprompted (+24.2% vs. +0.6%; adjusted odds ratio [AOR] = 32.7, 95% CI [5.4, 197.7]) and prompted (+35.7% vs. +4.1%; AOR = 6.2, 95% CI [3.6, 10.9]) recall increased to a greater extent in the intervention versus comparison site. There was a 10% greater increase in knowledge (+12.1% vs. +11.6%; AOR = 1.1, 95% CI [0.7, 1.5]) 2 months after the cancer label in the intervention versus comparison site. Similar results were found 6 months after the cancer label for all three outcomes. Conclusions: In a real-world setting, cancer warning labels get noticed and increase knowledge that alcohol can cause cancer. Additional cancer label intervention studies are required that are not compromised by industry interference.
Collapse
Affiliation(s)
- Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan McGavock
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Catherine Paradis
- Canadian Centre for Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
15
|
Vallance K, Stockwell T, Zhao J, Shokar S, Schoueri-Mychasiw N, Hammond D, Greenfield TK, McGavock J, Weerasinghe A, Hobin E. Baseline Assessment of Alcohol-Related Knowledge of and Support for Alcohol Warning Labels Among Alcohol Consumers in Northern Canada and Associations With Key Sociodemographic Characteristics. J Stud Alcohol Drugs 2020. [PMID: 32359055 PMCID: PMC7201212 DOI: 10.15288/jsad.2020.81.238] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Evidence-informed alcohol warning labels (AWLs) are a promising, well-targeted strategy to increase consumer awareness of health risks. We assessed consumers' baseline knowledge of alcohol-related cancer risk, standard drinks, and low-risk drinking guidelines as well as levels of support for AWLs. We further assessed associations with sociodemographic factors. METHOD Forming part of a larger study testing new evidence-informed AWLs in a northern Canadian territory compared with a neighboring territory, baseline surveys were completed among liquor store patrons systematically selected in both sites. Chi-square and multivariable logistic regression analyses were performed to assess outcomes. RESULTS In total, 836 liquor store patrons (47.8% female) completed baseline surveys across both sites. Overall, there was low knowledge of alcohol-related cancer risk (24.5%), limited ability to calculate a standard drink (29.5%), and low knowledge of daily (49.5%) and weekly (48.2%) low-risk drinking guideline limits. There was moderate support for AWLs with a health warning (55.9%) and standard drink information (51.4%), and lower support for low-risk drinking guideline labels (38.7%). No sociodemographic characteristics were associated with cancer knowledge. Identifying as female and having adequate health literacy were associated with support for all three AWLs; high alcohol use was associated with not supporting standard drink (adjusted odds ratio = 0.60, 95% CI [0.40, 0.88]) and low-risk drinking guideline (adjusted odds ratio = 0.57, 95% CI [0.38, 0.87]) labels. CONCLUSIONS Few consumers in this study had key alcohol-related health knowledge; however, there was moderate support for AWLs as a tool to raise awareness. Implementation of information-based interventions such as evidence-informed AWLs with health messages including alcohol-related cancer risk, standard drink information, and national drinking guidelines is warranted.
Collapse
Affiliation(s)
- Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Jinhui Zhao
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Simran Shokar
- Canadian Agency for Drugs and Technologies in Health, Toronto, Ontario, Canada
| | - Nour Schoueri-Mychasiw
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, California, United States
| | - Jonathan McGavock
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ashini Weerasinghe
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Hobin E, Shokar S, Vallance K, Hammond D, McGavock J, Greenfield TK, Schoueri-Mychasiw N, Paradis C, Stockwell T. Communicating risks to drinkers: testing alcohol labels with a cancer warning and national drinking guidelines in Canada. Canadian Journal of Public Health 2020; 111:716-725. [PMID: 32458295 DOI: 10.17269/s41997-020-00320-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 04/02/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To test whether alcohol labels with a cancer warning and national drinking guidelines are an effective tool for supporting more informed and safer alcohol consumption among drinkers. METHODS Using a quasi-experimental design, pre-post surveys were conducted with 1647 cohort participants systematically selected in liquor stores in two matched sites in Canada in 2017-2018. Enhanced labels designed according to best practices for effective product labels were applied to alcohol containers in the liquor store in the intervention site for one month, and usual practice continued in the comparison site. Generalized estimating equations tested the differences between sites over time in label salience and processing, and self-reported impact of the labels on drinking behaviours. RESULTS After the intervention, recall of the cancer warning label increased to a greater extent in the intervention versus comparison site (adjusted odds ratio (AOR) = 32.2, 95% CI = 5.4, 191.1), but not the national drinking guideline label (AOR = 2.7, 95% CI = 0.2, 31.8). There were significant label effects in the intervention versus comparison site for reading (AOR = 1.8, 95% CI = 1.3, 2.5), thinking about (AOR = 2.0, 95% CI = 1.4, 2.9), and talking with others about (AOR = 2.1, 95% CI = 1.3, 3.6) the labels, as well as self-reported impact to cut down on drinking (AOR = 2.5, 95% CI = 1.3, 4.7) and to drink less (AOR = 2.4, 95% CI = 1.3, 4.3). CONCLUSIONS Alcohol labels with a cancer warning and national drinking guidelines do a better job conveying risk information and promoting safer consumption than existing practices. Industry has a legal duty to adequately inform consumers about their products and should be mandated to include key information on alcohol containers.
