Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis

Abstract

Health warning labels (HWLs) could reduce harmful consumption of food (including non-alcoholic drinks) and alcoholic drinks. A systematic review with meta-analysis using Cochrane methods was conducted to assess the impact on selection (including hypothetical selection) or consumption of food or alcoholic drink products displaying image-andtext (sometimes termed 'pictorial') and text-only HWLs. Fourteen randomised controlled trials were included, three for alcohol, eleven for food. For the primary outcomes, eleven studies measured selection and one measured consumption (two measured only other secondary outcomes). Meta-analysis of twelve comparisons from nine studies (n=12,635) found HWLs reduced selection of the targeted product compared with no HWL (RR=0.74 (95%CI 0.68-0.80)), with participants 26% less likely to choose a product displaying a HWL. A planned subgroup analysis suggested a larger (although not statistically significant) effect on selection of image-and-text HWLs (RR=0.65 (95%CI 0.54-0.80)) than text-only HWLs (RR=0.79 (95%CI 0.74-0.85)). These findings suggest significant potential for HWLs to reduce selection of food and alcoholic drinks, but all experimental studies to date were conducted in laboratory or online settings with outcomes assessed immediately after a single exposure. Studies in field and naturalistic laboratory settings are needed to estimate the potential effects of food and alcohol HWLs.Study registration: PROSPERO 2018 (registration number: CRD42018106522).

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

“…The (online and lab) studies that focused on studying the graphic images on labels found that they elicited higher negative emotional arousal, fear and reactance, and were not well accepted by the participants. These results are also corroborated by the metanalysis investigating the impact of HWL in both alcohol and food products, and found that while health warning labels reduce product selection compared to no labels, the difference between image-and-text HWLs and text-only HWLs was not statistically significant (although in the former, the effect was slightly larger) [44].…”

“…There has also been increased research activity, and a number of labelling-related reviews have been published recently. Previous reviews focusing on alcohol HWL operated with a relative scarcity of studies [43], focused only on one aspect of the label (image vs. text) [44] or made a brief narrative overview of health labelling studies as part of broader alcohol labelling [45]. Whilst our work partially overlaps with other reviews in examining the impact of labels, our review adds a thorough and systematic examination of the scope of (quasi-)experimental research on new or enhanced health warning labels, including an overview of the labels used in the studies and the explanatory variables studied.…”

Energy (calorie) labelling for healthier selection and consumption of food or alcohol

“…We will not consider warning labels about the health implications of a product’s energy content to be eligible labels (e.g. Clarke 2020a ; Clarke 2020b ). We will also exclude logos or general health claims providing a summary assessment of the healthiness or content of a product.…”

“…Second, previous reviews have also shown differential effects of labelling interventions by study setting (e.g. Clarke 2020a ), and this could have important implications for the implementation of labels in different real-world contexts. Finally, SES could modify any potential impact of energy labelling, and interventions that involve the provision of numeric or text-based information may be less effective in more deprived populations ( Hollands 2016 ; Sarink 2016 ).…”

Awareness of and reactions to health and environmental harms of red meat among parents in the United States

“…A growing body of research has shown that communicating about a products' health harms, for example, through product warning labels and mass media campaigns, is an effective strategy for reducing unhealthy behaviours including cigarette smoking (20,21) , alcohol consumption (22) and sugary drink consumption (22)(23)(24)(25) . Similarly, a recent systematic review found that providing information about the health effects of meat consumption is an effective strategy for reducing intentions to eat meat as well as meat consumption (26) .…”