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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.
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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
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2
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Joyce KM, Davidson M, Manly E, Stewart SH, Al-Hamdani M. A systematic review on the impact of alcohol warning labels. J Addict Dis 2024; 42:170-193. [PMID: 37212771 DOI: 10.1080/10550887.2023.2210020] [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] [Indexed: 05/23/2023]
Abstract
Findings on the effects of alcohol warning labels (AWLs) as a harm reduction tool have been mixed. This systematic review synthesized extant literature on the impact of AWLs on proxies of alcohol use. PsycINFO, Web of Science, PubMED, and MEDLINE databases and reference lists of eligible articles. Following PRISMA guidelines, 1,589 articles published prior to July 2020 were retrieved via database and 45 were via reference lists (961 following duplicate removal). Article titles and abstracts were screened, leaving the full text of 96 for review. The full-text review identified 77 articles meeting inclusion/exclusion criteria which are included here. Risk of bias among included studies was examined using the Evidence Project risk of bias tool. Findings fell into five categories of alcohol use proxies including knowledge/awareness, perceptions, attention, recall/recognition, attitudes/beliefs, and intentions/behavior. Real-world studies highlighted an increase in AWL awareness, alcohol-related risk perceptions (limited findings), and AWL recall/recognition post-AWL implementation; these findings have decreased over time. Conversely, findings from experimental studies were mixed. AWL content/formatting and participant sociodemographic factors also appear to influence the effectiveness of AWLs. Findings suggest conclusions differ based on the study methodology used, favoring real-world versus experimental studies. Future research should consider AWL content/formatting and participant sociodemographic factors as moderators. AWLs appear to be a promising approach for supporting more informed alcohol consumption and should be considered as one component in a comprehensive alcohol control strategy.
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Affiliation(s)
- Kayla M Joyce
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Canada
| | - Myles Davidson
- Department of Psychology at Saint Mary's University, Halifax, Nova Scotia, Canada
| | - Eden Manly
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sherry H Stewart
- Department of Psychiatry, Dalhousie University, Halifax, Canada
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
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3
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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024; 403:1895-1950. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Krnel SR, Pravst I, Hribar M, Blažica B, Kušar A. How effective are health messages/warnings in improving knowledge and awareness of alcohol-related harm? The Slovenian case on using a mobile app. BMC Public Health 2023; 23:2467. [PMID: 38082375 PMCID: PMC10712114 DOI: 10.1186/s12889-023-17353-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Consumers generally lack access to information on alcoholic beverages, in spite of it being readily available for food and non-alcoholic beverages. Given the rights of consumers, and as with other products harmful to the population, there have been increasing calls for health warnings to be placed on alcoholic beverages, similar to those implemented on tobacco products. The aim of our research was to assess whether knowledge and awareness of the risks and harms associated with alcohol can be improved with a mobile app. METHODS Intervention was conducted using VKJ mobile app, which enables users to scan the barcode of an alcoholic beverage and receive feedback on its labelled alcohol content and estimated energy value. At each search, eleven different health messages/warnings about the risks and harms of alcohol are also displayed randomly, rotating on the screen. A survey was conducted before and after the intervention, to assess the knowledge and awareness of the risks and harms associated with drinking alcohol. RESULTS Significant differences were found for eight of the twelve tested statements. The improvement was seen to a greater extent in the group of high-risk drinkers. The results also showed that the vast majority of participants (78%) who were exposed to the health messages supported mandatory labelling of alcoholic beverages with information on ingredient listing and energy value, and 72% would like to have health warnings on alcohol products. CONCLUSIONS The use of a mobile app can be an option to improve knowledge and raise awareness of the risks and harms related to alcohol.
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Affiliation(s)
- Sandra Radoš Krnel
- Analysis and Development Centre, National Institute of Public Health, Trubarjeva Cesta 2, Ljubljana, Slovenia.
| | - Igor Pravst
- Nutrition and Public Health Research Group, Nutrition Institute, Koprska Ulica 98, Ljubljana, Slovenia
- Biotechnical Faculty, University of Ljubljana, Jamnikarjeva 101, Ljubljana, Slovenia
- VIST - Faculty of Applied Sciences, Gerbičeva Ulica 53, Ljubljana, Slovenia
| | - Maša Hribar
- Nutrition and Public Health Research Group, Nutrition Institute, Koprska Ulica 98, Ljubljana, Slovenia
| | - Bojan Blažica
- Computer Systems Department, Jožef Stefan Institute, Jamova Cesta 39, Ljubljana, Slovenia
| | - Anita Kušar
- Nutrition and Public Health Research Group, Nutrition Institute, Koprska Ulica 98, Ljubljana, Slovenia
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5
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Kowalski M, Livingston M, Wilkinson C, Ritter A. The impact of tableside ordering technologies on alcohol sales to the intoxicated. Drug Alcohol Rev 2023. [PMID: 36883348 DOI: 10.1111/dar.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Michala Kowalski
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Michael Livingston
- National Drug Research Institute and enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Claire Wilkinson
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia.,Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Sydney, Australia
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6
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Romeo JS, Huckle T, Casswell S, Connor J, Rehm J, McGinn V. Foetal alcohol spectrum disorder in Aotearoa, New Zealand: Estimates of prevalence and indications of inequity. Drug Alcohol Rev 2023; 42:859-867. [PMID: 36809679 DOI: 10.1111/dar.13619] [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: 09/27/2021] [Revised: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Foetal alcohol spectrum disorder (FASD) is 100% caused by alcohol. The lifelong disability caused by prenatal alcohol exposure cannot be reversed. Lack of reliable national prevalence estimates of FASD is common internationally and true of Aotearoa, New Zealand. This study modelled the national prevalence of FASD and differences by ethnicity. METHODS FASD prevalence was estimated from self-reported data on any alcohol use during pregnancy for 2012/2013 and 2018/2019, combined with risk estimates for FASD from a meta-analysis of case-ascertainment or clinic-based studies in seven other countries. A sensitivity analysis using four more recent active case ascertainment studies was performed to account for the possibility of underestimation. RESULTS We estimated FASD prevalence in the general population to be 1.7% (95% confidence interval [CI] 1.0%; 2.7%) in the 2012/2013 year. For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. In the 2018/2019 year, FASD prevalence was 1.3% (95% CI 0.9%; 1.9%). For Māori, the prevalence was significantly higher than for Pasifika and Asian populations. The sensitivity analysis estimated the prevalence of FASD in the 2018/2019 year to range between 1.1% and 3.9% and for Māori, from 1.7% to 6.3%. DISCUSSION AND CONCLUSIONS This study used methodology from comparative risk assessments, using the best available national data. These findings are probably underestimates but indicate a disproportionate experience of FASD by Māori compared with some ethnicities. The findings support the need for policy and prevention initiatives to support alcohol-free pregnancies to reduce lifelong disability caused by prenatal alcohol exposure.
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Affiliation(s)
- Jose S Romeo
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Taisia Huckle
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Sally Casswell
- SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand
| | - Jennie Connor
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Jurgen Rehm
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,PAHO/WHO Collaborating Centre for Addiction and Mental Health, Technische Universität Dresden, Klinische Psychologie and Psychotherapie, Dresden, Germany.,Zentrum für Interdisziplinäre Suchtforschung der Universität Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Valerie McGinn
- National Institute for Health Innovation, School of Population Health, The University of Auckland, Auckland, New Zealand.,FASD Centre, Aotearoa, Auckland, New Zealand
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7
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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.
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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
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8
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Glasgow TE, Miller CA, McGuire KP, Freudenberger DC, Fuemmeler BF. Support for cancer prevention public health policies: results from a nationally representative sample of residents in the United States. Transl Behav Med 2022; 12:1124-1132. [PMID: 35972325 PMCID: PMC9802572 DOI: 10.1093/tbm/ibac056] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Assessing public support of health policies designed to reduce cancer risk is important for policy implementation. This study aimed to identify support for cancer prevention policies and factors associated with support. Data were obtained from the Health Information National Trends Survey. Support for three types of cancer prevention policies were evaluated: tobacco, alcohol, and junk food regulations. Linear and logistic regression analyses were employed to assess the relationship between support for the different types of policies and sociodemographic, lifestyle behaviors, and cancer beliefs. Certain policies, such as providing warning labels on cigarettes (69.9% support) and requiring specific health warnings on alcohol containers (65.1% support), were popular. Banning outdoor advertising of alcohol was not popular (34.4% support). There were individual differences associated with policy support. For example, respondents who were 75 years or older (B = 0.61, p < .001) or female (B = 0.14, p < .008) were more likely to support tobacco polices compared to their counterparts (i.e., younger or male). Respondents who identified as politically conservative (B = -0.20, p < .004) or those who endorsed high cancer fatalistic beliefs (e.g., there's not much you can do to lower your chances of getting cancer, B = -0.07, p < .012) were less likely to support alcohol policies compared to those who were liberal or had lower cancer fatalistic beliefs. Generally, support was high for most policy questions. However, support varied by different individual factors. The findings also highlight that there may be opportunities to increase understanding and awareness about cancer prevention policies, especially among some segments of the population.