Collapse
Affiliation(s)
- Erin Hobin
- Public Health Ontario, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| | - Simran Shokar
- Public Health Ontario, 480 University Ave, Suite 300, Toronto, ON, M5G 1V2, Canada
| | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan McGavock
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Catherine Paradis
- Canadian Centre for Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
17
|
Pechey E, Clarke N, Mantzari E, Blackwell AKM, De-Loyde K, Morris RW, Marteau TM, Hollands GJ. Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability. BMC Public Health 2020; 20:376. [PMID: 32238154 PMCID: PMC7114781 DOI: 10.1186/s12889-020-8403-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/24/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Health warning labels (HWLs) using images and text to depict the negative health consequences of tobacco consumption are effective and acceptable for changing smoking-related outcomes. There is currently limited evidence concerning their potential use for reducing consumption of alcoholic drinks and energy-dense foods. The aim of this research was to describe the potential effectiveness and acceptability of image-and-text (also known as pictorial or graphic) HWLs applied to: i. alcoholic drinks and ii. energy-dense snack foods. METHODS Two online studies were conducted using between-subjects designs with general population samples. Participants rated one of 21 image-and-text HWLs on alcoholic drinks (n = 5528), or one of 18 image-and-text HWLs on energy-dense snacks (n = 4618). HWLs comprised a graphic image with explanatory text, depicting, respectively, seven diseases linked to excess alcohol consumption, and six diseases linked to excess energy intake. Diseases included heart disease and various cancers. Outcomes were negative emotional arousal, desire to consume the labelled product, and acceptability of the label. Free-text comments relating to HWLs were content analysed. RESULTS For both alcoholic drinks and energy-dense snacks, HWLs depicting bowel cancer generated the highest levels of negative emotional arousal and lowest desire to consume the product, but were the least acceptable. Acceptability was generally low for HWLs applied to alcohol, with 3 of 21 rated as acceptable, and was generally high for snacks, with 13 of 18 rated as acceptable. The majority of free-text comments expressed negative reactions to HWLs on alcohol or energy-dense snacks. CONCLUSIONS Image-and-text health warning labels depicting bowel cancer showed greatest potential for reducing selection and consumption of alcoholic drinks and energy-dense snacks, although they were the least acceptable. Laboratory and field studies are needed to assess their impact on selection and consumption.
Collapse
Affiliation(s)
- Emily Pechey
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Natasha Clarke
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Eleni Mantzari
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Anna K M Blackwell
- Tobacco and Alcohol Research Group, University of Bristol, School of Psychological Science, Bristol, BS8 1TU, UK
| | - Katie De-Loyde
- Tobacco and Alcohol Research Group, University of Bristol, School of Psychological Science, Bristol, BS8 1TU, UK
| | - Richard W Morris
- Bristol Medical School: Population Health Sciences, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK
| | - Gareth J Hollands
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, CB2 0SR, UK.
| |
Collapse
|
18
|
Schoueri-Mychasiw N, Weerasinghe A, Vallance K, Stockwell T, Zhao J, Hammond D, McGavock J, Greenfield TK, Paradis C, Hobin E. Examining the Impact of Alcohol Labels on Awareness and Knowledge of National Drinking Guidelines: A Real-World Study in Yukon, Canada. J Stud Alcohol Drugs 2020; 81:262-272. [PMID: 32359057 PMCID: PMC7201209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 01/15/2020] [Indexed: 03/29/2024] Open
Abstract
OBJECTIVE Alcohol labels are one strategy for communicating health information to consumers. This study tested the extent to which consumers recalled alcohol labels with national drinking guidelines and examined the impact of labels on awareness and knowledge of the guidelines. METHOD A quasi-experimental study was conducted in two jurisdictions in northern Canada examining the impact of labels on the following outcomes: unprompted and prompted recall of the drinking guideline label message, awareness of the drinking guidelines, and knowledge of the daily and weekly recommended drink limits. The intervention site applied labels with national drinking guidelines, a cancer warning, and standard drink information to alcohol containers in its liquor store, whereas the comparison site did not apply these labels. In total, 2,049 cohort participants in both sites were recruited to complete surveys before and at two time points after the intervention. Changes in outcomes were examined using generalized estimating equations. RESULTS After the intervention, unprompted and prompted recall of the drinking guideline label message increased more in the intervention versus comparison site (adjusted odds ratio [AOR] = 10.8, 95% CI [0.9, 127.6]; AOR = 7.0, 95% CI [3.3, 14.9], respectively). Awareness of the drinking guidelines increased 2.9 times more in the intervention versus comparison site (AOR = 2.9, 95% CI [2.0, 4.3]). In addition, knowledge of the daily and weekly drink limits increased 1.5 and 1.4 times more in the intervention versus comparison site, respectively (daily: AOR = 1.5, 95% CI [1.0, 2.1]; weekly: AOR = 1.4, 95% CI [1.0, 2.0]). CONCLUSIONS Enhanced alcohol labels get noticed and may be an effective population-level strategy for increasing awareness and knowledge of national drinking guidelines.
