Health warning labels and alcohol selection: a randomised controlled experiment in a naturalistic shopping laboratory

Abstract

Background and aims Health warning labels (HWLs) on tobacco products reduce smoking. There is an absence of evidence concerning the impact of alcohol HWLs on selection or purchasing in naturalistic settings. Using a commercial-standard naturalistic shopping laboratory, this study aimed to estimate the impact on selection of alcoholic drinks of HWLs describing adverse health consequences of excessive alcohol consumption.DesignA between-subjects randomised experiment with three groups: Group 1: image-and-text HWL; Group 2: text-only HWL; Group 3: no HWL.SettingA commercial-standard naturalistic shopping laboratory. Participants Adults (n=399) over the age of 18, who purchased beer or wine weekly to drink at home. InterventionsParticipants were randomised to one of three groups varying in the HWL displayed on the packaging of the alcoholic drinks: i. image-and-text HWL; ii. text-only HWL; iii. no HWL. Participants completed a shopping task, selecting items from a range of alcoholic and non-alcoholic drinks, and snacks. MeasurementThe primary outcome was the proportion of alcoholic drinks selected. Secondary outcomes included HWL ratings on negative emotional arousal and label acceptability.FindingsThere was no clear evidence of a difference in the HWL groups for the percentage of drinks selected that were alcoholic compared to no HWL (44%): image-and-text HWL: 46% (OR=1.08, 95%CI=0.82,1.42); text-only HWL: 41% (OR=0.87, 95%CI=0.67,1.14). Concordant with there being no difference between groups, there was extreme evidence in favour of the null hypothesis (Bayes factor [BF] < 0.01). Negative emotional arousal was higher (p< 0.001) and acceptability lower (p< 0.001) in the image-and-text HWL group, compared to the text-only HWL group. ConclusionsIn a naturalistic shopping laboratory, health warning labels describing the adverse health consequences of excessive alcohol consumption did not change selection behaviour.

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

“…In total, we identified 27 papers that fit our inclusion criteria (see Appendix A for PRISMA diagram) [ 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. One paper reported on two studies using different methodologies to study the same variables [ 50 ], and four papers reported on different aspects of one intervention [ 51 , 52 , 53 , 54 ].…”

“…One paper reported on two studies using different methodologies to study the same variables [ 50 ], and four papers reported on different aspects of one intervention [ 51 , 52 , 53 , 54 ]. The remaining papers were individual studies (with a complete or partial focus on alcohol HWL labelling), although some of them were part of the same research line of label development and testing (e.g., [ 55 , 56 , 57 , 58 , 59 , 60 ]) or studied the same labels (e.g., [ 61 , 62 ]).…”

“…In terms of study aims and studied independent variables, five papers (19%) compared only new or enhanced labels with no or regular labels [ 51 , 52 , 53 , 54 , 63 ]. Focusing on label content, eight papers (30%) compared text-only labels with text and image labels [ 55 , 56 , 61 , 62 , 64 , 65 , 66 , 67 ], twelve studies (44%) compared text message characteristics (e.g., content, specificity, framing, source, use of causal language) [ 57 , 58 , 59 , 60 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 ] and three (11%) compared image characteristics [ 57 , 66 , 75 ]. Four (15%) papers compared label formats, such as size, position, colour or branding [ 50 , 64 , 70 , 76 ].…”

“…The most commonly studied outcomes were attitude (41% of the papers), intentions (30%), emotion-related outcomes (e.g., fear, worry) (26%) and acceptability/support for the labels (26%). Behaviour was studied in six papers (22%)—in three of them through self-report [ 51 , 54 , 67 ], but also through purchasing [ 53 , 56 ] or consuming alcohol [ 62 ].…”

“…In terms of label content, eight studies studied a single message; the remaining were either comparing different labels (or groups of labels) or used several messages as a single intervention. Most commonly, the messages were referring either to cancer in general (e.g., “Warning: Alcohol causes cancer”) [ 51 , 52 , 53 , 54 , 57 , 58 , 59 , 60 , 63 , 67 , 71 , 75 ], or specifically to bowel cancer (e.g., “Alcohol causes bowel cancer”) [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 69 , 71 ], both in 41% of all papers. Overall, 70% of papers included at least one cancer-related message, with other mentioned cancers being also breast (33%) [ 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 60 ] and liver cancer (30%) [ 55 , 56 , 57 , 61 , 62 , 64 , 69 , 76 ].…”