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Affiliation(s)
- Trevin E Glasgow
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Carrie A Miller
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kandace P McGuire
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Devon C Freudenberger
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Norman T, Anderson-Luxford D, O’Brien P, Room R. Regulating alcohol advertising for public health and welfare in the age of digital marketing: challenges and options. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2148518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Thomas Norman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | - Paula O’Brien
- Melbourne Law School, University of Melbourne, Melbourne, Australia
| | - Robin Room
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
- Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
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10
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Muacevic A, Adler JR, Hussaini T, Omar M, Cox B, Marquez-Azalgara V, Yoshida EM. Liver Transplant Recipients Speak Out on Public Awareness and Education Surrounding Alcohol-Related Health Effects: A Survey Study. Cureus 2022; 14:e31760. [PMID: 36569722 PMCID: PMC9771763 DOI: 10.7759/cureus.31760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Compared to other recreational substances in Canada, alcohol consumption incurs the highest healthcare costs. Liver transplant recipients are unique stakeholders as members of the general public with lived experiences of liver disease. We sought to explore their perspectives on the current state of public education on alcohol-related health effects. METHODS The most recent 400 liver transplant recipients at Vancouver General Hospital, Canada, were invited to participate in an anonymous online survey on alcohol-related health effects by mail, email, and phone. RESULTS Of 372 contacted patients, 212 (57%) completed the survey. Most patients were between 60-79 years, 63% were male, and 69% were Caucasian. The most common liver conditions leading to transplant were viral hepatitis (33%), alcohol-related liver disease (16%), autoimmune liver disease (14%), and non-alcoholic fatty liver disease (15%). Most patients knew that alcohol leads to liver failure (85%), but fewer knew about alcohol leading to cancer (54%), heart disease (50%), and damage to other organs (58%). Most common sources of information included public media (61%), family and friends (52%), and physicians (49%), with narrative comments about learning of alcohol-related health effects after liver diagnosis. Most patients believed that public health education at a middle/high school level would have long-term efficacy (72%) compared to health warning labels (33%) and safety messaging in commercials (39%). Current public education was felt to be adequate by only 20% of patients and 73% of patients supported health warning labels. CONCLUSIONS Liver transplant patients reported a high, but not universal, awareness of alcohol-related health effects. A majority thought that current public health efforts were inadequate; it is critical to implement public health interventions to ensure consumers are able to make an informed decision on alcohol consumption.
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Kumar R, Kaushal SK, Kumar K. Does source credibility matter in promoting sustainable consumption? Developing an integrated model. SOCIAL RESPONSIBILITY JOURNAL 2022. [DOI: 10.1108/srj-07-2021-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to explore the role of source credibility while purchasing environment-friendly products using Ajzen’s (1991) theory of planned behavior as underpinning model.
Design/methodology/approach
The proposed theoretical model was empirically tested with the data collected from 334 respondents using structural equation modeling.
Findings
The results gave empirical support to the addition of source credibility to the original theory of planned. Moreover, consumer attitude was found mediating the effect of corporations’ credibility on purchase intention. Also, attitude and perceived behavioral control were found as the most important predictors of consumer’s intention to purchase environment-friendly products.
Practical implications
This study provides valuable insights for the marketers engaged in sustainable business practices. Amid, ever-increasing carbon emission, promoting the use of environment-friendly products has become the need of the time. Credibility plays a crucial role while promoting and communicating an organization’s sustainable practices among its stakeholders including consumers. Therefore, the marketer should formulate appropriate marketing communication strategy to communicate the consumer about the green practices and environment-friendly products they produce. The results suggest that corporation’s credibility shapes consumer attitude and influences intention to purchase environment-friendly products. Earning trust of the consumer is pivotal to achieve success in the market. Therefore, results may help the marketers to better understand consumer’s response toward their marketing strategies and further convince and persuade them to buy their products.
Social implications
The findings of this study may be useful for marketers, strategists, policymakers and government while formulating promotional strategies to make consumer aware, educate and persuade them to purchase products which do not cause harm to the environment.
Originality/value
The study is novel in terms of exploring role of source credibility and extending theory of planned behavior in the context of sustainable consumption.
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Budenz A, Moser RP, Eck R, Agurs-Collins T, McNeel TS, Klein WMP, Berrigan D. Awareness of Alcohol and Cancer Risk and the California Proposition 65 Warning Sign Updates: A Natural Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11862. [PMID: 36231178 PMCID: PMC9564772 DOI: 10.3390/ijerph191911862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
In 1986, California enacted Proposition 65 (P65), requiring businesses to display warning signs informing consumers that specific chemicals and alcohol exposure increase the risk of cancer and reproductive harm. In 2018, the P65 alcohol warning signs were updated to include an informational P65 website link, and the update was associated with media coverage and increased enforcement of warning requirements. This study examines knowledge of the association between alcohol use and cancer risk in California compared to the rest of the US before and after the 2018 P65 update. We analyzed state-level data on alcohol and cancer knowledge from the Health Information National Trends Survey from 2017 (n = 3285), 2019 (n = 5438), and 2020 (n = 3865). We performed multinomial logistic regressions to examine knowledge levels by survey year and location (California vs. all other states) and reported the predicted marginals of knowledge by survey year and location. The adjusted prevalence of respondents who reported an association between alcohol and cancer risk was higher in California (41.6%) than the remaining states (34.1%) (p = 0.04). However, knowledge levels decreased significantly over survey years, and there was no evidence for an effect of the P65 update on knowledge in California compared to other states based on the testing of an interaction between state and year (p = 0.32). The 1986 warning signs may have had an enduring effect on awareness, though the update, so far, has not. Further efforts are needed to determine how to increase alcohol and cancer knowledge to address the burden of alcohol-attributable cancers.
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Affiliation(s)
- Alexandra Budenz
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Richard P. Moser
- Office of the Associate Director, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Raimee Eck
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Tanya Agurs-Collins
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - Timothy S. McNeel
- Information Management Services, Inc., 3901 Calverton Blvd #200, Calverton, MD 20705, USA
| | - William M. P. Klein
- Office of the Associate Director, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
| | - David Berrigan
- Health Behaviors Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850, USA
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13
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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.
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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
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Davies EL, Foxcroft DR, Puljevic C, Ferris JA, Winstock AR. Global comparisons of responses to alcohol health information labels: A cross sectional study of people who drink alcohol from 29 countries. Addict Behav 2022; 131:107330. [PMID: 35504111 DOI: 10.1016/j.addbeh.2022.107330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 02/25/2022] [Accepted: 04/04/2022] [Indexed: 01/21/2023]
Abstract
AIMS The aim of this paper was to explore responses to alcohol health information labels from a cross sectional survey of people who drink alcohol from 29 countries. DESIGN This paper draws on findings from the Global Drug Survey (GDS) - an annual cross sectional online survey. PARTICIPANTS 75,969 (64.3% male) respondents from 29 countries were included in the study. MEASURES Respondents were shown seven health information labels (topics were heart disease, liver, cancer, calories, violence, taking two days off and myth of benefits of moderate drinking). They were asked if the information was new, believable, personally relevant, and if it would change their drinking. A multivariate multilevel Bayesian logistic regression model was used to estimate predicted probabilities for newness, believability, relevance and if messages would change drinking behaviour by country and information label. FINDINGS Predicted probabilities showed substantial variability in responses across countries. Respondents from Colombia, Brazil and Mexico were more likely to consider drinking less as well as have lower levels of previous awareness. Those from Denmark and Switzerland were not as likely to say the labels would make them consider drinking less. The cancer message was consistently the newest and most likely to make people consider drinking less across countries. CONCLUSIONS Country differences in responses to messages can be used to create targeted harm reduction measures as well as inform what should be on labels. The provision of such health information on alcohol product labels may play a role in raising awareness of the risk of drinking. Global comparisons of responses to alcohol health information labels: a cross sectional study of people who drink alcohol from 29 countries.