Collapse
Affiliation(s)
| | | | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - Jinhui Zhao
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Thomas K. Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, California, United States
| | - Catherine Paradis
- Canadian Centre on Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Hobin E, Weerasinghe A, Vallance K, Hammond D, McGavock J, Greenfield TK, Schoueri-Mychasiw N, Paradis C, Stockwell T. Testing Alcohol Labels as a Tool to Communicate Cancer Risk to Drinkers: A Real-World Quasi-Experimental Study. J Stud Alcohol Drugs 2020; 81:249-261. [PMID: 32359056 PMCID: PMC7201213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 03/04/2020] [Indexed: 11/14/2023] Open
Abstract
OBJECTIVE This study tested the initial and continued effects of cancer warning labels on drinkers' recall and knowledge that alcohol can cause cancer. METHOD A quasi-experiment was conducted to examine changes in the intervention versus comparison site for three outcomes: unprompted and prompted recall of the cancer warning, and knowledge that alcohol can cause cancer. The intervention site applied cancer warning labels to alcohol containers in its liquor store for 1 month, and the two liquor stores in the comparison site did not apply cancer labels. In total, 2,049 unique cohort participants (1,056 male) were recruited at liquor stores in the intervention and comparison sites to participate in surveys 4 months before labels were applied and 2 and 6 months after the cancer label was halted because of alcohol industry interference. Generalized estimating equations tested differences in outcomes between sites over time adjusting for socio-demographics and other covariates. RESULTS Two months after the cancer label, unprompted (+24.2% vs. +0.6%; adjusted odds ratio [AOR] = 32.7, 95% CI [5.4, 197.7]) and prompted (+35.7% vs. +4.1%; AOR = 6.2, 95% CI [3.6, 10.9]) recall increased to a greater extent in the intervention versus comparison site. There was a 10% greater increase in knowledge (+12.1% vs. +11.6%; AOR = 1.1, 95% CI [0.7, 1.5]) 2 months after the cancer label in the intervention versus comparison site. Similar results were found 6 months after the cancer label for all three outcomes. CONCLUSIONS In a real-world setting, cancer warning labels get noticed and increase knowledge that alcohol can cause cancer. Additional cancer label intervention studies are required that are not compromised by industry interference.
Collapse
Affiliation(s)
- Erin Hobin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | - Catherine Paradis
- Canadian Centre for Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
20
|
Hobin E, Schoueri-Mychasiw N, Weerasinghe A, Vallance K, Hammond D, Greenfield TK, McGavock J, Paradis C, Stockwell T. Effects of strengthening alcohol labels on attention, message processing, and perceived effectiveness: A quasi-experimental study in Yukon, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 77:102666. [PMID: 32171107 PMCID: PMC7224201 DOI: 10.1016/j.drugpo.2020.102666] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/28/2019] [Accepted: 01/07/2020] [Indexed: 01/28/2023]
Abstract
Alcohol labels are one strategy for raising consumer awareness about the negative consequences of alcohol, but evidence to inform labels is limited. This quasi-experimental study sought to test the real-world impact of strengthening health messages on alcohol container labels on consumer attention, message processing (reading, thinking, and talking with others about labels), and self-reported drinking. Alcohol labels with a cancer warning, national drinking guidelines, and standard drink information were implemented in the intervention site, and usual labelling practices continued in the comparison site. Changes in key indicators of label effectiveness were assessed among a cohort of adult drinkers in both the intervention and comparison sites using three waves of surveys conducted before and at two time-points after the alcohol label intervention. Generalized Estimating Equations with difference-in-difference terms were used to examine the impact of the label intervention on changes in outcomes. Strengthening health messages on alcohol container labels significantly increased consumer attention to [Adjusted Odds Ratio (AOR)=17.2, 95%CI:8.2,36.2] and processing of labels (e.g., reading labels: AOR=2.6, 95%CI:1.8,3.7), and consumer reports of drinking less due to the labels (AOR=3.7, 95%CI: 2.0,7.0). Strengthening health messages on alcohol containers can achieve their goal of attracting attention, deepening engagement, and enhancing motivation to reduce alcohol use. Strengthening alcohol labelling policies should be a priority for alcohol control globally.
