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WHO HEALTH EVIDENCE NETWORK SYNTHESIS REPORT 68. What is the current alcohol labelling practice in the WHO European Region and what are barriers and facilitators to development and implementation of alcohol labelling policy?
Abstract and Figures
The WHO European Region has the highest levels of alcohol consumption per capita in the world, yet alcohol labelling, a WHO-recommended practice that provides consumer information on the ingredients, nutritional values and harms of alcohol, is not mandatory. This report synthesizes evidence on alcohol labelling practices in the Region and aims to describe factors affecting implementation. To date, the introduction of alcohol labelling policy as part of a larger package of alcohol policy measures created with strong political support and consumer pressure has proved successful in providing consumers with information, although practices have been hindered by slow procedures in some parts of the Region, opposition from international institutions and the alcohol industry, and the lack of set labelling specifications and monitoring activities. Policy considerations for the development of successful labelling legislation should ideally address both health information and nutritional information, ensure regulated message presentation and implement independent monitoring and evaluation of measures.
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... Knai et al. [38] reported on a systematic review of reviews and Robinson et al. [27] conducted a rapid systematic review and metanalysis. A recent report from the WHO Regional Office for Europe on current alcohol-labelling practices in that region [39] noted that 28% of member states had some legislation on certain aspects of health information labelling, with a main focus being pregnancy or underage drinking. Some reviews [31,33,40] tended to conclude that there was not convincing evidence of changes in alcohol-related behavior as a result of an AWL. ...
... Several authors have advocated for alcohol labelling as part of a larger package of interventions; for example, Wilkinson and Room [14] and Neufeld et al. [12]. In the WHO European Region Report on alcohol labelling practices [39], the authors point to Israel, Lithuania and Ireland, which had introduced AWLs as part of broader prevention strategies focusing on alcohol. ...
... Alcohol consumption contributes to a wide range of chronic, acute and social problems [163]; these problems not only impact the drinkers but others, including innocent victims. Alcohol warning labels are an important component of a comprehensive and evidencebased policy response needed to reduce alcohol-related injury, disease and death [2,3,36,39]. As shown in Section 3 above, they can increase awareness of risks, change drinking behavior and reinforce a perspective that alcohol is not an ordinary commodity, and requires special attention and regulation. ...
A rapid review of research on health warning labels located on alcohol containers (AWLs) was conducted. Using five search engines (Embase, Medline, Pubmed, Scopus, Psyinfo), 2975 non-duplicate citations were identified between the inception date of the search engine and April 2021. Of those, 382 articles were examined and retrieved. We selected 122 research papers for analysis and narrative information extraction, focusing on population foci, study design, and main outcomes. Research included public opinion studies, surveys of post-AWL implementation, on-line and in-person experiments and real-world quasi-experiments. Many studies focused on the effects of the 1989 United States Alcoholic Beverage Labeling Act on perceptions, intentions and behavior. Others focused on Australia, Canada, the United Kingdom, England or Scotland, Italy and France. There was substantial variation in the design of the studies, ranging from small-scale focus groups to on-line surveys with large samples. Over time, evidence has been emerging on label design components, such as large size, combination of text and image, and specific health messaging, that is likely to have some desired impact on knowledge, awareness of risk and even the drinking behavior of those who see the AWLs. This body of evidence provides guidance to policy-makers, and national and regional authorities, and recommendations are offered for discussion and consideration.
... 15 Although alcoholic drink products are widely advertised, sold and consumed both in and outside of the home, 16 products containing an alcohol by volume (ABV) of >1.2% (the majority of beers, wines, spirits and other widely consumed alcoholic products) tend to be exempt from laws that require nutritional information on product labels or at point of purchase in most countries. [17][18][19] Indeed, there are stricter labelling requirements for bottled water compared to alcohol, across Europe. 20 In the US, energy labelling is required for alcoholic drinks sold by large businesses in the OOHFS, but this is not the case in other countries with OOHFS energy labelling laws, such as England. ...