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Affiliation(s)
- Emma L Davies
- Faculty of Health and Life Sciences, Oxford Brookes University, UK.
| | - David R Foxcroft
- Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - Cheneal Puljevic
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jason A Ferris
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Adam R Winstock
- University College London, UK; Global Drug Survey, London, UK
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15
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Pettigrew S, Booth L, Jongenelis MI, Brennan E, Chikritzhs T, Hasking P, Miller P, Hastings G, Wakefield M. A randomized controlled trial of the effectiveness of combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction communications. Addict Behav 2021; 121:107004. [PMID: 34102583 DOI: 10.1016/j.addbeh.2021.107004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Alcohol is a major source of harm worldwide. The aim of this study was to experimentally assess the effects of exposing Australian adult drinkers to combinations of 'why to reduce' and 'how to reduce' alcohol harm-reduction messages. METHODS Three online surveys were administered over six weeks: Time 1 at baseline (n = 7,995), Time 2 at three weeks post-baseline (n = 4,588), and Time 3 at six weeks post-baseline (n = 2,687). Participants were randomly assigned to one of eight conditions: (1) a control condition; (2) a 'why to reduce' television advertisement; (3-5) one of three 'how to reduce' messages referring to the following protective behavioral strategies (PBSs): Keep count of your drinks, Decide how many drinks and stick to it, It's okay to say no; and (6-8) the television advertisement combined with each PBS message individually. Intention-to-treat analyses were conducted to determine effects of condition assignment on changes over time in attempts to reduce alcohol consumption and amount of alcohol consumed. RESULTS Participants assigned to the 'TV ad' and 'TV ad + Keep count of your drinks PBS' conditions reported significant increases in attempts to reduce alcohol consumption. Only participants assigned to the 'TV ad + Keep count of your drinks PBS' condition exhibited a significant reduction in alcohol consumed (-0.87 drinks per person per week). CONCLUSIONS Well-executed 'why to reduce' alcohol harm-reduction advertisements can encourage drinkers to attempt to reduce their alcohol consumption. These ads may be effectively supplemented by specific 'how to reduce' messages designed to encourage drinkers to monitor their intake.
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Affiliation(s)
- Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, Australia; National Drug Research Institute, Curtin University, Kent St Bentley, WA, Australia.
| | - Leon Booth
- The George Institute for Global Health, University of New South Wales, 1 King St, Newtown, NSW, Australia; School of Population Health, Curtin University, Kent St Bentley, WA, Australia.
| | - Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Barry St, Melbourne, VIC, Australia.
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, Australia.
| | - Tanya Chikritzhs
- National Drug Research Institute, Curtin University, Kent St Bentley, WA, Australia.
| | - Penelope Hasking
- School of Population Health, Curtin University, Kent St Bentley, WA, Australia
| | - Peter Miller
- School of Psychology, Deakin University, Geelong Waterfront Campus, VIC, Australia.
| | - Gerard Hastings
- Institute for Social Marketing and Health, Stirling University, Stirling, Scotland, UK.
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC, Australia.
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Brooks JR, Ebi KL. Climate Change Warning Labels on Gas Pumps: The Role of Public Opinion Formation in Climate Change Mitigation Policies. GLOBAL CHALLENGES (HOBOKEN, NJ) 2021; 5:2000086. [PMID: 34631148 PMCID: PMC8495559 DOI: 10.1002/gch2.202000086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/30/2021] [Indexed: 06/13/2023]
Abstract
This article analyzes City of Cambridge, Massachusetts legislation that requires all gasoline and diesel pumps to display a consumer warning label outlining the climate change and public health impacts from fuel combustion. This review of empirical and theoretical scholarship on efficacy of carbon label programs and health warning labels suggests government-sponsored "warming labels" may increase self-efficacy beliefs. The analysis reveals warming labels may activate extant climate concern norms and shift public opinion toward long term support of sustainable transportation emissions policies and practices.
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Affiliation(s)
| | - Kristie L. Ebi
- University of Washington4225 Roosevelt Way NE #100SeattleWA98105USA
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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.
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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
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Critchlow N, Moodie C, Jones D. Health information and warnings on alcohol packaging in Ireland: it is time to progress the Public Health (Alcohol) Act 2018. Ir J Med Sci 2021; 191:1461-1463. [PMID: 34319546 PMCID: PMC8316105 DOI: 10.1007/s11845-021-02719-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/17/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland. .,UK-Ireland Alcohol Research Network (ACORN), University of Stirling, Stirling, Scotland.
| | - Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
| | - Daniel Jones
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
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19
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May NJ, Eliott J, Crabb S, Miller ER, Braunack-Mayer A. Alcohol warning labels to reduce alcohol-related harm: a scoping review protocol. JBI Evid Synth 2021; 18:186-193. [PMID: 31972681 DOI: 10.11124/jbisrir-2017-003973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aims to explore international literature relating to alcohol warning labels as a public health approach for reducing alcohol-related harm. INTRODUCTION Alcohol-related harm is a global public health issue. More than 200 injuries, diseases and conditions are attributable to alcohol, and almost 6% of all global deaths are related to alcohol consumption.A common approach to raising public awareness of health hazards is product warning labels. Currently, 31 countries or territories have mandated the inclusion of alcohol warning labels on alcoholic beverages. However, research findings on the effectiveness of alcohol warning labeling to reduce alcohol-related harm are mixed and debatable. INCLUSION CRITERIA This review will consider studies that focus on alcohol warning labeling (in the form of alcoholic beverage containers, simulated messages displayed on a computer screen or cards shown to participants that depict alcohol warning labels on beverage containers) as a strategy to reduce alcohol-related harm (e.g. drunk driving, violence, drinking while pregnant). METHODS PubMed, Embase, Scopus, Cochrane Library, PsycINFO, Web of Science, CINAHL and JSTOR will be searched for relevant articles. The search for unpublished studies will utilise Trove and Google Scholar. Studies published in English from 1989 to the present will be considered. Retrieved papers will be screened for inclusion by at least two reviewers. Data will be extracted and presented in tabular form and a narrative summary that align with the review's objective.
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Affiliation(s)
- Natalie J May
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Jaklin Eliott
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Shona Crabb
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Emma R Miller
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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20
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Yau MTK, Chandok N, Yoshida EM. Alcohol product warning labels to deter alcohol misuse and prevent alcohol-related diseases: a call to action in Canada. CANADIAN LIVER JOURNAL 2021; 4:75-78. [DOI: 10.3138/canlivj-4-2-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022]
Affiliation(s)
| | - Natasha Chandok
- Division of Gastroenterology, William Osler Health System, Brampton, Ontario, Canada
| | - Eric M Yoshida
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
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21
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Noel JK. Using social media comments to reduce alcohol purchase intentions: An online experiment. Drug Alcohol Rev 2021; 40:1047-1055. [PMID: 33677837 DOI: 10.1111/dar.13262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alcohol advertising is prevalent on social media. The current study sought to identify effective message types to pair with social media alcohol ads to minimise purchase intentions associated with exposure. METHODS A 6 (within) × 5 (between) randomised controlled experiment was conducted with n = 723 US participants. Participants viewed six unique social media alcohol ads and were randomised to view one of four message types (i.e. pro-drinking comments, anti-drinking comments, industry responsibility messages and health warning labels) associated with the ads or the control (i.e. no messages). Purchase intentions were measured after each ad exposure. Significant main and interactive effects were determined by two-level, random intercept hierarchical linear models. RESULTS Purchase intentions were significantly lower among participants who viewed anti-drinking comments relative to the control (P = 0.022) and warning labels (P = 0.016). Purchase intentions were significantly greater among participants who viewed pro-drinking comments and had a family history of alcohol use (P = 0.032) and among those who viewed warning labels and were previously exposed to alcohol depictions through family and friends' social media posts (P = 0.033). DISCUSSION AND CONCLUSIONS Anti-drinking messages, written by social media users, may be effective at reducing alcohol purchase intentions when posted as social media comments. Current industry responsibility messages had no effect, and caution may be needed if warning labels are applied to ads in this medium.