Collapse
Affiliation(s)
- Erin Hobin
- Health Promotion, Chronic Disease & Injury Prevention, Public Health Ontario, 480 University Ave, Suite 300, Toronto M5G 1V2, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Nour Schoueri-Mychasiw
- Health Promotion, Chronic Disease & Injury Prevention, Public Health Ontario, 480 University Ave, Suite 300, Toronto M5G 1V2, ON, Canada
| | - Ashini Weerasinghe
- Health Promotion, Chronic Disease & Injury Prevention, Public Health Ontario, 480 University Ave, Suite 300, Toronto M5G 1V2, ON, Canada
| | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, CA, United States
| | - Jonathan McGavock
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB, Canada
| | - Catherine Paradis
- Canadian Centre for Substance Use and Addiction, Ottawa, Ontario, Canada
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| |
Collapse
|
21
|
Vallance K, Stockwell T, Hammond D, Shokar S, Schoueri-Mychasiw N, Greenfield T, McGavock J, Zhao J, Weerasinghe A, Hobin E. Testing the Effectiveness of Enhanced Alcohol Warning Labels and Modifications Resulting From Alcohol Industry Interference in Yukon, Canada: Protocol for a Quasi-Experimental Study. JMIR Res Protoc 2020; 9:e16320. [PMID: 31922493 PMCID: PMC6996737 DOI: 10.2196/16320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/13/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol warning labels are a promising, well-targeted strategy to increase public awareness of alcohol-related health risks and support more informed and safer use. However, evidence of their effectiveness in real-world settings remains limited and inconclusive. OBJECTIVE This paper presents a protocol for a real-world study examining the population-level impact of enhanced alcohol warning labels with a cancer message; national drinking guidelines; and standard drink information on attention, processing, and alcohol-related behaviors among consumers in Canada. Postimplementation modifications to the original protocol due to interference by national alcohol industry representatives are also described. METHODS This quasi-experimental study involved partnering with local governments in two northern Canadian territories already applying alcohol warning labels on alcohol containers for sale in liquor stores. The study tested an 8-month intervention consisting of three new enhanced, rotating alcohol warning labels in an intervention site (Whitehorse, Yukon) relative to a comparison site (Yellowknife, Northwest Territories) where labelling practices would remain unchanged. Pre-post surveys were conducted at both sites to measure changes in awareness and processing of label messages, alcohol-related knowledge, and behaviors. Liquor store transaction data were collected from both sites to assess changes in population-level alcohol consumption. The intervention was successfully implemented for 1 month before it was halted due to complaints from the alcohol industry. The government of the intervention site allowed the study to proceed after a 2-month pause, on the condition that the cancer warning label was removed from rotation. Modifications to the protocol included applying the two remaining enhanced labels for the balance of the intervention and adding a third wave of surveys during the 2-month pause to capture any impact of the cancer label. RESULTS This study protocol describes a real-world quasi-experimental study that aimed to test the effectiveness of new enhanced alcohol warning labels as a tool to support consumers in making more informed and safer alcohol choices. Alcohol industry interference shortly after implementation compromised both the intervention and the original study design; however, the study design was modified to enable completion of three waves of surveys with cohort participants (n=2049) and meet the study aims. CONCLUSIONS Findings from this study will directly inform alcohol labelling policies in Canada and internationally and provide further insight into the alcohol industry's attempts to disrupt research in this area. Additional unimpeded real-world evaluations of enhanced alcohol warning labels are recommended. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/16320.
Collapse
Affiliation(s)
- Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Timothy Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - David Hammond
- School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Simran Shokar
- Canadian Agency for Drugs and Technologies in Health, Toronto, ON, Canada
| | - Nour Schoueri-Mychasiw
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| | - Thomas Greenfield
- Alcohol Research Group, Public Health Institute, Emeryville, CA, United States
| | - Jonathan McGavock
- Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jinhui Zhao
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC, Canada
| | - Ashini Weerasinghe
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| | - Erin Hobin
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, Toronto, ON, Canada
| |
Collapse
|
22
|
Weerasinghe A, Schoueri-Mychasiw N, Vallance K, Stockwell T, Hammond D, McGavock J, Greenfield TK, Paradis C, Hobin E. Improving Knowledge that Alcohol Can Cause Cancer is Associated with Consumer Support for Alcohol Policies: Findings from a Real-World Alcohol Labelling Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E398. [PMID: 31936173 PMCID: PMC7014334 DOI: 10.3390/ijerph17020398] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/25/2022]
Abstract
Knowledge that alcohol can cause cancer is low in Canada. Alcohol labels are one strategy for communicating alcohol-related harms, including cancer. Extending existing research observing an association between knowledge of the alcohol-cancer link and support for alcohol policies, this study examined whether increases in individual-level knowledge that alcohol is a carcinogen following an alcohol labelling intervention are associated with support for alcohol polices. Cancer warning labels were applied to alcohol containers at the intervention site, and the comparison site did not apply cancer labels. Pre-post surveys were conducted among liquor store patrons at both sites before and two-and six-months after the intervention was stopped due to alcohol industry interference. Limiting the data to participants that completed surveys both before and two-months after the cancer label stopped, logistic regression was used to examine the association between increases in knowledge and support for policies. Support for pricing and availability policies was low overall; however, increases in individual-level knowledge of the alcohol-cancer link was associated with higher levels of support for pricing policies, specifically, setting a minimum unit price per standard drink of alcohol (OR = 1.86, 95% CI: 1.11-3.12). Improving knowledge that alcohol can cause cancer using labels may increase support for alcohol policies. International Registered Report Identifier (IRRID): RR2-10.2196/16320.