... In the absence of mandatory laws that require energy labelling of alcoholic drinks there is very limited voluntary provision of this information, as evidenced by recent EU and UK studies. 17,21 In a 2017 report, the World Health Organization (WHO) concluded that 'providing consumers with information about the calorie content of alcoholic beverages is a potentially important way of helping them reduce their calorie intake if they so wish' 22 and a 2017 European Commission report suggested 'there were no objective grounds that justify the absence of nutritional information from alcohol products.' 17 Because the alcohol industry have tended not to follow these recommendations and provide nutritional information voluntarily, there are now calls for mandatory nutritional labelling of alcoholic drinks. ...
... 17,21 In a 2017 report, the World Health Organization (WHO) concluded that 'providing consumers with information about the calorie content of alcoholic beverages is a potentially important way of helping them reduce their calorie intake if they so wish' 22 and a 2017 European Commission report suggested 'there were no objective grounds that justify the absence of nutritional information from alcohol products.' 17 Because the alcohol industry have tended not to follow these recommendations and provide nutritional information voluntarily, there are now calls for mandatory nutritional labelling of alcoholic drinks. For example, Ireland is the first EU member state to recently pass legislation that will require alcoholic drink packaging to include energy content information. ...
Alcohol is calorie dense, but unlike food products, alcoholic drinks tend to be exempt from nutritional labelling laws that require energy content information to be displayed on packaging or at point of purchase. This review provides a perspective on the likely efficacy of alcoholic drink energy labelling as a public health policy to reduce obesity and discusses key questions to be addressed by future research. First, the contribution that alcohol makes to population level daily energy intake and obesity is outlined. Next, consumer need for alcohol energy labelling and the potential impacts on both consumer and industry behaviour are discussed. Pathways and mechanisms by which energy labelling of alcoholic drinks could reduce obesity are considered, as well as possible unintended consequences of alcoholic drink energy labelling. Would widespread energy labelling of alcoholic drinks reduce obesity? The unclear effect that alcohol has on population level obesity, the modest contribution calories from alcohol make to daily energy intake and limited impact nutritional labelling policies tend to have on behaviour, suggest alcohol energy labelling alone may have limited impact on population obesity prevalence as a standalone policy. However, there are a number of questions that will need to be answered by future research to make definitive conclusions on the potential for alcohol energy labelling policies to reduce obesity. This article is protected by copyright. All rights reserved. Would widespread energy labelling of alcoholic drinks reduce obesity? We provide a perspective on the potential of this obesity policy" cd_value_code="text
... In Switzerland, wine and beer are the most popular alcoholic beverages, whereas spirits such as vodka account for only a minor share of consumption [1]. Per capita, European citizens-including Swiss-consume twice as much alcohol as the world average [2]. It is thus unsurprising that Europeans' norms of drinking alcohol correlate with alcohol-related diseases, accidents, and dependency [3]. ...
... In our analysis, we estimated numbers of standard glasses by multiplying consumption frequencies by consumption quantities. The answer options for consumption frequency were coded based on numbers of occasions per month: I do not drink wine (0), less than once a month (0.5), about once a month (1), several times a month (2), about once a week (4), several times a week (12), and daily (30). The answer options were recoded into specific numbers of glasses: less than a glass (0.5), 1-2 glasses (1.5), 2-3 glasses (2.5), 3-4 glasses (3.5), 4-5 glasses (4.5), 1 bottle (7.5), or more than 1 bottle (8). ...
... In investigating HWLs' influence on risk perceptions for wine and vodka, this study found that HWL did not significantly affect mean risk perceptions. 2 The inclusion of an HWL on an alcohol container did not increase perceived personal risk, F(1, 502) = 0.01, p = 0.920, partial η 2 < 0.001. However, beverage types significantly affected perceived personal risk, F(1, 502) = 127.66, ...