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Affiliation(s)
- Jonathan K Noel
- Department of Health Science, College of Health and Wellness, Johnson and Wales University, Providence, USA
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22
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May NJ, Eliott J, Crabb S. 'Alcohol causes cancer': a difficult message for Australians to swallow. Health Promot Int 2021; 37:6155890. [PMID: 33675657 DOI: 10.1093/heapro/daab024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Alcohol is a modifiable risk factor for cancer. Public awareness of the link between alcohol and cancer risk is poor; thus, alcohol consumers may be unknowingly putting themselves at increased risk of cancer. One way to raise awareness of alcohol-related cancer is through placing labels warning of cancer risk on alcoholic beverage containers; however, little is known about the impact of such labels. We conducted seven focus groups, comprising participants who self-identified as low-to-moderate alcohol consumers, to gauge public attitudes towards the labels and messages relating to alcohol-related cancer risk. Transcripts of discussions were coded to identify emergent themes. Participants expressed a negative response to the alcohol warning labels, and their talk worked to challenge the legitimacy of alcohol-related cancer messages, and the entities responsible for disseminating the information. These responses functioned to counter any implied recommendation for reduction in speakers' alcohol consumption. These findings illustrate how the general population make sense of information about health risks, using this knowledge to make decisions about personal behaviour. In combination with other public health initiatives, alcohol-warning labels have the potential to increase awareness of cancer risk and help in the fight against cancer, but any messaging will need to account for probable consumer resistance.
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Affiliation(s)
- Natalie Jane May
- School of Public Health, University of Adelaide Faculty of Sciences, Level 9, 57 North Terrace, Adelaide 5005, Australia
| | - Jaklin Eliott
- School of Public Health, The University of Adelaide, Adelaide 5000, Australia
| | - Shona Crabb
- Discipline of Public Health, The University of Adelaide, Adelaide, Australia
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23
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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.
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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.
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Abstract
Background: Alcohol marketing has proliferated on social media. When exposed to social media advertisements, users view comments written in response to the ad and user engagement metrics, in addition to the ad itself. Here, the independent effect of different types of comments on alcohol craving was assessed. Methods: In all, n = 722 participants were randomized to view either no comments, pro-drinking comments, anti-drinking comments, warning labels, or industry responsibility messages associated with six alcohol ads. Alcohol cravings, measured using the Desires for Alcohol Questionnaire (DAQ), were assessed before and after ad exposure. Smoking urges were also assessed. The significance of main effects was determined using repeated-measures ANCOVA. Results: Warning labels significantly decreased scores on the desires and intentions to drink DAQ sub-scale (p = .025) and decreased smoking urges (p = .024). Pro-drinking comments significantly increased scores on the control of drinking sub-scale (p = .006). Conclusions: The findings suggest that user-generated comments can influence the desire to drink and smoking urges, beyond the effects of ads themselves. If so, alcohol warning labels may decrease alcohol cravings when used in this way. Additionally, to limit the loss of control over drinking, the ability of social media users to post pro-drinking comments may need to be curtailed.
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Affiliation(s)
- Jonathan K Noel
- Department of Health Science, College of Health & Wellness, Johnson & Wales University, Providence, RI, USA
| | - Haleigh A Lakhan
- Department of Health Science, College of Health & Wellness, Johnson & Wales University, Providence, RI, USA
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Coomber K, Hayley A, Miller PG. Unconvincing and ineffective: Young adult responses to current Australian alcohol product warnings. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Kerri Coomber
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia,
| | - Alexa Hayley
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia,
| | - Peter G. Miller
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, Australia,
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Critchlow N, Jones D, Moodie C, MacKintosh AM, Fitzgerald N, Hooper L, Thomas C, Vohra J. Awareness of product-related information, health messages and warnings on alcohol packaging among adolescents: a cross-sectional survey in the United Kingdom. J Public Health (Oxf) 2020; 42:e223-e230. [PMID: 31322661 PMCID: PMC7435209 DOI: 10.1093/pubmed/fdz080] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Alcohol packaging can be used to communicate product-related information, health messages and health warnings to consumers. We examined awareness and recall of such information and messaging among adolescents in the United Kingdom. METHOD A cross-sectional survey was conducted with 11-19 year olds in the United Kingdom (n = 3399), with participants asked if they had seen any information, health messages or warnings on alcohol packaging in the past month (Yes/No) and, if so, what they recalled. We also assessed higher-risk drinking among current drinkers (≥5 Alcohol Use Disorders Identification Test-Consumption) and susceptibility to consume among never-drinkers. RESULTS One-third (32%) of participants had seen information, health messages or warnings on alcohol packaging. Chi-Square tests showed awareness was greater for current drinkers than non-drinkers (46% vs. 19%; P < 0.001), higher-risk drinkers than lower-risk drinkers (55% vs. 39%; P < 0.001), and susceptible never-drinkers than non-susceptible never-drinkers (21% vs. 16%; P = 0.01). Ten messages were recalled, with drinking responsibly (18%) and not drinking during pregnancy (13%) most recalled. CONCLUSION Most young drinkers, including almost half of higher-risk drinkers, did not recall seeing any information, health messages or warnings on alcohol packaging in the past month, suggesting that current labelling is failing to reach this key audience.
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Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Daniel Jones
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Anne Marie MacKintosh
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Niamh Fitzgerald
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Lucie Hooper
- Cancer Policy Research Centre (CPRC), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Christopher Thomas
- Cancer Policy Research Centre (CPRC), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
| | - Jyotsna Vohra
- Cancer Policy Research Centre (CPRC), Cancer Research UK, Angel Building, 407 St. John Street, London, UK
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Malouff JM, Schutte-Malouff BP. Government-mandated warnings on cannabis legally sold for recreational use. J Cannabis Res 2020; 2:22. [PMID: 33526134 PMCID: PMC7819339 DOI: 10.1186/s42238-020-00029-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/16/2020] [Indexed: 11/15/2022] Open
Abstract
Background Frequent cannabis use can pose risks to health and safety. Multiple governments have legalized the sale of cannabis for recreational use and mandated health and safety warnings for recreational cannabis packages or signs at sales locations. The purposes of this study were to identify common themes across warnings and to compare the actual warnings with those previously recommended by cannabis experts and cannabis users. Methods We searched Google and Google Scholar for online lists of governments that allow or will soon allow the sale of cannabis for recreational use. Using the online lists we found, we searched for laws mandating the warnings, using the search terms “mandated warnings for recreational use marijuana” in addition to the name of the jurisdiction under review. We evaluated the content of the warnings and compared them with warnings recommended by cannabis experts and by users of recreational cannabis. Results Each search led to millions of results. Within the top results of each of the searches there were website links to official legislative websites, databases and documents of the jurisdiction under review. We used these official documents. The search revealed that 11 U.S. states and two countries allow the recreational use of cannabis and that 10 U.S. states and Canada mandate warnings on legally sold recreational cannabis. The mandated warnings can be categorized as focusing on one of nine risks: (1) negative health effects on the user, (2) harm to children or fetuses, (3) risks related to driving or operating machinery, (4) risks of habit formation leading to over-use, (5) risks relating to over-use on a single occasion, especially with regard to edible cannabis, (6) developmental risks for young people, (7) harm caused by secondary smoke, (8) risks of effects lasting several hours, and (9) risks specific to using cannabis topicals. The warnings include no graphic images and no phone number to call for help quitting. Conclusions The warnings, as a group, parallel most warnings recommended by cannabis experts and a sample of recreational users of cannabis. The effects of the warnings are unknown, but prior research findings on warnings for cannabis and for other substances suggest potential for positive effects in raising awareness of risks and decreasing the risks. The warnings could be used in public health campaigns. Public health professionals may find it possible through research to help improve the warnings, either in presentation or in content. Cannabis researchers can use the list to identify additional risks suitable for inclusion in mandated warnings.
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Affiliation(s)
- John M Malouff
- University of New England School of Psychology, Armidale, NSW, 2351, Australia.