Collapse
Affiliation(s)
| | | | - Kate Vallance
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 2Y2, Canada; (K.V.); (T.S.)
| | - Tim Stockwell
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC V8P 2Y2, Canada; (K.V.); (T.S.)
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, MB R3E 3P4, Canada;
| | | | - Catherine Paradis
- Canadian Centre for Substance Use and Addiction, Ottawa, ON K1P 5E7, Canada;
| | - Erin Hobin
- Public Health Ontario, Toronto, ON M5G 1V2, Canada; (A.W.); (N.S.-M.)
| |
Collapse
|
23
|
Winstock AR, Holmes J, Ferris JA, Davies EL. Perceptions of Alcohol Health Warning Labels in a Large International Cross-Sectional Survey of People Who Drink Alcohol. Alcohol Alcohol 2019; 55:315-322. [DOI: 10.1093/alcalc/agz099] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 12/31/2022] Open
Abstract
Abstract
Aims
This paper aimed to explore perceptions of alcohol health warning labels amongst a large international sample of people who drink alcohol.
Methods
The Global Drug Survey (GDS) is the world’s largest annual cross sectional survey of drug use. Seven health warning labels were presented (relating to heart disease, liver, cancer, calories, violence, taking two days off and the myth of benefits to moderate drinking). People were asked if they were aware of the information, believed it, if it was personally relevant, and if it would change their drinking. This paper included data from 75,969 respondents from 29 countries/regions who reported the use of alcohol in the last 12 months, collected during November–December 2017 (GDS2018).
Results
The fact that drinking less can reduce the risk of seven types of cancer was the least well known, and yet was demonstrated to encourage almost 40% of drinkers to consider drinking less. Women and high risk drinkers were more likely to indicate they would reduce their drinking in response to all labels. Personal relevance was identified as a key predictor of individual responses.
Conclusion
Findings highlight the potential of a range of health messages displayed on alcoholic beverages to raise awareness of alcohol-related harms and potentially support a reduction in drinking. Further research should explore what influences personal relevance of messages as this may be a barrier to effectiveness.
Collapse
Affiliation(s)
- Adam R Winstock
- Institute of Epidemiology and Health Care, University College London, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jason A Ferris
- Centre for Health Services Research, University of Queensland, Brisbane, Australia
| | - Emma L Davies
- Department of Psychology, Oxford Brookes University, Gipsy Lane, Oxford, UK
| |
Collapse
|
24
|
Meyer SB, Foley K, Olver I, Ward PR, McNaughton D, Mwanri L, Miller ER. Alcohol and breast cancer risk: Middle-aged women's logic and recommendations for reducing consumption in Australia. PLoS One 2019; 14:e0211293. [PMID: 30759125 PMCID: PMC6374008 DOI: 10.1371/journal.pone.0211293] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/10/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We aimed to understand the factors shaping alcohol consumption patterns in middle-aged women (45-64), and to identify participant-driven population- and policy-level strategies that may be used to addresses alcohol consumption and reduce breast cancer risk. METHODS Semi-structured interviews (n = 35) were conducted with 'middle-aged' women conversant in English and living in South Australia with no history of breast cancer diagnosis. Data were deductively coded using a co-developed framework including variables relevant to our study objectives. Women were asked about their current level of awareness of the association between alcohol and breast cancer risk, and their personal recommendations for how to decrease consumption in middle-aged Australian women. RESULTS Women discussed their previous efforts to decrease consumption, which we drew on to identify preliminary recommendations for consumption reduction. We identified a low level of awareness of alcohol and breast cancer risk, and confusion related to alcohol as a risk for breast cancer, but not always causing breast cancer. Participants suggested that education and awareness, through various means, may help to reduce consumption. CONCLUSIONS Participants' description of strategies used to reduce their own consumption lead us to suggest that campaigns might focus on the more salient and immediate effects of alcohol (e.g. on physical appearance and mental health) rather than longer-term consequences. Critical considerations for messaging include addressing the personal, physical and social pleasures that alcohol provides, and how these may differ across socio-demographics.
Collapse
Affiliation(s)
- Samantha B. Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Kristen Foley
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ian Olver
- University of South Australia Cancer Research Institute, Adelaide, South Australia, Australia
| | - Paul R. Ward
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Darlene McNaughton
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Emma R. Miller
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
25
|
Jongenelis MI, Johnston R, Stafford J. Factors Associated with Parents' Belief in the Appropriateness of Providing Alcohol to their Child. Subst Use Misuse 2018; 53:2281-2290. [PMID: 29889614 DOI: 10.1080/10826084.2018.1473433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Parental provision of alcohol to their underage child has been associated with risky adolescent drinking. While parents' belief in the appropriateness of providing their child with alcohol may influence their provision behaviors, research into the factors associated with this belief is lacking. OBJECTIVES This study sought to identify the factors associated with parents' belief in the appropriateness of providing alcohol to their underage child. METHODS Western Australian parents of 12-17 year olds (n = 443) completed an online survey assessing their drinking habits, alcohol provision behaviors, alcohol-related beliefs and attitudes, their child's alcohol consumption, and demographics. RESULTS Nearly half (44%) the parents surveyed reported providing their underage child with alcohol. Parents of older children and parents who (i) did not believe in the harms and recommendations associated with alcohol use in youth, (ii) agreed with youth-related drinking myths, and (iii) reported more occasions of alcohol consumption by their child were more likely to believe that it was appropriate to provide alcohol to their underage child. Those who believed providing alcohol to their underage child was appropriate were in turn more likely to provide alcohol. CONCLUSIONS Interventions aiming to reduce parental provision of alcohol to children should focus on changing parents' beliefs that this is an appropriate harm minimization behavior. Belief change may be facilitated by the implementation of public education campaigns that increase parents' belief in the alcohol-related harms associated with youth drinking and debunk youth-related drinking myths.