Background
Wine consumption has a particular place in the culture of many European countries, and beliefs that wine offers health benefits are widespread. High consumption of wine and other alcoholic beverages among many Europeans correlates with alcohol-related accidents and disease burdens. Health warning labels (HWLs) on alcohol containers have been increasingly recommended to deter consumers from drinking. However, findings on the impact of HWLs on consumers’ behavior have been mixed. Moreover, many European consumers have been found to reject the use of warning labels as a policy intervention, especially for wine, perhaps due to its cultural and economic importance.
Methods
An online study with a between-subjects design was conducted in Switzerland ( N = 506) to assess whether HWLs can influence the perceived risk associated with drinking wine and vodka, a beverage insignificant to Swiss culture. Participants were presented an image of either a wine or vodka bottle with or without an HWL presenting a liver cancer warning statement. They were then asked to indicate their perceived risk of regularly consuming the depicted beverage. Acceptance and rejection of HWLs were also assessed.
Results
The perceived risk of vodka consumption exceeded the corresponding risk for wine but was unaffected by an HWL. Perceived health benefits were the main, negative predictor of perceived consumption risk. Participants mainly rejected HWLs due to their perceived effectiveness, perceived positive health effects, social norms, and individualistic values.
Conclusions
Perceived risk is an important determinant of drinking behavior, and our results suggest that HWLs may be unable to alter risk perceptions. Furthermore, a strong belief in the health benefits of alcohol consumption, particularly wine consumption, reduce risk perceptions and may be unaffected by HWLs.
... The copyright holder for this preprint this version posted July 22, 2022. ; 1 7 Calorie labels show promise and warrant further evaluation, particularly current government interest in their potential implementation in the UK 17,20 and internationally; for example Ireland recently passed legislation that requires energy content information on alcohol packaging 43 . The World Health Organisation recommends that successful alcohol labelling legislation should include information about the harm from alcohol 44 and be consistent with non-alcoholic drink labelling, including the provision of calorie information 43 . ...
... ; 1 7 Calorie labels show promise and warrant further evaluation, particularly current government interest in their potential implementation in the UK 17,20 and internationally; for example Ireland recently passed legislation that requires energy content information on alcohol packaging 43 . The World Health Organisation recommends that successful alcohol labelling legislation should include information about the harm from alcohol 44 and be consistent with non-alcoholic drink labelling, including the provision of calorie information 43 . Regardless of whether labelling can elicit meaningful effects on behaviour, information on calories can enable people to accurately estimate calorie intake from drinks 45 and appears to be highly acceptable to the public. ...
Objective
Health warning and calorie labels on alcohol have the potential to reduce consumption at population level but remain unevaluated using robust designs with behavioural outcomes. The aim of the current study is to estimate the impact on selection and actual purchasing of (a) health warning labels (text-only and image-and-text) on alcoholic drinks and (b) calorie labels on alcoholic and non-alcoholic drinks.
Design
Parallel-groups randomised controlled trial.
Setting
Participants selected drinks in a simulated online supermarket, before purchasing them in an actual online supermarket.
Participants
Adults in England and Wales who regularly consumed and purchased beer or wine online (n= 644).
Interventions
Participants were randomised to one of six groups in a between-subjects 3 ( Health warning labels (HWLs) : i. image-and-text HWL, ii. text-only HWL, iii. no HWL) x 2 ( Calorie labels : present vs absent) factorial design.
Main outcome measures
The number of alcohol units selected (with intention to purchase); secondary outcomes included alcohol units purchased and calories selected and purchased.
Results
608 participants completed the study and were included in the primary analysis. There was no evidence of an overall difference for either (a) HWLs, or (b) calorie labels on the number of alcohol units selected [HWLs: F(2,599) = 0.406, p = .666; calorie labels: F(1,599) = 0.002, p = .961]. There was also no evidence of an overall difference on any secondary outcomes, including the number of alcohol units purchased [HWLs: F(2,462) = 1.85, p = .159; calorie labels: F(1,462) = 0.193, p = .661].
