Impact of health warning labels and calorie labels on selection and purchasing of alcoholic and non-alcoholic drinks: a randomised controlled trial

Clarke, Natasha; Ferrar, Jennifer; Pechey, Emily; Ventsel, Minna; Pilling, Mark; Munafò, Marcus R; Marteau, Theresa M.; Hollands, Gareth J

doi:10.1101/2022.07.22.22277929

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…Many cues in physical and economic environments influence alcohol consumption across populations. These include advertising, marketing [6][7][8][9], product labelling [10][11][12], the availability of alcohol [13][14][15][16][17], and price [18,19]. Interventions, therefore, that target cues in physical and economic environments have significant potential, based on indirect evidence, to exert effects scalable to populations [20,21].…”

Section: Introductionmentioning

confidence: 99%

Impact on wine sales of removing the largest serving size by the glass: An A-B-A reversal trial in 21 pubs, bars, and restaurants in England

Mantzari,

Ventsel,

Pechey

et al. 2024

PLoS Med

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Background Interventions that alter aspects of the physical environments in which unhealthy behaviours occur have the potential to change behaviour at scale, i.e., across populations, and thereby decrease the risk of several diseases. One set of such interventions involves reducing serving sizes, which could reduce alcohol consumption. The effect of modifying the available range of serving sizes of wine in a real-world setting is unknown. We aimed to assess the impact on the volume of wine sold of removing the largest serving size by the glass from the options available in licensed premises. Methods and findings The study was conducted between September 2021 and May 2022 in 21 licensed premises in England that sold wine by the glass in serving sizes greater than 125 ml (i.e., 175 ml or 250 ml) and used an electronic point of sale till system. It used an A-B-A reversal design, set over 3 four-weekly periods. “A” represented the nonintervention periods during which standard serving sizes were served and “B” the intervention period when the largest serving size for a glass of wine was removed from the existing range in each establishment: 250 ml (18 premises) or 175 ml (3 premises). The primary outcome was the daily volume of wine sold, extracted from sales data. Twenty-one premises completed the study, 20 of which did so per protocol and were included in the primary analysis. After adjusting for prespecified covariates, the intervention resulted in −420·8 millilitres (ml) (95% confidence intervals (CIs) −681·4 to −160·2 p = 0·002) or −7·6% (95% CI −12·3%, −2·9%) less wine being sold per day. There was no evidence that sales of beer and cider or total daily revenues changed but the study was not powered to detect differences in these outcomes. The main study limitation is that we were unable to assess the sales of other alcoholic drinks apart from wine, beer, and cider, estimated to comprise approximately 30% of alcoholic drinks sold in participating premises. Conclusions Removing the largest serving size of wine by the glass from those available reduced the volume of wine sold. This promising intervention for decreasing alcohol consumption across populations merits consideration as part of alcohol licensing regulations. Trial registration ISRCTN https://doi.org/10.1186/ISRCTN33169631; OSF https://osf.io/xkgdb.

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Section: Introductionmentioning

confidence: 99%

Impact on wine sales of removing the largest serving size by the glass: An A-B-A reversal trial in 21 pubs, bars, and restaurants in England

Mantzari,

Ventsel,

Pechey

et al. 2024

PLoS Med

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“…An evaluation of both a HWL and product descriptors on tobacco packs suggests the warning can reduce favourable product perceptions and increase health concerns compared to when no warning is present, yet is not sufficient to overcome the effects of the product descriptors [29]. A United Kingdom experiment testing the provision of a cancer warning and calorie information adjacent to alcohol products in a simulated online supermarket found no evidence that the information impacted the number of alcohol units selected; however, the sample size was determined based on available resources and likely underpowered to detect smaller effects, and displaying the intervention information adjacent to versus on the product may reduce its credibility or appear artificial [44]. Because the primary purpose of HWLs is to communicate risk information, alcohol studies have not examined the effectiveness of HWLs for countering advertising messages promoting alcohol products as safe, appealing and health enhancing.…”

Section: Introductionmentioning

confidence: 99%

Can a health warning label diminish the persuasive effects of health‐oriented nutrition advertising on ready‐to‐drink alcohol product packaging? A randomized experiment