Collapse
Affiliation(s)
| | - Robyn Johnston
- b McCusker Centre for Action on Alcohol and Youth, Curtin University , Perth , Western Australia , Australia
| | - Julia Stafford
- b McCusker Centre for Action on Alcohol and Youth, Curtin University , Perth , Western Australia , Australia
| |
Collapse
|
26
|
Jongenelis MI, Pratt IS, Slevin T, Chikritzhs T, Liang W, Pettigrew S. The effect of chronic disease warning statements on alcohol-related health beliefs and consumption intentions among at-risk drinkers. HEALTH EDUCATION RESEARCH 2018; 33:351-360. [PMID: 30085037 DOI: 10.1093/her/cyy025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
Abstract
Informing drinkers of the health risks associated with alcohol consumption via warning statements located on alcohol products can increase their capacity to make healthier choices. This study assessed whether exposing at-risk drinkers to warning statements relating to specific chronic diseases increases the extent to which alcohol is believed to be a risk factor for those diseases and influences consumption intentions. Australians drinking at levels associated with long-term risk of harm (n = 364; 72% male) completed an online survey assessing their drinking habits, beliefs in the link between alcohol and various diseases and drinking intentions. Respondents were then exposed to one of five statements advising of the potential risks associated with alcohol consumption (either cancer, liver damage, diabetes, mental illness or heart disease). Beliefs and drinking intentions were reassessed. Significant increases in the extent to which alcohol was believed to be a risk factor for diabetes, heart disease, mental illness and cancer were found. With the exception of the liver damage and heart disease statements, exposure to each statement was associated with a significant reduction in consumption intentions. Warning statements advising of the specific chronic diseases associated with alcohol consumption can produce favourable changes in drinking intentions among at-risk drinkers.
Collapse
Affiliation(s)
| | - Iain S Pratt
- School of Psychology, Curtin University, GPO Box U1987, Perth, WA, Australia
- Cancer Council Western Australia, 420 Bagot Road Subiaco, WA, Australia
| | - Terry Slevin
- School of Psychology, Curtin University, GPO Box U1987, Perth, WA, Australia
- Cancer Council Western Australia, 420 Bagot Road Subiaco, WA, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA, Australia
| | - Wenbin Liang
- National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA, Australia
| | - Simone Pettigrew
- School of Psychology, Curtin University, GPO Box U1987, Perth, WA, Australia
| |
Collapse
|
27
|
Noar SM, Barker J, Yzer M. Measurement and Design Heterogeneity in Perceived Message Effectiveness Studies: A Call for Research. THE JOURNAL OF COMMUNICATION 2018; 68:990-993. [PMID: 30479402 PMCID: PMC6241501 DOI: 10.1093/joc/jqy047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Indexed: 06/01/2023]
Affiliation(s)
- Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua Barker
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marco Yzer
- Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
28
|
Pettigrew S, Hafekost C, Jongenelis M, Pierce H, Chikritzhs T, Stafford J. Behind Closed Doors: The Priorities of the Alcohol Industry as Communicated in a Trade Magazine. Front Public Health 2018; 6:217. [PMID: 30109222 PMCID: PMC6079248 DOI: 10.3389/fpubh.2018.00217] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/10/2018] [Indexed: 11/13/2022] Open
Abstract
Background: Efforts to reduce alcohol-related harm face strong resistance from the alcohol industry. It is important to monitor industry actions over time to assist in developing appropriate responses to this resistance. Monitoring can enable public health to identify industry positions on alcohol policy issues, stay abreast of current and emerging marketing tactics, and inform the development of possible counter-actions. One form of monitoring is the examination of industry trade publications where the industry converses with itself. The aim of this study was to assess industry strategic approaches as communicated in articles published in a leading Australian alcohol trade magazine to provide insights for policy makers and advocacy groups. Methods: Thematic analysis of 362 articles published in a trade magazine over a one-year period. Results: Three primary themes were evident in the articles: (1) the legitimization of alcohol as an important social and economic product, (2) the portrayal of the industry as trustworthy and benign, and (3) the strategic embedding of alcohol in various facets of everyday life. Conclusions: There was a general failure to acknowledge the substantial burden of disease caused by alcohol products, and instead much effort was expended on legitimizing the product and the companies responsible for its production, distribution, and promotion. The level of denial exhibited shows that additional regulation of the industry and its tactics will need to proceed without industry acceptance. Clear resistance to increasing consumer protections also points to the futility of inviting industry members to the policy table.