In pre-specified subgroup analyses comparing the ‘calorie label only’ group (n = 101) to the ‘no label’ group (n = 104) there was no evidence that calorie labels reduced the number of calories selected [unadjusted means: 1913 calories vs 2203 calories, p = .643]. Amongst the 75% of participants who went on to purchase drinks, those in the ‘calorie label only’ group (n = 74) purchased fewer calories than those in the ‘no label’ group (n = 79) [unadjusted means: 1532 calories vs 2090, p = .028].
Conclusion
There was no evidence that health warning labels reduced the number of alcohol units selected or purchased in an online purchasing setting. There was some evidence suggesting that calorie labels on alcoholic and non-alcoholic drinks may reduce calories purchased. Further evaluation is warranted in suitably powered studies in real world settings.
Trial registration
Pre-registered protocol ( https://osf.io/ch2sm/ ) and prospective ISCRTN registration: https://www.isrctn.com/ISRCTN10313219
Funding
This study was funded by Wellcome [Grant number 206853/Z/17/Z].
... Under Australian regulations, alcoholic beverages that do not make a nutrition content claim are not required by law to provide any nutrition content information, as is the case in other countries, including Canada [12,13]. Other jurisdictions have different requirements, for example countries belonging to the Eurasian Economic Union mandate presentation of the beverage's energy content on all alcohol labels [14]. The global alcohol industry has committed to improving alcohol nutritional labelling through more consistent and user-friendly presentation of nutritional content on alcoholic beverages [14][15][16]. ...
... Other jurisdictions have different requirements, for example countries belonging to the Eurasian Economic Union mandate presentation of the beverage's energy content on all alcohol labels [14]. The global alcohol industry has committed to improving alcohol nutritional labelling through more consistent and user-friendly presentation of nutritional content on alcoholic beverages [14][15][16]. The recently released Australian National Preventive Health Strategy 2021-2030 includes a recommendation that energy content information should be presented on all packaged alcoholic products. ...
Alcoholic beverages sold in Australia are largely exempt from requirements to display nutrition information on packages, unlike other food and beverages. However, alcoholic beverage manufacturers can provide nutrition-related information voluntarily. This study aimed to investigate the prevalence of nutrition-related information on packaged alcoholic beverages in Australia. An in-store audit of the largest alcohol retailer in Melbourne, Australia was conducted in July 2021. A systematic sampling method was used to assess the presence and format of nutrition information on 850 alcoholic beverages across 5 alcohol categories (wine (n = 200), beer (n = 200), spirits (n = 200), ready-to-drink beverages (n = 140) and ciders (n = 110)). Most products (n = 682, 80.2%) did not present nutrition-related information. Where information was presented (n = 168), it was most frequently on ready-to-drink beverages (n = 81, 57.9%) and least frequently on spirits (n = 9, 4.5%) and wines (n = 9, 4.5%). Nutrition information was most frequently in the format of a nutrition information panel (n = 150, 89.3%) and approximately half of labelled beverages (n = 86, 51.2%) included a nutrition content claim (e.g., ‘low in carbs’). Given limited voluntary implementation of nutrition labelling on alcoholic beverages in Australia and the substantial contribution of alcoholic beverages to energy intake, consideration of mandatory nutrition labelling, in a standardised format designed to maximise public health benefit, on alcoholic beverages is warranted.
... In the European Union (EU), alcohol labelling for beverages is evolving. Its harmful consumption is considered the causal agent of many human diseases (cardiovascular 19%, liver cirrhosis 20%, cancer 29%) and injuries (19%) in the EU [1]. Consequently, a set of new actions has been proposed by the European Commission (EC) on the label of alcohol beverages in accordance with the United Nations Sustainable Development Goals and with its Europe's Beating Cancer Plan. ...
... The latter and health issues have always aroused conflicting opinions. On the one hand, the consumption of wine induces enthusiasm and health benefits, but on the other hand and owing to its alcohol degree and excessive consumption, wine induces heath concerns (i.e., liver or pregnancy damage), can lead to violence and causes mortality and morbidity [1]. Despite these conflicting opinions, its effects on the cardiovascular system and the antioxidant action of the substances contained such as polyphenols are evident [4]. ...
