Impact of health warning labels communicating the risk of cancer on alcohol selection: an online experimental study

Natasha Clarke; Emily Pechey; Eleni Mantzari; Anna K.M. Blackwell; Katie De-loyde; Richard W. Morris; Marcus R. Munafò; Theresa M. Marteau; Gareth J. Hollands

doi:10.1111/add.15072

Impact of health warning labels communicating the risk of cancer on alcohol selection: an online experimental study

Natasha Clarke, Emily Pechey, Eleni Mantzari, Anna K.M. Blackwell, Katie De-loyde, Richard W. Morris, Marcus R. Munafò, Theresa M. Marteau, Gareth J. Hollands

Department of Psychology

Research output: Contribution to journal › Article › peer-review

38 Citations (SciVal)

Abstract

Aims: Evidence from tobacco research suggests that health warning labels (HWLs) depicting the adverse consequences of consumption change smoking behaviours, with image-and-text (also known as ‘pictorial’ or ‘graphic’) HWLs most effective. There is an absence of evidence concerning the potential impact of HWLs placed on alcohol products on selection of those products. This study aimed to obtain a preliminary assessment of the possible impact of (i) image-and-text, (ii) text-only, and (iii) image-only HWLs on selection of alcoholic versus non-alcoholic drinks. Design: A between-subjects randomised experiment with a 2 (image: present versus absent) × 2 (text: present versus absent) factorial design. Setting: The study was conducted on the online survey platform Qualtrics. Participants: Participants (n = 6024) were adults over the age of 18 who consumed beer or wine regularly (i.e. at least once a week), recruited through a market research agency. Interventions: Participants were randomised to one of four groups varying in the HWL displayed on the packaging of alcoholic drinks: (i) image-and-text HWL; (ii) text-only HWL; (iii) image-only HWL; and (iv) no HWL. HWLs depicted bowel cancer, breast cancer and liver cancer, which were each displayed twice across six alcoholic drinks. Each group viewed six alcoholic and six non-alcoholic drinks and selected one drink that they would like to consume. Measurements: The primary outcome was the proportion of participants selecting an alcoholic versus a non-alcoholic drink. Findings: Alcoholic drink selection was lower for all HWL types compared with no HWL (image-and-text: 56%; image-only: 49%; text-only: 61%; no HWL: 77%), with selection lowest for HWLs that included an image. Image-and-text HWLs reduced the odds of selecting an alcoholic drink compared with text-only HWLs (OR = 0.80, 95% CI = 0.69, 0.92), but increased the odds of selecting an alcoholic drink compared with image-only HWLs (OR = 1.34, 95% CI = 1.16, 1.55). Conclusions: Health warning labels communicating the increased risk of cancers associated with alcohol consumption reduced selection of alcoholic versus non-alcoholic drinks in a hypothetical choice task in an online setting; labels displaying images had the largest effect. Their impact in laboratory and real-world field settings using physical products awaits investigation.

Original language	English
Pages (from-to)	41-52
Number of pages	12
Journal	Addiction
Volume	116
Issue number	1
Early online date	4 Jan 2021
DOIs	https://doi.org/10.1111/add.15072
Publication status	Published - 31 Jan 2021

Bibliographical note

Funding Information:
This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z to T.M.M., Paul Fletcher, G.J.H. and M.R.M.). G.J.H., T.M.M., N.C., E.P., E.M. and A.K.M. B. conceived the study and collaborated in designing the procedures. N.C. and E.P. coordinated the study and data collection. K.D., M.R.M. and R.W.M. performed the data analyses. N.C. and G.J.H. drafted the manuscript, with all authors providing critical revisions. All authors read and approved the final manuscript. Approved by the Psychology Research Ethics Committee of the University of Cambridge (Reference Number: PRE.2018.072). All participants provided informed consent. The authors declare no competing interests. The views expressed in this publication are those of the author(s) and not necessarily those of Wellcome Trust. Registration and data available on the Open Science Framework: https://osf.io/pr8zu/

Funding Information:
This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z to T.M.M., Paul Fletcher, G.J.H. and M.R.M.).