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Gleeson D, O'Brien P. Alcohol labelling rules in free trade agreements: Advancing the industry's interests at the expense of the public's health. Drug Alcohol Rev 2020; 40:31-40. [PMID: 32239601 DOI: 10.1111/dar.13054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS The Trans-Pacific Partnership Agreement (TPP) included novel rules for wine and spirits requiring parties to allow wine and spirits importers to display information required by the importing country on a supplementary label rather than on the standard label. Since the TPP negotiations concluded, alcohol-specific supplementary labelling rules have begun to appear in other trade agreements. The aim of this paper was to map the new instruments containing these rules and examine developments in the rules with implications for health information on alcohol containers. DESIGN AND METHODS Trade agreements signed after the TPP negotiations concluded were retrieved and searched for alcohol-specific labelling provisions. A legal analysis of these provisions and related exceptions was undertaken. RESULTS Supplementary labelling rules similar or identical to those in the TPP have been included in five subsequent trade agreements. The United States-Mexico-Canada Agreement also includes several additional provisions about alcohol labelling. Exceptions in the agreements provide some space for governments to defend labelling measure that might otherwise breach the rules, in the event of a dispute. DISCUSSION AND CONCLUSIONS By securing these rules, the alcohol industry is better positioned to claim the space on the standard label as industry 'real estate' and to oppose mandatory health information incorporated into the standard labelling. These risks can be mitigated by stemming the adoption of supplementary labelling rules in further trade agreements; clarifying the text of agreements and ensuring that regulators understand that the rules do not prevent the use of 'best-practice' warning labels.
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Affiliation(s)
- Deborah Gleeson
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Paula O'Brien
- Melbourne Law School, The University of Melbourne, Melbourne, Australia
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McBride-Henry K, Lui SM, Woods L, Officer TN. Consumer alcohol exposure in supermarkets: legislatively adherent, but a societal problem. Aust N Z J Public Health 2020; 44:22-27. [PMID: 32003540 DOI: 10.1111/1753-6405.12963] [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: 05/01/2019] [Revised: 11/01/2019] [Accepted: 11/01/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The Sale and Supply of Alcohol Act 2012 came into force to promote the safe and responsible sale, supply, and consumption of alcohol in New Zealand. The Act was intended to minimise harm caused by excessive consumption of alcohol and reduce exposure to alcohol promotion. This study assessed supermarket adherence to sections 112-114 of the Act related to the display and advertisement of alcohol. It also assessed consumer exposure to alcohol marketing in these businesses. METHODS This paper reports on an audit of nine supermarkets in a major New Zealand city. RESULTS Supermarkets exhibited high average adherence with the Act (86% adherence across audit fields); despite this, exposure to alcohol displays, promotions and advertisements remained an issue regardless of supermarket geographic location, size or chain affiliation. CONCLUSIONS Supermarkets are an increasingly popular source of off-licence alcohol sales. Exposure to alcohol marketing in these businesses will likely influence consumer purchasing behaviour. Implications for public health: As an important public health challenge, based on this study, it would appear that supermarkets mostly meet the provisions of the Sale and Supply of Alcohol Act 2012, but not the intent. Additional work is required to strengthen their response to the Act.
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Affiliation(s)
- Karen McBride-Henry
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, New Zealand
| | - Si Man Lui
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, New Zealand
| | - Lisa Woods
- School of Mathematics and Statistics, Victoria University of Wellington, New Zealand
| | - Tara Nikki Officer
- Health Services Research Centre, Victoria University of Wellington, New Zealand
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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.
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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
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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.
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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
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Musicus AA, Moran AJ, Lawman HG, Roberto CA. Online Randomized Controlled Trials of Restaurant Sodium Warning Labels. Am J Prev Med 2019; 57:e181-e193. [PMID: 31753271 DOI: 10.1016/j.amepre.2019.06.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Policymakers are interested in requiring chain restaurants to display sodium warning labels on menus to reduce sodium consumption. This study examined the influence of label design on consumers' hypothetical choices, meal perceptions, and knowledge. STUDY DESIGN Four sequential, randomized, controlled online experiments were conducted. SETTING/PARTICIPANTS Across all 4 experiments, 10,412 sociodemographically diverse participants were recruited online through Survey Sampling International and Amazon Mechanical Turk. INTERVENTION Participants were randomized to view restaurant menus with either no sodium label (control) or 1 of 13 sodium warning labels that varied the text (e.g., "sodium warning" versus "high sodium"), icons (e.g., stop sign), and colors (red/black) used. Participants placed a hypothetical meal order and rated restaurant meal perceptions. Data were collected and analyzed in 2016-2019. MAIN OUTCOME MEASURES The primary outcome was sodium content of hypothetical restaurant choices. Secondary outcomes included restaurant meal perceptions and sodium knowledge. RESULTS In Experiments 1-3, all warning labels reduced average sodium ordered across both restaurants (by 19-81 mg) versus controls, with some of the largest reductions from traffic light and stop sign labels, but results were not statistically significant. In a larger, preregistered replication (Experiment 4) testing traffic light and red stop sign labels versus control, traffic light and red stop sign labels significantly reduced average sodium ordered across both restaurants (-68 mg, p=0.002 and -46 mg, p=0.049, respectively). Warnings also significantly increased participants' knowledge of sodium content and perceived health risks associated with high-sodium meals compared with no label. CONCLUSIONS Traffic light and red stop sign warning labels significantly reduced sodium ordered compared with a control. Warning labels also increased knowledge about high sodium content in restaurant meals. Designs with warning text are likely to improve consumer understanding.
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Affiliation(s)
- Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Alyssa J Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hannah G Lawman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
| | - Christina A Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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Trajectories of alcohol use problems based on early adolescent alcohol use: Findings from a 35 year population cohort. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:18-25. [DOI: 10.1016/j.drugpo.2019.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 11/20/2022]
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Associations Between Alcohol Policies and Adolescent Alcohol Use: A Pooled Analysis of GSHS and ESPAD Data. Alcohol Alcohol 2019; 54:639-646. [DOI: 10.1093/alcalc/agz068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/08/2019] [Accepted: 07/13/2019] [Indexed: 12/23/2022] Open
Abstract
Abstract
Aims
Alcohol-attributable harm remains high worldwide, and alcohol use among adolescents is particularly concerning. The purpose of this study is to determine the effect of national alcohol control policies on adolescent alcohol use in low-, middle- and high-income countries and improve on previous cross-national attempts to estimate the impact of alcohol policy on this population.
Methods
Data on adolescent (n = 277,110) alcohol consumption from 84 countries were pooled from the Global School-based Health Survey and the European School Survey Project on Alcohol and Other Drugs. Alcohol use measures included lifetime alcohol use, current (past 30 days) alcohol use and current (past 30 days) binge drinking. Information on national alcohol control policies was obtained from the World Health Organization’s Global Information System on Alcohol and Health and scored for effectiveness. Main effects were estimated using two-level, random intercept hierarchical linear models, and the models were adjusted for sex and age of the participants, and pattern of drinking score, gross domestic product based on purchasing power parity and study at the country level.
Results
Availability (OR [95% CI] = 0.991 [0.983, 0.999]), marketing (OR [95% CI] = 0.994 [0.988, 1.000]) and pricing (OR [95% CI] = 0.955 [0.918, 0.993]) policies were inversely associated with lifetime drinking status. Pricing policies were also inversely associated with current binge drinking status among current drinkers (OR [95% CI] = 0.939 [0.894, 0.986]). There were no associations between the included alcohol policies and current drinking status.
Conclusions
Strong availability, marketing and pricing policies can significantly and practically impact adolescent alcohol consumption.
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Ventura-Cots M, Ballester-Ferré MP, Ravi S, Bataller R. Public health policies and alcohol-related liver disease. JHEP Rep 2019; 1:403-413. [PMID: 32039391 PMCID: PMC7005647 DOI: 10.1016/j.jhepr.2019.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022] Open
Abstract
Alcohol-related liver disease (ALD) represents a major public health problem worldwide. According to the World Health Organization, the highest levels of per capita alcohol consumption are observed in countries of the European Region. Alcohol consumption is also alarmingly increasing in developing countries. ALD is one of the main contributors to the burden of alcohol-attributable deaths and disability. In the United States, severe forms of ALD such alcoholic hepatitis have increased in the last decade and in the United Kingdom, three-quarters of liver-related mortality results from alcohol consumption. Besides genetic factors, there is strong evidence that the amount of alcohol consumed plays a major role in the development of advanced ALD. Establishing effective public health policies is therefore mandatory to reduce the burden of ALD. Since the 90s, major public health institutions and governments have developed a variety of policies in order to reduce the harm caused by excessive drinking. These policies encompass multiple factors, from pricing and taxation to advertising regulation. Measures focused on taxation and price regulation have been shown to be the most effective at reducing alcohol-related mortality. However, there are few studies focused on the effect of public policies on ALD. This review article summarises the factors influencing ALD burden and the role of different public health policies.
