Reducing harm caused by alcohol


How can alcohol labels be improved to help people make informed consumption choices

Dr Elena D Dimova and Danielle Mitchell

Alcohol continues to be a major cause for concern in Scotland, with 24% of adults drinking at hazardous levels. It causes a range of health conditions including at least seven types of cancer, although public knowledge of the direct health effects of alcohol remains poor. Alcohol labelling can provide people with health information and help them to make decisions about what products to purchase and how much to consume.  

In the UK, alcohol labels are required by law to include the volume of the container, the drink’s strength (alcohol by volume, ABV) and whether common allergens are present. Alcohol labels are also expected to include information on units, the Chief Medical Officers’ (CMO) low risk drinking guidelines and advice on drinking during pregnancy; however, these are not mandatory or regulated, but are voluntary.  The voluntary nature of the information included on labels falls on both the government to provide the industry with suggestions as to what to include on labels and industry funded organisations, such as The Portman Group, who are responsible for the naming, packaging and promotion of alcoholic products in the UK. In practice, only a small number of products meet these expectations: a review of alcohol labels in 2019 found that over 70% do not include the official low-risk drinking guidelines.

What can we learn about alcohol labels?

Given the failures of the industry to include health and nutritional information on alcohol labels, the public health community are calling for alcohol labelling to include mandatory information. This information includes the range of health effects caused by alcohol (e.g. cancer, liver cirrhosis etc.) and basic nutritional guidance, such as calorie and sugar content. For a mandatory approach to alcohol labels to be implemented, it is necessary to gain an understanding on effective labelling approaches.

We undertook a world-wide review, commissioned by Alcohol Focus Scotland, to understand what impact health messaging and product information on alcohol labels have on people.  Specifically, we wanted to find out how effective alcohol labelling is in increasing people’s attention to labels; understanding and recall of information on labels; and prompting people to think about and change their drinking behaviour. We also wanted to find out what makes an alcohol label effective to inform future labelling policies.

We brought together information from 73 research studies on alcohol labelling, published across the world. We also looked at available research on tobacco and foods high in fat, sugar or salt, to find out what can be learned from existing labelling in those fields. Based on these studies, we identified several ways in which alcohol warning labels could be used to effectively raise awareness of alcohol-related harms and reduce alcohol consumption:

  • The use of large, colourful labels on the front of alcohol products increases label visibility and message salience.

For example, colourful pictograms (e.g. drinking driving and pregnancy pictograms) that stand out from the packaging itself, with these ideally displayed on the front of the label.Similar findings emerged from the field of foods high in fat, sugar and/or salt. The use of specific colours has also been suggested in the tobacco field with darker colours shown to reduce product attractiveness.

  • Health warnings that focus on the short-term alcohol-related risks (e.g. violence and accidents) and those linking alcohol to specific diseases, such as cancer, are effective in raising awareness of the harms of drinking and prompting people to consider drinking less.

For example, a recent real-world study in Canada found that cancer warning labels get noticed and increase knowledge that alcohol can cause cancer.

  • Explicit, negatively framed statements, especially statements that contain the phrase “health warning”, might motivate people to drink less.

Examples of this include, statements about drinking during pregnancy and potential harm to the unborn baby.Negatively framed statements may be particularly effective among people who drink at harmful levels. Although graphic health warnings are widely used to communicate tobacco harm, we do not know whether these would be effective in reducing alcohol consumption.

  • The most effective way to help people make healthier choices may be to communicate unit content per serving, in addition to a graphical representation of what percentage of the weekly recommended amount a serving size represents.

Lessons could be learned from research on foods high in fat, sugar and/or salt where such information is communicated in the form of colour-coded schemes.

Alcohol labels provide a direct opportunity to help people make decisions about what they purchase and consume, in addition to increasing awareness and knowledge of alcohol related harms. To achieve this, alcohol labels should include clear health warnings that stand out from the rest of the product packaging using prescribed and colourful designs that cover the range of health effects caused by alcohol. Alcohol labels should also include nutritional information, such as calorie and sugar content, like those already included on the packaging of food.

About the authors: Dr Elena D Dimova is a Research Fellow at Glasgow Caledonian University. Her research focuses on reducing alcohol-related harm in different groups. Some of her recent projects include a review on men’s alcohol consumption in the context of becoming a father (funded by The Institute of Alcohol Studies) and a review of alcohol interventions among LGBTQ+ adults. She is also involved in studies that look at the impact of Minimum Unit Pricing on homeless and street drinkers (funded by CSO) and the impact of alcohol and tobacco availability on the health and wellbeing of people in Scotland (funded by ESRC).
Email: Twitter: @ ElenaDDimova

Danielle Mitchell recently completed her PhD within the Institute for Social Marketing and Health at the University of Stirling. Her main research focus has been on adolescents’ responses to standardised tobacco packaging, the latest tobacco control policy in the UK, and further packaging measures to dissuade smoking, such as on-cigarette health warnings. In addition, she has worked across projects as a research assistant exploring approaches to marketing e-cigarette brands (funded by CRUK) and marketing activities by gambling brands during the COVID-19 pandemic (Funded by ESRC) and projects exploring the smoking ban and use of e-cigarettes in Scottish Prisons (funded by NIHR and CRUK).
Email: Twitter: @DanielleM_30