Collapse
Affiliation(s)
| | - Claire Hafekost
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | | | - Hannah Pierce
- McCusker Centre for Action on Alcohol and Youth, Curtin University, Perth, WA, Australia
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Perth, WA, Australia
| | - Julia Stafford
- McCusker Centre for Action on Alcohol and Youth, Curtin University, Perth, WA, Australia
| |
Collapse
|
29
|
Tinawi G, Gray T, Knight T, Glass C, Domanski N, Wilson N, Hoek J, Thomson G. Highly deficient alcohol health warning labels in a high-income country with a voluntary system. Drug Alcohol Rev 2018; 37:616-626. [DOI: 10.1111/dar.12814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 01/17/2018] [Accepted: 04/15/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Georges Tinawi
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Tessa Gray
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Thomas Knight
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Chayce Glass
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Nina Domanski
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Nick Wilson
- Department of Public Health; University of Otago; Wellington New Zealand
| | - Janet Hoek
- Department of Public Health; University of Otago; Wellington New Zealand
- Department of Marketing; University of Otago; Dunedin New Zealand
| | - George Thomson
- Department of Public Health; University of Otago; Wellington New Zealand
| |
Collapse
|
30
|
Scheideler JK, Klein WM. Awareness of the Link between Alcohol Consumption and Cancer across the World: A Review. Cancer Epidemiol Biomarkers Prev 2018; 27:429-437. [DOI: 10.1158/1055-9965.epi-17-0645] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/13/2017] [Accepted: 01/09/2018] [Indexed: 11/16/2022] Open
|
31
|
Martin N, Buykx P, Shevills C, Sullivan C, Clark L, Newbury-Birch D. Population Level Effects of a Mass Media Alcohol and Breast Cancer Campaign: A Cross-Sectional Pre-Intervention and Post-Intervention Evaluation. Alcohol Alcohol 2018; 53:31-38. [PMID: 29155922 DOI: 10.1093/alcalc/agx071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 09/12/2017] [Indexed: 12/22/2022] Open
Abstract
AIMS To examine the relationship between a TV-led breast cancer mass-media campaign in the North East of England (conducted in two waves: Jul/2015 and Nov/2015), awareness of the link between alcohol and cancer, intention to reduce alcohol consumption and support for alcohol related policies. METHODS Three cross-sectional surveys were conducted; one over the 2 weeks pre-campaign (n = 572); one immediately following campaign wave 1 (n = 576); and another immediately following campaign wave 2 (n = 552). Survey questions assessed; campaign exposure; awareness of the links between alcohol and related cancers; intention to change alcohol consumption; and support for alcohol related policies. RESULTS The proportion of respondents indicating awareness of alcohol as a cancer risk factor was larger post-campaign compared to pre-campaign. The largest increase was seen for breast cancer with 45% aware of the links post-campaign wave 2 compared to 33% pre-campaign. The proportion of respondents indicating 'strong support' of the seven alcohol related policies significantly increased between surveys. The proportion of respondents both aware of alcohol as a cancer risk factor and supportive of the seven alcohol related policies significantly increased between surveys. There was no significant change in self-reported intention to reduce alcohol consumption amongst increasing/higher risk drinkers. CONCLUSION These findings indicate that a mass-media campaign raising awareness of the links between alcohol and breast cancer is associated with increased awareness and alcohol related policy support at a population level. However, there was no association found with a change in short-term drinking intentions. SHORT SUMMARY A mass-media campaign raising awareness of the links between alcohol and breast cancer is associated with increased awareness and alcohol policy support at a population level but does not appear to be associated with a change in short term drinking intentions.
Collapse
Affiliation(s)
- Neil Martin
- Balance-The North East Alcohol Office, Bede House, Ground Floor East, Unit 3, Belmont Business Park, Durham DH1 1TW, UK
| | - Penny Buykx
- School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK
| | - Colin Shevills
- Balance-The North East Alcohol Office, Bede House, Ground Floor East, Unit 3, Belmont Business Park, Durham DH1 1TW, UK
| | - Claire Sullivan
- Public Health England, Waterfront 4, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK
| | - Lynsey Clark
- Bluegrass Research Limited, Design Works, William Street, Gateshead NE10 0JP, UK
| | - Dorothy Newbury-Birch
- School of Health & Social Care, Teesside University, Middlesbrough, Tees Valley TS1 3BX, UK
| |
Collapse
|
32
|
Factors associated with high consumption of soft drinks among Australian secondary-school students. Public Health Nutr 2017; 20:2340-2348. [DOI: 10.1017/s1368980017000118] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveTo examine demographic and behavioural correlates of high consumption of soft drinks (non-alcoholic sugar-sweetened carbonated drinks excluding energy drinks) among Australian adolescents and to explore the associations between high consumption and soft drink perceptions and accessibility.DesignCross-sectional self-completion survey and height and weight measurements.SettingAustralian secondary schools.SubjectsStudents aged 12–17 years participating in the 2012–13 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 7835).ResultsOverall, 14 % of students reported consuming four or more cups (≥1 litres) of soft drinks each week (‘high soft drink consumers’). Demographic factors associated with high soft drink consumption were being male and having at least $AU 40 in weekly spending money. Behavioural factors associated with high soft drink consumption were low fruit intake, consuming energy drinks on a weekly basis, eating fast foods at least once weekly, eating snack foods ≥14 times/week, watching television for >2 h/d and sleeping for <8 h/school night. Students who perceived soft drinks to be usually available in their home, convenient to buy and good value for money were more likely to be high soft drink consumers, as were students who reported usually buying these drinks when making a beverage purchase from the school canteen/vending machine.ConclusionsHigh soft drink consumption clusters with other unhealthy lifestyle behaviours among Australian secondary-school students. Interventions focused on reducing the availability of soft drinks (e.g. increased taxes, restricting their sale in schools) as well as improved education on their harms are needed to lower adolescents’ soft drink intake.