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Affiliation(s)
- Meritxell Ventura-Cots
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Samhita Ravi
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ramon Bataller
- Center for Liver Diseases, Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Pittsburgh Liver Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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The impacts of potency, warning messages, and price on preferences for Cannabis flower products. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:1-10. [PMID: 31382201 DOI: 10.1016/j.drugpo.2019.07.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Recreational cannabis has been legalized in 11 states and Washington DC in the US. However, little is known about individual preferences for legal cannabis products. This study estimated the impacts of tetrahydrocannabinol (THC), cannabidiol (CBD), warning messages, and price on preferences for cannabis flowers. METHODS A cross-sectional online survey with discrete choice experiments was implemented in October 2017. A sample of 2400 adults aged 21 years or older were recruited from 6 US states with recreational cannabis legalization, consisting of 1200 past-year nonusers and 1200 past-year users. Each respondent was randomly assigned to 12 discrete choice scenarios, each asking them to choose from an opt-out option and 3 cannabis flower products with varying levels in THC, CBD, warning messages, and price. The impacts of product attributes on individual choices were analyzed with nested logit regressions. RESULTS Both cannabis nonusers and users preferred higher CBD and lower price. Users also preferred higher THC. The results on warning messages were mixed: graphic warning on drugged driving and text warning message had positive impacts on nonusers' and users' preferences for cannabis flowers, respectively, whereas FDA disapproval disclaimer had negative impacts on nonusers' preferences. Heterogeneities in preferences were revealed among nonusers by former use status and among users by reason of use. Particularly, medical cannabis users were not as responsive to THC as recreational cannabis users or dual users were. Regarding relative importance of the attributes, all respondents but medical cannabis users perceived price as the most important attribute (relative importance 51-64%), whereas medical cannabis users perceived CBD as the most important attribute (relative importance 47%). CONCLUSION The findings indicated that product characteristics may have influences on US adults' choices of legal cannabis flower products and may deserve consideration for cannabis regulatory framework.
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Millum J, Campbell M, Luna F, Malekzadeh A, Karim QA. Ethical challenges in global health-related stigma research. BMC Med 2019; 17:84. [PMID: 31030670 PMCID: PMC6487527 DOI: 10.1186/s12916-019-1317-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is critically important to conduct research on stigmatized conditions, to include marginalized groups that experience stigma, and to develop interventions to reduce stigma. However, such research is ethically challenging. Though superficial reference is frequently made to these widely acknowledged challenges, few publications have focused on ethical issues in research on stigmatized groups or conditions. In fact, a brief literature review found only two such publications. MAIN TEXT At a recent Science of Stigma Reduction workshop comprising 60 stigma researchers from the USA and low and middle-income countries, the need for more robust and critical discussion of the ethics of the research was highlighted. In this paper we describe, illustrate through cases, and critically examine key ethical challenges that are more likely to arise because a research study focuses on health-related stigma or involves stigmatized groups or conditions. We examine the ethics of this research from two perspectives. First, through the lens of overprotection, where we discuss how the perception of stigma can impede ethical research, disrespect research participants, and narrow the research questions. Second, through the lens of research risks, where we consider how research with stigmatized populations can unintentionally result in harms. Research-related harms to participants include potential breaches of confidentiality and the exacerbation of stigma. Potential harms also extend to third parties, including families and populations who may be affected by the dissemination of research results. CONCLUSIONS Research with stigmatized populations and on stigmatized conditions should not be impeded by unnecessary or inappropriate protective measures. Nevertheless, it may entail different and greater risks than other health research. Investigators and research ethics committees must be particularly attentive to these risks and how to manage them.
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Affiliation(s)
- Joseph Millum
- Clinical Center Department of Bioethics, National Institutes of Health, 10/1C118, 10 Center Drive, Bethesda, MD, 20892, USA. .,Fogarty International Center, National Institutes of Health, 31 Center Dr, Bethesda, MD, 20892, USA.
| | - Megan Campbell
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Florencia Luna
- CONICET, Programa de Bioética, FLACSO Argentina, Tucumán 1966, C1050AAN, Caba, Argentina
| | - Arianne Malekzadeh
- Fogarty International Center, National Institutes of Health, 31 Center Dr, Bethesda, MD, 20892, USA
| | - Quarraisha Abdool Karim
- Centre for the AIDS Program of Research in South Africa, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, 4013, South Africa
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Popova L, Nonnemaker J, Taylor N, Bradfield B, Kim A. Warning Labels on Sugar-sweetened Beverages: An Eye Tracking Approach. Am J Health Behav 2019; 43:406-419. [PMID: 30808479 DOI: 10.5993/ajhb.43.2.16] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we examined visual attention of a warning label on a sugar-sweetened beverage (SSB) and its effects on visual attention to SSB product descriptors and perceptions of SSB using eye tracking technology. Methods: We had 180 young adults view an image of a generic soda can with or without a text warning on a computer monitor. Results: Participants spent less time looking at marketing elements on the can in the "Warning" condition compared to the "No warning" (control) condition. Compared to the control, participants in the "Warning" condition viewed the sugar-sweetened beverage as less healthy (1.78 warning vs 2.21 control, p < .01) and believed that drinking SSBs contributed to diabetes (5.70 warning vs 5.27 control, p < .01). Visual attention to warning label was associated with correct recall of the warning and opting out of purchasing the can. Conclusions: Textual warning on SSB reduced visual attention to marketing elements on the can. Although there were few statistically significant differences between the conditions on most measures of product appeal or risk perception, warnings increased some perceived risks of SSBs indicating that warning labels on SSBs might be a promising strategy in informing consumers, particularly young adults, about risks of added sugars.
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Affiliation(s)
- Lucy Popova
- Assistant Professor, School of Public Health, Georgia State University, Atlanta, GA;,
| | - James Nonnemaker
- Senior Research Scientist, RTI International, Center for Health Policy Science and Tobacco Research, Research Triangle Park, NC
| | - Nathaniel Taylor
- Economist, RTI International, Center for Health Policy Science and Tobacco Research, Research Triangle Park, NC
| | - Brian Bradfield
- Economist, RTI International, Center for Health Policy Science and Tobacco Research, Research Triangle Park, NC
| | - Annice Kim
- Senior Social Scientist, RTI International, Center for Health Policy Science and Tobacco Research, Research Triangle Park, NC
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Ang FJL, Agrawal S, Finkelstein EA. Pilot randomized controlled trial testing the influence of front-of-pack sugar warning labels on food demand. BMC Public Health 2019; 19:164. [PMID: 30732609 PMCID: PMC6367807 DOI: 10.1186/s12889-019-6496-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/29/2019] [Indexed: 12/03/2022] Open
Abstract
Background Front-of-pack (FOP) nutrition warning labels to identify potentially harmful foods/beverages have recently been considered in Singapore. The objective of this study was to pilot test two promising FOP warning labels intended to reduce purchases of products high in sugar to determine whether a full scale trial testing one or both these labels using actual purchases is warranted. Methods Five hundred twelve participants ≥21 years old and residing in Singapore completed all study elements online via the NUSMart Online Grocery Store study website. The study was designed as a Randomized Controlled Trial (RCT) where consumers were randomized and asked to hypothetically shop in one of three versions of an online grocery store; 1) no FOP label (control), 2) a graphical high-in-sugar label shaped like a stop sign, or 3) a text-based warning label. The proportion of labelled products purchased (primary outcome) and all secondary measures of diet quality were calculated using participants’ orders. Ordinary Least Squares (OLS) regression was used to compare purchasing behavior across the three study arms. Results The proportion of high-in-sugar products selected (i.e., those targeted for labelling) was largest in the no label control arm at 20%. The proportion was a non-statistically significant 2 percentage points lower (P = 0.146) for the high-in-sugar stop-sign label arm and 4 percentage points lower (P < 0.05) in the warning label with deterrent text arm. We could not reject the hypothesis of equal effectiveness of the two warning labels (P = 0.231). Conclusions Results suggest that the two health warning labels have potential to reduce demand for high-in-sugar products in Singapore. Future studies should test the influence of these labels using actual purchases in efforts to identify whether either labelling strategy should be considered for adoption in the local setting. Trial registration The American Economic Association’s registry for randomized controlled trials; AEARCTR-0003800. Registered 18 January 2019. Electronic supplementary material The online version of this article (10.1186/s12889-019-6496-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felicia Jia Ler Ang
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Sagun Agrawal
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Eric A Finkelstein
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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Hydes T, Gilmore W, Sheron N, Gilmore I. Treating alcohol-related liver disease from a public health perspective. J Hepatol 2019; 70:223-236. [PMID: 30658724 DOI: 10.1016/j.jhep.2018.10.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 02/06/2023]
Abstract
Herein, we describe the evolving landscape of alcohol-related liver disease (ALD) including the current global burden of disease and cost to working-aged people in terms of death and disability, in addition to the larger spectrum of alcohol-related heath complications and its wider impact on society. We further review the most effective and cost-effective public health policies at both a population and individual level. Currently, abstinence is the only effective treatment for ALD, and yet because the majority of ALD remains undetected in the community abstinence is initiated too late to prevent premature death in the majority of cases. We therefore hope that this review will help inform clinicians of the "public health treatment options" for ALD to encourage engagement with policy makers and promote community-based hepatology as a speciality, expanding our patient cohort to allow early detection, and thereby a reduction in the enormous morbidity and mortality associated with this disease.