Hobin,

Thielman,

Forbes

et al. 2024

Addiction

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Background and aimsA health warning label (HWL) cautioning about the link between alcohol and cancer may be able to communicate alcohol risks to consumers and potentially counter health‐oriented nutrition advertising on ready‐to‐drink alcoholic beverages. This study aimed to examine the independent and combined effects of nutrient content claims (e.g. 0 g sugar) and a HWL on perceived product characteristics and intentions to consume, and whether these effects differed by gender and age.DesignA between‐subjects randomized experiment. Participants were randomized to view one of six experimental label conditions: nutrient content claims plus nutrition declaration (NCC + ND), ND only, NCC + ND + HWL, ND + HWL, HWL only and no NCC, ND or HWL, all on a ready‐to‐drink (RTD) vodka‐based soda container.Setting and participantsAlcohol consumers (n = 5063; 52% women) in Canada aged 18–64 recruited through a national online panel.MeasurementsParticipants completed ratings of perceived product characteristics, perceived product health risks, and intentions to try, buy, binge and drink the product.FindingsCompared with the reference condition NCC + ND (current policy scenario in Canada), the other five experimental label conditions were associated with lower ratings for perceiving the product as healthy. All experimental conditions with a HWL were associated with lower product appeal, higher risk perceptions and reduced intentions to try, buy and binge. The experimental condition with a HWL only was associated with intentions to consume fewer cans in the next 7 days (β = −0.72, 95% confidence interval [CI] = −1.37,−0.08) versus the reference. Few interactions were observed, suggesting that label effects on outcomes were similar by gender and age.ConclusionsHealth warning labels on alcohol packaging appear to be associated with lower product appeal, higher perceived health risks and reduced consumption intentions, even in the presence of nutrient content claims.

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Impact on sales of adding a smaller serving size of beer and cider in licensed premises: an A-B-A reversal design

et al. 2023

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Background Smaller serving sizes of alcoholic drinks could reduce alcohol consumption across populations thereby lowering the risk of many diseases. The effect of modifying the available range of serving sizes of beer and cider in a real-world setting has yet to be studied. The current study assessed the impact on beer and cider sales of adding a serving size of draught beer and cider (2/3 pint) that was between the current smallest (1/2 pint) and largest (1 pint) standard serving sizes. Methods Twenty-two licensed premises in England consented to taking part in the study. The study used an ABA reversal design, set over three 4-weekly periods, with A representing the non-intervention periods, during which standard serving sizes were served and B the intervention period when a 2/3 pint serving size of draught beer and cider was added to the existing range, along with smaller 1/2 pint and larger 1 pint serving sizes. The primary outcome was the daily volume of beer and cider sold, extracted from sales data. Results Fourteen premises started the study, of which thirteen completed it. Twelve of those did so per protocol and were included in the primary analysis. After adjusting for pre-specified covariates, the intervention did not have a significant effect on the volume of beer and cider sold per day (3.14 ml; 95%CIs -2.29 to 8.58; p = 0.257). Conclusions In licensed premises, there was no evidence that adding a smaller serving size for draught beer and cider (2/3 pint) when the smallest (1/2 pint) and largest (1 pint) sizes were still available, affected the volume of beer and cider sold. Studies are warranted to assess the impact of removing the largest serving size. Trial registration ISRCTN: https://doi.org/10.1186/ISRCTN33169631 (08/09/2021), OSF: https://osf.io/xkgdb/ (08/09/2021).

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Impact of health warning labels and calorie labels on selection and purchasing of alcoholic and non-alcoholic drinks: a randomised controlled trial

Cited by 3 publications

References 32 publications

Impact on wine sales of removing the largest serving size by the glass: An A-B-A reversal trial in 21 pubs, bars, and restaurants in England

Impact on wine sales of removing the largest serving size by the glass: An A-B-A reversal trial in 21 pubs, bars, and restaurants in England

Can a health warning label diminish the persuasive effects of health‐oriented nutrition advertising on ready‐to‐drink alcohol product packaging? A randomized experiment

Impact on sales of adding a smaller serving size of beer and cider in licensed premises: an A-B-A reversal design

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