A healthy-nutrient wine has been recently developed by Apulian wineries (southern Italy), using autochthonous wine grapes cultivars, selected strains and specific processes of production. As such, this research elicits Italian wine consumers’ preferences towards this innovative Apulian wine with regard to additional labelling information associated with health-nutrients and the origin of grapes on the bottle of wine. For this purpose, a social survey based on the choice experiment approach is considered. The results reveal a heterogeneity of preferences among respondents for which the origin of wine grapes cultivars is the most appreciated (an average Willingness-to-Pay of EUR 6.57), thereby inducing an increase in their function utility, while the health-nutrients attribute is relatively less appreciated (an average Willingness-to-Pay of EUR 3.95). Furthermore, four class consumers’ cluster profile have been identified in respect to their: (i) behavior and propensity to wine consumption and purchase, (ii) health-claims importance on the wine bottle label, (iii) socio-economic characteristics and (iv) health conditions. This paper has marketing and public implications and contributes to an understanding of how additional information on the label of a wine bottle may affect the market-segmentation, influence wine consumers’ utility, protect their health and increase their level of awareness to wine ingredients labelling.
... 18 Moreover, according to the WHO report on alcohol labelling in Europe, only France, Ireland and Lithuania have a legal requirement for a PWL on alcoholic beverages to inform the public of the danger of alcohol consumption during pregnancy. 19 ...
Purpose - Upstream social marketers advocate implementing effective public policies to protect vulnerable populations from the impacts of advertising harmful products. This research explores how alcohol ad content restrictions (as practised in some countries where ads may only convey factual information and objective properties of alcohol products) versus non-regulated advertising affect consumers’ product perceptions, attitude towards the ad, and desire to drink. It also examines how such restrictions influence the noticeability of text health warnings in ads (signalling alcohol-related risks) depending on their prominence.
Design/methodology - A multi-method study was used to increase the validity of results. An online quantitative survey (n = 348) and an eye-tracking study (n = 184) were conducted on young French people (15–30). The eye-tracking method is particularly relevant for objectively measuring visual attention.
Findings - Results show that content restrictions on alcohol advertising reduce ad appeal and desire to drink. A more prominent format enhanced attentional processing of the text warning, whereas none of the tested ad contents influenced its noticeability.
Originality - To the best of the authors’ knowledge, this is the first multi-method study that assesses the effect of regulated vs. non-regulated alcohol ads in terms of persuasion and of text warning visibility.
Practical implications - This study assesses scientific evidence of the effect on alcohol ad content regulations adopted by some countries and provides arguments for upstream social marketers to inform and influence policy makers.
... 18 Moreover, according to the WHO report on alcohol labelling in Europe, only France, Ireland and Lithuania have a legal requirement for a PWL on alcoholic beverages to inform the public of the danger of alcohol consumption during pregnancy. 19 ...
Objectives
Every year, foetal alcohol spectrum disorders impact 1 in 100 live births in France. France is one of the few countries with mandated labelling that must include a pregnancy warning. However, as the regulation passed with minimal specifications regarding the size and colour of the ensuing pictogram, the current pregnancy warning labels (PWLs) is often barely visible. This study investigated the potential influence of the PWL design on women's attention and alcohol product choice.
Study design
The study used a within-subject experiment, with participants exposed to four PWL conditions.
Methods
An eye-tracking method was adopted. Eye movement was used as a proxy for measuring visual attention. In total, 4752 observations were collected (99 participants × 48 wine bottles) among women of childbearing age.
Results
The results show that almost none of the participants paid attention to the current French PWL. However, the findings also indicate that a larger colourful PWL, with a combined text and pictogram, attracts far more attention, and that participants chose the bottles of wine displaying this type of PWL less frequently.
Conclusions
The study indicates that the current French PWL is insufficient to draw women's attention and suggests improvements to the PWL design to help increase its effectiveness.
