Two recent studies have explored the extent to which 'warning' or 'responsible drinking' messages on drinks labels or in bars or pubs are noticed. Both studies firstly question the level of attention given to such messages in the first case, but also whether attention to such messages may have any effect on drinking behaviour.
The research may be considered relevant in the context of policy debates about how to support 'informed decision making' for alcohol consumers. Currently there is no legal requirement for drinks to contain health warning messages in England, but the former responsibility deal claimed it had succeeded in its pledge to meet a voluntary code on 80% of on shelf products by 2013 - a claim questioned in this BMJ piece. Whilst some public health advocates have argued that labelling requirements should be made mandatory, including calorie content, others have may see the need for action on pricing and availability as more pressing policy issues.
Drinks warning labels - noticed or ignored?
A study by researchers at the University of Liverpool found that typically drinkers paid minimal attention specifically to warning labels on alcohol packaging, attracting only 7–8% of the total viewing time given to the overall branding and packaging of alcohol products. Even drinkers motivated to cut down did not increase their attention to warning labels, but did reduce attention to overall branding.
The authors suggest the low level of attention is likely to reflect the limited space given to alcohol warning labels on packaging, which on average take up less than 5%. They also suggest that drinkers may not see the messages as relevant to any motives to cut down because the messages do not provide information on consequences, rather than just provide unit or guideline information. As such drinkers may just regard such 'warning messages' as part of the packaging, whereas previous research cited in the study found that 'unambiguous information about the effect of alcohol consumption on liver cancer made people perceive the product more negatively', and was therefore more likely to trigger a behavioural effect.
Furthermore, the authors highlight concerns that “drink responsibly” messages 'may be primarily used as a means to promote drinking rather than raise awareness of the harmful consequences of alcohol consumption'. In conclusion, the authors advise that alcohol warning labels need to be more prominent with clearer information on the potential negative consequences of heavy drinking.
Posters in the pub - can they work?
Researchers at London Southbank University have made further use of their simulated 'pub laboratory' in a new study exploring whether the context of a responsible drinking poster influenced attention towards it and any effect on drinking. Perhaps not surprisingly, participants were less likely to look at the responsible drinking posters in the bar than in the traditional laboratory, although was not the case for the general fitness posters as a control condition.
However no effect on consumption of alcohol was found, so despite suggesting that posters will be noticed more in visually quieter locations such as toilet cubicles, the authors highlight a lack of evidence to support the use of responsible drinking posters to reduce risky drinking.
However the results did not replicate previous findings from London Southbank, where observing a responsible drinking poster was actually found to have increased consumption. The posters used though contrasted significantly - posters in the previous study were 'visually complex, and contained messages from which the goal of responsible drinking needed to be inferred', whereas the current study 'disentangled these effects by presenting a simpler poster [see image], where only the text was manipulated and the message to drink responsibly was clear.'
Informed policy making?
PHE's recent evidence review suggests that efforts on alcohol labelling internationally 'have been poorly implemented which may, in part, explain the finding that labels are ineffective in changing drinking behaviour'. Indeed it identifies 'five key elements' which may increase effectiveness as including:
- list of ingredients
- nutritional information (including calories)
- standard drink size and servings per container
- drinking guidelines/definition of ‘moderate’ intake
- health warnings
However PHE found this approach was not consistent with the Responsibility Deal's labelling pledge, highlighting only 57% of the labelling of products met the Portman Group’s own best practice guidance. PHE states 'similar obfuscating tactics were observed in a previous evaluation of a voluntary agreement in 2007', for example the use of smaller text where information was included.
Similarly PHE report that other informational approaches such as responsible drinking messages via posters have little evidence to support an impact on behaviour change. Nonetheless, 'providing information is an important component of a comprehensive policy approach' since 'alcohol consumers have a right to understand the risks associated with alcohol consumption and increasing awareness of the harms relating to alcohol can increase public support for effective alcohol control policies.'
Indeed few would argue against the rights of drinkers to know what they are consuming and the potential harms. To what extent alcohol policy extends beyond this into influencing environmental factors is of course fiercely contested. Policy makers will undoubtedly be aware that upping the level of information available to consumers is unlikely to affect levels of alcohol harm itself in the broader context of wider influences on drinking behaviours. Public support for improved labelling though is more clear cut than most other alcohol policy areas - usually an important factor for policy change.