Alcohol packaging can be used to communicate the harms associated with consumption. Daniel Jones, a research assistant at the University of Stirling, assessed a sample of young adults’ exposure to, and engagement with, current messaging on packs, support for displaying product and health-related information, and reactions to novel warnings. In this blog, he reflects on the findings.
The harmful use of alcohol is a key risk factor for illness, disability and death, implicated in more than 200 diseases and responsible for over 3 million deaths worldwide every year. The UK is no exception with 8,974 alcohol-specific deaths in 2020, a 19% increase compared with 2019.
However, alcohol packaging in the UK is not designed to reflect these risks. The only product and health-related information legally required on alcohol packaging in the UK is volume, strength/alcohol by volume (ABV) and presence of common allergens. The inclusion of warnings is voluntary; where used, these are typically restricted to small symbols warning not to drink if pregnant or driving.
Previous research with young adult drinkers in Scotland found that most participants did not attend to or meaningfully engage with the health-related information, messaging and warnings currently provided on packs, viewing them as unnoticeable, obscure and ineffective. A recent report by Alcohol Health Alliance UK argues that alcohol labelling is failing consumers. For example, more than a third of the 369 alcohol products analysed did not inform consumers of the UK Chief Medical Officers’ low-risk drinking guidelines, while only a fifth of the products provided full ingredients lists.
What we did
In this study, 1,360 drinkers aged 18–35 living in the UK participated in an online survey and experiment. We explored three aims: 1) exposure to, and engagement with, current messaging on packs; 2) support for displaying product and health-related information; and 3) reactions to novel warnings regarding product appeal, social acceptability, and cognitive and behavioural impact.
To address aim 1, participants were asked how often they see, and read or look closely at, the health-related information, messages or warnings on alcohol packaging. To address aim 2, we explored whether participants supported displaying the following information on alcohol packaging: strength/ABV; number of units; ingredients; number of servings equal to recommended weekly guidelines; weekly unit guidelines for men and women; calories; health conditions which can result from drinking alcohol; health warnings on the front of packs.
To assess the impact of warnings (aim 3), participants were randomly assigned to one of four conditions and viewed images of a market-leading brand of vodka with no warnings (i.e. control), small-text warnings, large-text warnings or pictorial warnings (i.e. image-and-text). Participants responded to statements relating to product appeal and social acceptability (e.g. ‘I would feel comfortable having these alcohol products in my home’), and cognitive and behavioural impact (e.g. ‘These alcohol products would make me aware of the health risks of drinking’).
Each warning set included one general (‘Alcohol damages your health’) and two specific (‘Alcohol causes liver disease’, ‘Alcohol causes mouth cancer’) warnings. The specific warnings were selected as more than three-quarters of alcohol-specific deaths in the UK in 2020 were caused by alcoholic liver disease and past research suggests that it is more effective to specify the type of cancer, with alcohol-related mouth cancer prevalent in the UK. For those in the pictorial warning condition, an appropriate image was chosen to reflect each warning: ‘Alcohol damages your health’ (image of blood pressure test); ‘Alcohol causes liver disease’ (image of person clutching their liver); ‘Alcohol causes mouth cancer’ (image of CT scanner in a hospital).
What we found
While most participants (59.9%) reported ‘always’, ‘often’ or ‘sometimes’ seeing health-related information, messages or warnings on alcohol packaging, 40.1% ‘rarely’ or ‘never’ did. The majority (69.9%) said they ‘rarely’ or ‘never’ read or looked closely at such information.
There was strong support for displaying strength/ABV, number of units, ingredients, weekly guidelines (by serving and gender) and calories on alcohol packaging, with moderate support for displaying warnings. Table 3 in the paper provides a full breakdown of participants’ support for displaying product and health-related information on alcohol packaging.
As expected, participants who viewed the product with no warnings had the highest social appeal and acceptability ratings, and the lowest reported impact on cognition and behaviour. Including a front-of-pack health warning (small-text, large-text or pictorial) reduced product appeal and social acceptability, and positively influenced alcohol-related cognitions and behaviours, e.g. increased awareness of harms. Larger warnings (with/without image) were most effective in reducing product appeal and social acceptability.
Surprisingly, we did not find clear differences between warning designs regarding positively impacting cognitions and behaviours. This is in contrast to tobacco research where larger warnings with images are more effective at positively influencing smoking-related thoughts and behaviours than smaller, text-only warnings. This may be partially explained by the modest sample size and somewhat benign images used in our study. Other alcohol and tobacco studies suggest that more severe images can evoke stronger reactions from consumers and may have a greater impact on cognitions and behaviours.
This sample of young adult drinkers reported limited engagement with the health information, messages and warnings on current alcohol packaging and largely supported the inclusion of product and health-related information. Prominent warnings on alcohol packaging can help to capture attention, counteract the appeal and social acceptability of alcohol products, and may encourage consumers to think about their drinking. Well-designed health warnings on packs have the potential to support a reduction in alcohol consumption and related harms.
Written by Daniel Jones
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.