... Despite international public health calls [16,40] and specific World Health Organization recommendations for widespread provision of nutrition information on packaged alcoholic products to guide informed consumer choice [41], energy labelling (i.e., the listing of calorie/ kilojoule information) is not mandatory in many jurisdictions, including the United States, European Union, and Australia. Reports suggest international alcohol industry pressure has delayed more widespread uptake in international policy (e.g., the Codex Alimentarius) of labelling requirements supported by public health evidence [42]. ...
Background
Alcohol is a discretionary, energy dense, dietary component. Compared to non-drinkers, people who consume alcohol report higher total energy intake and may be at increased risk of weight gain, overweight, and obesity, which are key preventable risk factors for illness. However, accurate consumer knowledge of the energy content in alcohol is low. To inform future behaviour change interventions among drinkers, this study investigated individual characteristics associated with changing alcohol consumption due to energy-related concerns.
Methods
An online survey was undertaken with 801 Australian adult drinkers (18–59 years, 50.2% female), i.e. who consumed alcohol at least monthly. In addition to demographic and health-related characteristics, participants reported past-year alcohol consumption, past-year reductions in alcohol consumption, frequency of harm minimisation strategy use (when consuming alcohol), and frequency of changing alcohol consumption behaviours because of energy-related concerns.
Results
When prompted, 62.5% of participants reported changing alcohol consumption for energy-related reasons at least ‘sometimes’. Women, those aged 30–44 years, metropolitan residents, those with household income $80,001–120,000, and risky/more frequent drinkers had increased odds of changing consumption because of energy-related concerns, and unemployed respondents had reduced odds.
Conclusions
Results indicate that some sociodemographic groups are changing alcohol consumption for energy-related reasons, but others are not, representing an underutilised opportunity for health promotion communication. Further research should investigate whether messaging to increase awareness of alcohol energy content, including through systems-based policy actions such as nutritional/energy product labelling, would motivate reduced consumption across a broader range of drinkers.
Objectives
To test the efficacy of calorie labelling for alcoholic and non-alcoholic beverages on restaurant menus on noticing calorie information, calorie knowledge, and perceived and actual influence on hypothetical beverage orders.Methods
Participants included upper-level university students of legal drinking age residing in Ontario, Canada (n = 283). Using a between-groups experiment, participants were randomized to view one of two menus: (1) No Calorie Information (control), and (2) Calorie Information adjacent to each beverage. Participants completed a hypothetical ordering task, and measures related to noticing calorie information, calorie knowledge, and actual and perceived influence of calorie information on beverages ordered were assessed. Linear, logistic, and multinomial logistic regression models were used to examine the four outcomes.ResultsThe odds of noticing calorie information were significantly higher in the Calorie Information (72.6%) versus No Calorie Information condition (8.0%) (OR = 43.7, 95% CI: 16.8, 113.8). Compared to those in the No Calorie Information condition, participants in the Calorie Information condition had significantly lower odds of responding ‘Don’t know’ (OR = 0.04, 95% CI: 0.02, 0.09), underestimating (OR = 0.06, 95% CI: 0.02, 0.2), and overestimating (OR = 0.05, 95% CI: 0.02, 0.2) versus accurately estimating calories in beverages ordered. No significant differences were observed between menu labelling conditions in the calories in beverages ordered or the perceived influence of calorie information on the number of beverages ordered.Conclusion
Exposure to menus with calorie information increased consumers noticing the calorie information, and accurately estimating calories in alcoholic and non-alcoholic beverages ordered. These results have implications for policy-makers considering mandatory menu labelling policy inclusive of alcoholic beverages.