Collapse
|
33
|
Al-Hamdani M, Smith SM. Alcohol health-warning labels: promises and challenges. J Public Health (Oxf) 2017; 39:3-5. [DOI: 10.1093/pubmed/fdx010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
34
|
Alcohol consumers' attention to warning labels and brand information on alcohol packaging: Findings from cross-sectional and experimental studies. BMC Public Health 2017; 17:123. [PMID: 28122527 PMCID: PMC5267428 DOI: 10.1186/s12889-017-4055-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 01/19/2017] [Indexed: 11/29/2022] Open
Abstract
Background Alcohol warning labels have a limited effect on drinking behavior, potentially because people devote minimal attention to them. We report findings from two studies in which we measured the extent to which alcohol consumers attend to warning labels on alcohol packaging, and aimed to identify if increased attention to warning labels is associated with motivation to change drinking behavior. Methods Study 1 (N = 60) was an exploratory cross-sectional study in which we used eye-tracking to measure visual attention to brand and health information on alcohol and soda containers. In study 2 (N = 120) we manipulated motivation to reduce drinking using an alcohol brief intervention (vs control intervention) and measured heavy drinkers’ attention to branding and warning labels with the same eye-tracking paradigm as in study 1. Then, in a separate task we experimentally manipulated attention by drawing a brightly colored border around health (or brand) information before measuring participants’ self-reported drinking intentions for the subsequent week. Results Study 1 showed that participants paid minimal attention to warning labels (7% of viewing time). Participants who were motivated to reduce drinking paid less attention to alcohol branding and alcohol warning labels. Results from study 2 showed that the alcohol brief intervention decreased attention to branding compared to the control condition, but it did not affect attention to warning labels. Furthermore, the experimental manipulation of attention to health or brand information did not influence drinking intentions for the subsequent week. Conclusions Alcohol consumers allocate minimal attention to warning labels on alcohol packaging and even if their attention is directed to these warning labels, this has no impact on their drinking intentions. The lack of attention to warning labels, even among people who actively want to cut down, suggests that there is room for improvement in the content of health warnings on alcohol packaging. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4055-8) contains supplementary material, which is available to authorized users.
Collapse
|
35
|
Coomber K, Mayshak R, Curtis A, Miller PG. Awareness and correlates of short-term and long-term consequences of alcohol use among Australian drinkers. Aust N Z J Public Health 2017; 41:237-242. [PMID: 28110495 DOI: 10.1111/1753-6405.12634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/01/2016] [Accepted: 09/01/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To investigate awareness of short-term and long-term consequences of alcohol use among a sample of Australian adult drinkers. Demographic correlates of the awareness of each consequence were also explored. METHODS Participants aged 18-45 years (n=1,061; mean age=33.2 years) drawn from an online panel completed a web-based survey assessing demographics, awareness of alcohol warning labels, and awareness of seven short-term and 12 long-term consequences of alcohol use. RESULTS The level of awareness of short- and long-term consequences ranged from 16% (breast cancer) to 69% (low coordination and slower reflexes). The study found consistent differences in awareness of consequences by gender, with some differences for specific consequences by age, education, SES, rurality and awareness of alcohol warning labels. CONCLUSIONS Most consumers lack a sufficient understanding of the potential consequences of alcohol use. Particular subgroups of drinkers may not equate drinking with negative consequences. Implications for public health: Front-of-label alcohol warnings on all products and public health and education campaigns presenting messages targeting subgroups of drinkers could increase awareness of short- and long-term negative health and social effects of alcohol use.
Collapse
Affiliation(s)
- Kerri Coomber
- School of Psychology, Faculty of Health, Deakin University, Victoria
| | - Richelle Mayshak
- School of Psychology, Faculty of Health, Deakin University, Victoria
| | - Ashlee Curtis
- School of Psychology, Faculty of Health, Deakin University, Victoria
| | - Peter G Miller
- School of Psychology, Faculty of Health, Deakin University, Victoria
| |
Collapse
|