Publisher Copyright:
© 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction

Keywords

alcohol
cancer
choice architecture
graphic warnings
health warning label
pictorial health warning label

ASJC Scopus subject areas

Medicine (miscellaneous)
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1111/add.15072Licence: CC BY

Cite this

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title = "Impact of health warning labels communicating the risk of cancer on alcohol selection: an online experimental study",

abstract = "Aims: Evidence from tobacco research suggests that health warning labels (HWLs) depicting the adverse consequences of consumption change smoking behaviours, with image-and-text (also known as {\textquoteleft}pictorial{\textquoteright} or {\textquoteleft}graphic{\textquoteright}) HWLs most effective. There is an absence of evidence concerning the potential impact of HWLs placed on alcohol products on selection of those products. This study aimed to obtain a preliminary assessment of the possible impact of (i) image-and-text, (ii) text-only, and (iii) image-only HWLs on selection of alcoholic versus non-alcoholic drinks. Design: A between-subjects randomised experiment with a 2 (image: present versus absent) × 2 (text: present versus absent) factorial design. Setting: The study was conducted on the online survey platform Qualtrics. Participants: Participants (n = 6024) were adults over the age of 18 who consumed beer or wine regularly (i.e. at least once a week), recruited through a market research agency. Interventions: Participants were randomised to one of four groups varying in the HWL displayed on the packaging of alcoholic drinks: (i) image-and-text HWL; (ii) text-only HWL; (iii) image-only HWL; and (iv) no HWL. HWLs depicted bowel cancer, breast cancer and liver cancer, which were each displayed twice across six alcoholic drinks. Each group viewed six alcoholic and six non-alcoholic drinks and selected one drink that they would like to consume. Measurements: The primary outcome was the proportion of participants selecting an alcoholic versus a non-alcoholic drink. Findings: Alcoholic drink selection was lower for all HWL types compared with no HWL (image-and-text: 56%; image-only: 49%; text-only: 61%; no HWL: 77%), with selection lowest for HWLs that included an image. Image-and-text HWLs reduced the odds of selecting an alcoholic drink compared with text-only HWLs (OR = 0.80, 95% CI = 0.69, 0.92), but increased the odds of selecting an alcoholic drink compared with image-only HWLs (OR = 1.34, 95% CI = 1.16, 1.55). Conclusions: Health warning labels communicating the increased risk of cancers associated with alcohol consumption reduced selection of alcoholic versus non-alcoholic drinks in a hypothetical choice task in an online setting; labels displaying images had the largest effect. Their impact in laboratory and real-world field settings using physical products awaits investigation.",

keywords = "alcohol, cancer, choice architecture, graphic warnings, health warning label, pictorial health warning label",

author = "Natasha Clarke and Emily Pechey and Eleni Mantzari and Blackwell, {Anna K.M.} and Katie De-loyde and Morris, {Richard W.} and Munaf{\`o}, {Marcus R.} and Marteau, {Theresa M.} and Hollands, {Gareth J.}",

note = "Funding Information: This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z to T.M.M., Paul Fletcher, G.J.H. and M.R.M.). G.J.H., T.M.M., N.C., E.P., E.M. and A.K.M. B. conceived the study and collaborated in designing the procedures. N.C. and E.P. coordinated the study and data collection. K.D., M.R.M. and R.W.M. performed the data analyses. N.C. and G.J.H. drafted the manuscript, with all authors providing critical revisions. All authors read and approved the final manuscript. Approved by the Psychology Research Ethics Committee of the University of Cambridge (Reference Number: PRE.2018.072). All participants provided informed consent. The authors declare no competing interests. The views expressed in this publication are those of the author(s) and not necessarily those of Wellcome Trust. Registration and data available on the Open Science Framework: https://osf.io/pr8zu/ Funding Information: This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z to T.M.M., Paul Fletcher, G.J.H. and M.R.M.). Publisher Copyright: {\textcopyright} 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction",

year = "2021",

month = jan,

day = "31",

doi = "10.1111/add.15072",

language = "English",

volume = "116",

pages = "41--52",

journal = "Addiction",

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number = "1",

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TY - JOUR

T1 - Impact of health warning labels communicating the risk of cancer on alcohol selection

T2 - an online experimental study

AU - Clarke, Natasha

AU - Pechey, Emily

AU - Mantzari, Eleni

AU - Blackwell, Anna K.M.

AU - De-loyde, Katie

AU - Morris, Richard W.

AU - Munafò, Marcus R.

AU - Marteau, Theresa M.

AU - Hollands, Gareth J.

N1 - Funding Information: This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z to T.M.M., Paul Fletcher, G.J.H. and M.R.M.). G.J.H., T.M.M., N.C., E.P., E.M. and A.K.M. B. conceived the study and collaborated in designing the procedures. N.C. and E.P. coordinated the study and data collection. K.D., M.R.M. and R.W.M. performed the data analyses. N.C. and G.J.H. drafted the manuscript, with all authors providing critical revisions. All authors read and approved the final manuscript. Approved by the Psychology Research Ethics Committee of the University of Cambridge (Reference Number: PRE.2018.072). All participants provided informed consent. The authors declare no competing interests. The views expressed in this publication are those of the author(s) and not necessarily those of Wellcome Trust. Registration and data available on the Open Science Framework: https://osf.io/pr8zu/ Funding Information: This work was funded by a Collaborative Award in Science from Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z to T.M.M., Paul Fletcher, G.J.H. and M.R.M.). Publisher Copyright: © 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction

PY - 2021/1/31

Y1 - 2021/1/31

N2 - Aims: Evidence from tobacco research suggests that health warning labels (HWLs) depicting the adverse consequences of consumption change smoking behaviours, with image-and-text (also known as ‘pictorial’ or ‘graphic’) HWLs most effective. There is an absence of evidence concerning the potential impact of HWLs placed on alcohol products on selection of those products. This study aimed to obtain a preliminary assessment of the possible impact of (i) image-and-text, (ii) text-only, and (iii) image-only HWLs on selection of alcoholic versus non-alcoholic drinks. Design: A between-subjects randomised experiment with a 2 (image: present versus absent) × 2 (text: present versus absent) factorial design. Setting: The study was conducted on the online survey platform Qualtrics. Participants: Participants (n = 6024) were adults over the age of 18 who consumed beer or wine regularly (i.e. at least once a week), recruited through a market research agency. Interventions: Participants were randomised to one of four groups varying in the HWL displayed on the packaging of alcoholic drinks: (i) image-and-text HWL; (ii) text-only HWL; (iii) image-only HWL; and (iv) no HWL. HWLs depicted bowel cancer, breast cancer and liver cancer, which were each displayed twice across six alcoholic drinks. Each group viewed six alcoholic and six non-alcoholic drinks and selected one drink that they would like to consume. Measurements: The primary outcome was the proportion of participants selecting an alcoholic versus a non-alcoholic drink. Findings: Alcoholic drink selection was lower for all HWL types compared with no HWL (image-and-text: 56%; image-only: 49%; text-only: 61%; no HWL: 77%), with selection lowest for HWLs that included an image. Image-and-text HWLs reduced the odds of selecting an alcoholic drink compared with text-only HWLs (OR = 0.80, 95% CI = 0.69, 0.92), but increased the odds of selecting an alcoholic drink compared with image-only HWLs (OR = 1.34, 95% CI = 1.16, 1.55). Conclusions: Health warning labels communicating the increased risk of cancers associated with alcohol consumption reduced selection of alcoholic versus non-alcoholic drinks in a hypothetical choice task in an online setting; labels displaying images had the largest effect. Their impact in laboratory and real-world field settings using physical products awaits investigation.

AB - Aims: Evidence from tobacco research suggests that health warning labels (HWLs) depicting the adverse consequences of consumption change smoking behaviours, with image-and-text (also known as ‘pictorial’ or ‘graphic’) HWLs most effective. There is an absence of evidence concerning the potential impact of HWLs placed on alcohol products on selection of those products. This study aimed to obtain a preliminary assessment of the possible impact of (i) image-and-text, (ii) text-only, and (iii) image-only HWLs on selection of alcoholic versus non-alcoholic drinks. Design: A between-subjects randomised experiment with a 2 (image: present versus absent) × 2 (text: present versus absent) factorial design. Setting: The study was conducted on the online survey platform Qualtrics. Participants: Participants (n = 6024) were adults over the age of 18 who consumed beer or wine regularly (i.e. at least once a week), recruited through a market research agency. Interventions: Participants were randomised to one of four groups varying in the HWL displayed on the packaging of alcoholic drinks: (i) image-and-text HWL; (ii) text-only HWL; (iii) image-only HWL; and (iv) no HWL. HWLs depicted bowel cancer, breast cancer and liver cancer, which were each displayed twice across six alcoholic drinks. Each group viewed six alcoholic and six non-alcoholic drinks and selected one drink that they would like to consume. Measurements: The primary outcome was the proportion of participants selecting an alcoholic versus a non-alcoholic drink. Findings: Alcoholic drink selection was lower for all HWL types compared with no HWL (image-and-text: 56%; image-only: 49%; text-only: 61%; no HWL: 77%), with selection lowest for HWLs that included an image. Image-and-text HWLs reduced the odds of selecting an alcoholic drink compared with text-only HWLs (OR = 0.80, 95% CI = 0.69, 0.92), but increased the odds of selecting an alcoholic drink compared with image-only HWLs (OR = 1.34, 95% CI = 1.16, 1.55). Conclusions: Health warning labels communicating the increased risk of cancers associated with alcohol consumption reduced selection of alcoholic versus non-alcoholic drinks in a hypothetical choice task in an online setting; labels displaying images had the largest effect. Their impact in laboratory and real-world field settings using physical products awaits investigation.

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KW - cancer

KW - choice architecture

KW - graphic warnings

KW - health warning label

KW - pictorial health warning label

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Impact of health warning labels communicating the risk of cancer on alcohol selection: an online experimental study

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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