Direct messaging: warning labels on alcohol

Researchers say warning labels are the best way of communicating alcohol’s health risks.

Ask anyone about the health hazards of smoking, and they’re likely to quickly rattle off a laundry list: cancer, heart disease, COPD, stroke and many more. But ask them the same question about alcohol, and they might not be so quick to answer; some may even reply that drinking wine can be good for you in small amounts.

But a growing body of evidence is showing us that not only are these health claims about alcohol likely false; alcohol is harmful to our health even in very small doses. Researchers at the University of Victoria’s Canadian Institute for Substance Use Research (CISUR) have been at the forefront of this research for years, despite consistent disapproval from the alcohol industry.

“If you look back at tobacco, we were in the same boat 60 years ago. I remember when all the evidence began to come out about tobacco and cancer and there was a big pushback from the industry and it took a long while for governments to act,” says CISUR director Tim Stockwell. “I think we’re just in a naïve state right now. Alcohol is an important part of our lives culturally and socially and it can be very pleasurable and we don’t want to hear much bad about it.”

A recent study co-led by Stockwell, other researchers at CISUR and the Canadian Centre on Substance Use and Addiction in Ottawa, called the Canadian Substance Use Costs and Harms project, looked at alcohol, tobacco and other drugs across four different cost areas (health care, criminal justice, lost productivity and other direct costs). It was estimated that alcohol actually surpassed tobacco in terms of economic costs to Canadian society, with tobacco costs clocking in at $12 billion and alcohol at $14.7 billion in 2014, the most recent figures available.

So what do we do about it? Stockwell says that the most effective government policy levers, such as minimum pric.ing tied to alcohol strength, won’t gain popular support until people know about alcohol’s harms—and one of the ways to increase awareness is by introducing warning labels on alcohol containers.

“Warning labels are brilliant,” he says. “They’re so focused and targeted: the more you drink, the more you see them. There’s no other media for communication about alcohol that so precisely targets those most at risk.”

In late 2017, Stockwell co-led a research experiment with Public Health Ontario’s Erin Hobin, piloting a series of warning labels on alcohol containers in Yukon to measure their impact on peoples’ knowledge of alcohol’s health effects or their drink.ing patterns. Three labels were used: one with national low-risk drinking guidelines, one with standard-drink information, and one with a warning about alcohol’s link to breast and colon cancer. One month into the study, however, the alcohol industry made veiled legal threats; the study was paused, and only allowed to resume once the cancer labels were removed.

But the researchers didn’t let the cancer label go without a fight. What was supposed to be a small study wound up becoming an international media story, with articles in the New York Times and the Wall Street Journal. Media outlets in Ireland, a country that was debating cancer warning labels on alcohol containers around the same time, were frequently referencing the Yukon study, says CISUR research associate Kate Vallance, who managed the Yukon project and is authoring several papers on its findings.

“I think it’s going to be a fairly pivotal study in the history of alcohol-policy measures in Canada,” she says. “Funnily enough, because of the industry interference, the story went from being something that was really local to Yukon to being both national and international news. Because of that bigger focus, it sort of forces the issue.”

As it turns out, the alcohol industry has reason to be concerned. Surveys conducted in the months before the labels were applied found that knowledge of low-risk drinking guidelines, standard-drink measurements and alcohol’s link to cancer was very low in both Yukon and Northwest Territories, with the latter used as a comparison group. After the new labels were introduced, knowledge of each of these key health messages increased in Yukon—as did support for policies that would help reduce peoples’ alcohol-related health risks.

“Because the labels were presenting new information in a way that was more novel and engaging and because there were the three different labels, they seemed to stick in peoples’ memories and have more of an impact,” says Vallance. “There was also a decrease in alcohol sales during the time the labels were on there.”

As Stockwell, Vallance and the team at CISUR and beyond prepare to publish their findings from the groundbreaking Yukon study, it’s safe to say that the world is watching—even if it’s going to give us news about alcohol consumption we might not want to hear.

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