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Affiliation(s)
- Theresa Hydes
- Department of Gastroenterology and Hepatology, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - William Gilmore
- National Drug Research Institute, Faculty of Health Sciences, Curtin University, Australia
| | - Nick Sheron
- Department of Gastroenterology and Hepatology, University Hospital Southampton NHS Foundation Trust, United Kingdom.
| | - Ian Gilmore
- University of Liverpool, Liverpool Science Park, United Kingdom
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Sillero-Rejon C, Attwood AS, Blackwell AKM, Ibáñez-Zapata JA, Munafò MR, Maynard OM. Alcohol pictorial health warning labels: the impact of self-affirmation and health warning severity. BMC Public Health 2018; 18:1403. [PMID: 30577730 PMCID: PMC6303887 DOI: 10.1186/s12889-018-6243-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We examined whether enhancing self-affirmation among a population of drinkers, prior to viewing threatening alcohol pictorial health warning labels, would reduce defensive reactions and promote reactions related to behaviour change. We also examined how health warning severity influences these reactions and whether there is an interaction between self-affirmation and severity. METHODS In this experimental human laboratory study, participants (n = 128) were randomised to a self-affirmation or control group. After the self-affirmation manipulation was administered, we tracked participants' eye movements while they viewed images of six moderately-severe and six highly-severe pictorial health warning labels presented on large beer cans. Self-reported responses to the pictorial health warning labels were then measured, including avoidance, reactance, effectiveness, susceptibility and motivation to drink less. Finally, participants reported their self-efficacy to drink less and their alcohol use. RESULTS There was no clear evidence that enhancing self-affirmation influenced any outcome. In comparison to moderately-severe health warnings, highly-severe health warnings increased avoidance and reactance and were perceived as more effective and increased motivation to drink less. CONCLUSIONS These findings call into question the validity of the self-affirmation manipulation, which is purported to reduce defensive reactions to threatening warnings. We discuss possible explanations for this null effect, including the impact of participants' low perceived susceptibility to the risks shown on these pictorial health warning labels. Our finding that highly-severe health warnings increase avoidance and reactance but are also perceived as being more effective and more likely to motivate people to drink less will inform future health warning design and have implications for health warning label theory.
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Affiliation(s)
- Carlos Sillero-Rejon
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
- Department of Marketing and Market Research, University of Granada, Granada, Spain
- School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU UK
| | - Angela S. Attwood
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
| | - Anna K. M. Blackwell
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
| | | | - Marcus R. Munafò
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
| | - Olivia M. Maynard
- UK Centre for Tobacco and Alcohol Studies, School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK
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Informing drinkers: Can current UK alcohol labels be improved? Drug Alcohol Depend 2018; 192:163-170. [PMID: 30265999 PMCID: PMC6204577 DOI: 10.1016/j.drugalcdep.2018.07.032] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/07/2018] [Accepted: 07/06/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Alcohol labeling provides a relatively low-cost, population-level approach to providing information about alcohol's content and harms. METHOD We conducted an online between-subjects experiment with two tasks to examine the impact of alcohol labels (n = 1884). In one task, participants were randomized to view one of four different unit labels (including labels currently used by the alcohol industry and novel labels which provide more information about how the number of units relates to recommended drinking guidelines). We assessed participants' accuracy of estimating weekly serving limits of alcohol. In a second task, participants were randomized to view one of eight health warnings (which varied according to message content, specificity, and framing). We assessed the motivation to quit after viewing the health warning. RESULTS Accuracy of estimating weekly serving limits of alcohol was greater for participants who viewed novel unit labels compared to the industry standard labels. Motivation to drink less was higher amongst participants who had viewed both cancer and negatively framed messages, compared to mental health and positively framed messages. CONCLUSION Existing unit labels used by the alcohol industry can be improved; the inclusion of unit information per serving and how these relate to low-risk drinking guidelines may be important for facilitating consumer understanding. Health warning labels should be included alongside units to provide consumers with information about the harms associated with alcohol and discourage riskier drinking behavior.
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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.
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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
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Pham C, Rundle-Thiele S, Parkinson J, Li S. Alcohol Warning Label Awareness and Attention: A Multi-method Study. Alcohol Alcohol 2018; 53:39-45. [PMID: 29136096 DOI: 10.1093/alcalc/agx087] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 10/18/2017] [Indexed: 01/01/2023] Open
Abstract
Aims Evaluation of alcohol warning labels requires careful consideration ensuring that research captures more than awareness given that labels may not be prominent enough to attract attention. This study investigates attention of current in market alcohol warning labels and examines whether attention can be enhanced through theoretically informed design. Attention scores obtained through self-report methods are compared to objective measures (eye-tracking). Methods A multi-method experimental design was used delivering four conditions, namely control, colour, size and colour and size. The first study (n = 559) involved a self-report survey to measure attention. The second study (n = 87) utilized eye-tracking to measure fixation count and duration and time to first fixation. Analysis of Variance (ANOVA) was utilized. Results Eye-tracking identified that 60% of participants looked at the current in market alcohol warning label while 81% looked at the optimized design (larger and red). In line with observed attention self-reported attention increased for the optimized design. Conclusions The current study casts doubt on dominant practices (largely self-report), which have been used to evaluate alcohol warning labels. Awareness cannot be used to assess warning label effectiveness in isolation in cases where attention does not occur 100% of the time. Mixed methods permit objective data collection methodologies to be triangulated with surveys to assess warning label effectiveness. Short summary Attention should be incorporated as a measure in warning label effectiveness evaluations. Colour and size changes to the existing Australian warning labels aided by theoretically informed design increased attention.
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Affiliation(s)
- Cuong Pham
- Social Marketing @ Griffith, Griffith Business School, Griffith University, Nathan Campus, 170 Kessels Road, Nathan 4111, Queensland, Australia
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Griffith Business School, Griffith University, Nathan Campus, 170 Kessels Road, Nathan 4111, Queensland, Australia
| | - Joy Parkinson
- Social Marketing @ Griffith, Griffith Business School, Griffith University, Nathan Campus, 170 Kessels Road, Nathan 4111, Queensland, Australia
| | - Shanshi Li
- School of Management, Xiamen University, 422 Siming S Rd, Siming Qu, Xiamen Shi, Fujian Sheng, 361005, China
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Buykx P, Li J, Gavens L, Hooper L, Gomes de Matos E, Holmes J. Self-Reported Knowledge, Correct Knowledge and use of UK Drinking Guidelines Among a Representative Sample of the English Population. Alcohol Alcohol 2018; 53:453-460. [PMID: 29351574 PMCID: PMC6016612 DOI: 10.1093/alcalc/agx127] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/20/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS Promotion of lower risk drinking guidelines is a commonly used public health intervention with various purposes, including communicating alcohol consumption risks, informing drinkers' decision-making and, potentially, changing behaviour. UK drinking guidelines were revised in 2016. To inform potential promotion of the new guidelines, we aimed to examine public knowledge and use of the previous drinking guidelines, including by population subgroup. METHODS A demographically representative, cross-sectional online survey of 2100 adults living in England in July 2015 (i.e. two decades after adoption of previous guidelines and prior to introduction of new guidelines). Univariate and multivariate logistic regressions examined associations between demographic variables, alcohol consumption (AUDIT-C), smoking, and knowledge of health conditions and self-reported knowledge and use of drinking guidelines. Multinomial logistic regression examined the same set of variables in relation to accurate knowledge of drinking guidelines (underestimation, accurate-estimation, overestimation). RESULTS In total, 37.8% of drinkers self-reported knowing their own-gender drinking guideline, of whom 66.2% gave an accurate estimate. Compared to accurate estimation, underestimation was associated with male gender, lower education and AUDIT-C score, while overestimation was associated with smoking. Few (20.8%) reported using guidelines to monitor drinking at least sometimes. Drinking guideline use was associated with higher education, overestimating guidelines and lower AUDIT-C. Correctly endorsing a greater number of health conditions as alcohol-related was associated with self-reported knowledge of guidelines, but was not consistently associated with accurate estimation or use to monitor drinking. CONCLUSIONS Two decades after their introduction, previous UK drinking guidelines were not well known or used by current drinkers. Those who reported using them tended to overestimate recommended daily limits. SHORT SUMMARY We examined public knowledge and use of UK drinking guidelines just before new guidelines were released (2016). Despite previous guidelines being in place for two decades, only one in four drinkers accurately estimated these, with even fewer using guidelines to monitor drinking. Approximately 8% of drinkers overestimated maximum daily limits.
