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Randomized Controlled Trial
. 2021 Dec;116(12):3333-3345.
doi: 10.1111/add.15519. Epub 2021 May 25.

Health warning labels and alcohol selection: a randomised controlled experiment in a naturalistic shopping laboratory

Natasha Clarke  1 , Anna K M Blackwell  2 , Katie De-Loyde  2 , Emily Pechey  1 , Alice Hobson  1 , Mark Pilling  1 , Richard W Morris  3 , Theresa M Marteau  1 , Gareth J Hollands  1
Affiliations
Randomized Controlled Trial

Health warning labels and alcohol selection: a randomised controlled experiment in a naturalistic shopping laboratory

Natasha Clarke et al. Addiction. 2021 Dec.

Abstract

Background and aims: Health warning labels (HWLs) on tobacco products reduce smoking. There is an absence of evidence concerning the impact of alcohol HWLs on selection or purchasing in naturalistic settings. Using a commercial-standard naturalistic shopping laboratory, this study aimed to estimate the impact on selection of alcoholic drinks of HWLs describing adverse health consequences of excessive alcohol consumption.

Design: A between-subjects randomised experiment with three groups was conducted: group 1: image-and-text HWL; group 2: text-only HWL; group 3: no HWL.

Setting: A commercial-standard naturalistic shopping laboratory in the United Kingdom.

Participants: Adults (n = 399, 55% female) over the age of 18 years, who purchased beer or wine weekly to drink at home.

Interventions: Participants were randomised to one of three groups varying in the HWL displayed on the packaging of the alcoholic drinks: (i) image-and-text HWL (n = 135); (ii) text-only HWL (n = 129); (iii) no HWL (n = 135). Participants completed a shopping task, selecting items from a range of alcoholic and non-alcoholic drinks, and snacks.

Measurement: The primary outcome was the proportion of alcoholic drinks selected. Secondary outcomes included HWL ratings on negative emotional arousal and label acceptability.

Findings: There was no clear evidence of a difference in the HWL groups for the percentage of drinks selected that were alcoholic compared to no HWL (44%): image-and-text HWL: 46% (odds ratio [OR] = 1.08, 95% confidence interval [CI] = 0.82, 1.42); text-only HWL: 41% (OR = 0.87, 95% CI = 0.67, 1.14). Concordant with there being no difference between groups, there was extreme evidence in favour of the null hypothesis (Bayes factor [BF] < 0.01). Negative emotional arousal was higher (P < 0.001) and acceptability lower (P < 0.001) in the image-and-text HWL group, compared to the text-only HWL group.

Conclusions: In a naturalistic shopping laboratory, there was no evidence that health warning labels describing the adverse health consequences of excessive alcohol consumption changed selection behaviour.

Keywords: Alcohol; choice architecture; graphic warnings; health warning label; labelling, pictorial health warning label.

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References

    1. Rehm J., Guiraud J., Poulnais R., Shield K. D. Alcohol dependence and very high risk level of alcohol consumption: a life-threatening and debilitating disease. Addict Biol 2018; 23: 961-968.
    1. Sheron N., Gilmore I. Effect of policy, economics, and the changing alcohol marketplace on alcohol related deaths in England and Wales. BMJ Clin Res 2016; 353: i1860.
    1. World Health Organization (WHO). Global strategy to reduce the harmful use of alcohol. 2015. Available at: https://www.who.int/publications/i/item/9789241599931
    1. Hammond D. Tobacco Labelling and Packaging Toolkit: A guide to FCTC Article 11. 2009; Available at: https://www.who.int/fctc/guidelines/adopted/article_11/en/. Accessed September 2020.
    1. Hammond D., McDonald P., Fong G., Stephen Brown K., Cameron R. The impact of cigarette warning labels and smoke-free bylaws on smoking cessation: evidence from former smokers. Can J Public Health 2003; 95: 201-204.

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