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Affiliation(s)
- Penny Buykx
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK
| | - Jessica Li
- dosomething.org, 19 W 21st St, New York, NY, USA
| | - Lucy Gavens
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK
| | - Lucie Hooper
- Policy Research Centre for Cancer Prevention, Cancer Research, Angel Building, 407 St John Street, London, UK
| | - Elena Gomes de Matos
- Epidemiology and Diagnostics, Institut für Therapieforschung, Parzivalstraβe 25, München, Germany
| | - John Holmes
- ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK
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Abstract
PURPOSE OF REVIEW This review is a critical reflection on the effectiveness of evidence-based alcohol policies and their implementation, based on studies and observations that have arisen in recent years. RECENT FINDINGS This article covers themes in recent literature of: the relationship between alcohol consumption and harm, the variability of country contextual factors and the interactions of both country contexts and alcohol policies on changes in alcohol consumption and harm. SUMMARY These recent observations imply that alcoholic beverage policies and programmes should focus on contextual determinants in each country and community, and address targeted problems (like problem drinking) and harm (such as liver cirrhosis, cancer and road accidents), rather than consumption per se.
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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
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Vasiljevic M, Couturier DL, Marteau TM. Impact of low alcohol verbal descriptors on perceived strength: An experimental study. Br J Health Psychol 2017; 23:38-67. [PMID: 28990270 PMCID: PMC5765494 DOI: 10.1111/bjhp.12273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 08/18/2017] [Indexed: 12/03/2022]
Abstract
Objectives Low alcohol labels are a set of labels that carry descriptors such as ‘low’ or ‘lighter’ to denote alcohol content in beverages. There is growing interest from policymakers and producers in lower strength alcohol products. However, there is a lack of evidence on how the general population perceives verbal descriptors of strength. The present research examines consumers’ perceptions of strength (% ABV) and appeal of alcohol products using low or high alcohol verbal descriptors. Design A within‐subjects experimental study in which participants rated the strength and appeal of 18 terms denoting low (nine terms), high (eight terms) and regular (one term) strengths for either (1) wine or (2) beer according to drinking preference. Methods Thousand six hundred adults (796 wine and 804 beer drinkers) sampled from a nationally representative UK panel. Results Low, Lower, Light, Lighter, and Reduced formed a cluster and were rated as denoting lower strength products than Regular, but higher strength than the cluster with intensifiers consisting of Extra Low, Super Low, Extra Light, and Super Light. Similar clustering in perceived strength was observed amongst the high verbal descriptors. Regular was the most appealing strength descriptor, with the low and high verbal descriptors using intensifiers rated least appealing. Conclusions The perceived strength and appeal of alcohol products diminished the more the verbal descriptors implied a deviation from Regular. The implications of these findings are discussed in terms of policy implications for lower strength alcohol labelling and associated public health outcomes. Statement of contribution What is already known about this subject? Current UK and EU legislation limits the number of low strength verbal descriptors and the associated alcohol by volume (ABV) to 1.2% ABV and lower. There is growing interest from policymakers and producers to extend the range of lower strength alcohol products above the current cap of 1.2% ABV set out in national legislation. There is a lack of evidence on how the general population perceives verbal descriptors of alcohol product strength (both low and high).
What does this study add? Verbal descriptors of lower strength wine and beer form two clusters and effectively communicate reduced alcohol content. Low, Lower, Light, Lighter, and Reduced were considered lower in strength than Regular (average % ABV). Descriptors using intensifiers (Extra Low, Super Low, Extra Light, and Super Light) were considered lowest in strength. Similar clustering in perceived strength was observed amongst the high verbal descriptors. The appeal of alcohol products reduced the more the verbal descriptors implied a deviation from Regular.
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Affiliation(s)
- Milica Vasiljevic
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, UK
| | | | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, UK
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Nutrition warnings as front-of-pack labels: influence of design features on healthfulness perception and attentional capture. Public Health Nutr 2017; 20:3360-3371. [DOI: 10.1017/s136898001700249x] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveWarnings are a new directive front-of-pack (FOP) nutrition labelling scheme that highlights products with high content of key nutrients. The design of warnings influences their ability to catch consumers’ attention and to clearly communicate their intended meaning, which are key determinants of their effectiveness. The aim of the present work was to evaluate the influence of design features of warnings as a FOP nutrition labelling scheme on perceived healthfulness and attentional capture.DesignFive studies with a total of 496 people were carried out. In the first study, the association of colour and perceived healthfulness was evaluated in an online survey in which participants had to rate their perceived healthfulness of eight colours. In the second study, the influence of colour, shape and textual information on perceived healthfulness was evaluated using choice-conjoint analysis. The third study focused on implicit associations between two design features (shape and colour) on perceived healthfulness. The fourth and fifth studies used visual search to evaluate the influence of colour, size and position of the warnings on attentional capture.ResultsPerceived healthfulness was significantly influenced by shape, colour and textual information. Colour was the variable with the largest contribution to perceived healthfulness. Colour, size and position of the warnings on the labels affected attentional capture.ConclusionsResults from the experiments provide recommendations for the design of warnings to identify products with unfavourable nutrient profile.
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Dossou G, Gallopel-Morvan K, Diouf JF. The effectiveness of current French health warnings displayed on alcohol advertisements and alcoholic beverages. Eur J Public Health 2017; 27:699-704. [PMID: 28339661 PMCID: PMC5881700 DOI: 10.1093/eurpub/ckw263] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Many countries use health warnings in an attempt to regulate alcohol consumption. However, there is a lack of conclusive evidence in the research on alcohol warnings to support decision-making on effective health policies. This study explores the effectiveness of two mandatory warnings introduced in France in 1991 and 2007: the first (Alcohol abuse is harmful) is displayed on alcohol advertisements; the second (a pictogram) on bottles. Given that advertising content regulations have been implemented in some countries to reduce the attractiveness of alcohol marketing (e.g. the Evin law in France), this research also aims to explore whether such regulations can improve the effectiveness of warnings. Methods In-depth interviews were conducted with 26 French people aged 15-29 years. The effectiveness of health warnings was assessed in terms of recall, noticeability, credibility, comprehension, responsiveness, and ability to encourage moderate drinking and abstinence during pregnancy. Participants were shown alcohol advertisements and bottles that either followed or challenged content regulations. The data were analyzed using double manual coding and NVivo software. Results While both warnings suffered from a lack of visibility and noticeability due to their size, location, and outdatedness and because of competition from marketing design elements, the warning on the advertisement that followed content regulations was most visible. Both warnings were considered to be informationally vague, lacking in credibility and ineffective in terms of making participants feel concerned and influencing consumption habits. Conclusions Current French warnings are ineffective and require modification. Improvements are suggested regarding the design and content of warnings to help increase their effectiveness.
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Affiliation(s)
- Gloria Dossou
- EHESP School of Public Health, EA 7348 MOS, Rennes Cedex, France
| | | | - Jacques-François Diouf
- EHESP School of Public Health, EA 7348 MOS, Rennes Cedex, France
- Graduate School of Management, University of Rennes 1, UMR 6211 CREM, Rennes, France
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