BACKGROUND: Alcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older. METHODS: Using 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health. FINDINGS: Globally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. For the population aged 15–49 years, female attributable DALYs were 2·3% (95% UI 2·0–2·6) and male attributable DALYs were 8·9% (7·8–9·9). The three leading causes of attributable deaths in this age group were tuberculosis (1·4% [95% UI 1·0–1·7] of total deaths), road injuries (1·2% [0·7–1·9]), and self-harm (1·1% [0·6–1·5]). For populations aged 50 years and older, cancers accounted for a large proportion of total alcohol-attributable deaths in 2016, constituting 27·1% (95% UI 21·2–33·3) of total alcohol-attributable female deaths and 18·9% (15·3–22·6) of male deaths. The level of alcohol consumption that minimised harm across health outcomes was zero (95% UI 0·0–0·8) standard drinks per week. INTERPRETATION: Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption. FUNDING: Bill & Melinda Gates Foundation.
The proposal to introduce a Public Health (Alcohol) Bill marks a significant development in Ireland’s alcohol policymaking landscape. While the Bill has generated support from public health advocates, it has also raised considerable opposition, particularly from industry. This analysis aims to examine the debate around this Bill using the theoretical framework of critical discourse analysis and applying Carol Bacchi’s What’s the Problem Represented To Be critical mode of analysis. A key objective is to analyze the current prevailing representations of alcohol and its regulation in Ireland but also to consider what they reveal about the underlying governing rationality in relation to alcohol regulation. In particular, it questions whether the Bill signals a shift in the official governing rationality regarding alcohol regulation. The analysis illustrates how alcohol is problematized in markedly different ways in the debates and how such debates are often underpinned by multifaceted elements. Despite such differences, it argues that there are still signs of a neoliberal rhetoric emerging within the public health discourses, raising a question over whether the Bill and its supporting discourses signal a paradigmatic shift or are more indicative of a policy embracing hybrid forms of rule.
Background
In France, since 2007, there is a compulsory warning recommending abstinence during pregnancy on every container of alcohol. Awareness of this warning, which consists of a small pictogram, is unknown. The aim of this study was to assess awareness of the warning and risk perceptions about prenatal drinking in pregnant and postpartum women.
Methods
A cross-sectional survey was carried out by telephone five years after the introduction of the warning label. A total of 3603 pregnant or postpartum French women participated. A quota sampling method was used to ensure the sample reflected the population. Multivariate analyses examined the characteristics associated with knowledge of risks and with awareness of the warning label.
Results
The warning label had been noticed by 66.1% of women and 77.3% of drinkers. Of those who had noticed the warning, 98.6% thought that it suggested abstinence. Overall, 40.8% of the women thought that spirits were more harmful than wine or beer, and 8.9% thought that drinking beer was recommended for lactation.
Conclusion
Awareness of the warning is high but knowledge about the risks associated with wine and beer is poor.
Practice Implications
Future information campaigns should educate women about standard drinks and their pure alcohol equivalent. They should emphasize the risks associated with drinking during breastfeeding.
The proposal to make it compulsory to include a list of ingredients in the labelling of wine and other alcoholic beverages has been debated and rejected many times. It was discussed at length during the legal process leading to the adoption of Directive 79/112/EEC on the labelling, presentation and advertising of foodstuffs, when the ultimately successful arguments presented by opponents of the measure ranged from the view that wine is a living organism whose composition is constantly mutating, to the opinion that such information is irrelevant to consumers. Alcoholic beverages thus remained exempt, despite article 6.3 of the Directive prescribing that «in the case of beverages containing more than 1.2 % by volume of alcohol, the council, acting on a proposal from the commission, shall, before the expiry of a period of four years following notification of this directive , determine the rules for labelling ingredients and, possibly, indicating the alcoholic strength». In fact, no such measure was adopted (although the sixth recital of the Directive specified that «… the prime consideration for any rules on the labelling of foodstuffs should be the need to inform and protect the consumer»).
Background: Many countries use warnings in an attempt to regulate alcohol consumption. However, there is a lack of conclusive evidence in the research on alcohol warnings to support decision-making on effective health policies. This study explores the effectiveness of two mandatory warnings introduced in France in 1991 and 2007: the first (“Alcohol abuse is harmful”) is displayed on advertisements; the second (a pictogram) on bottles. Given that advertising content regulations have been implemented in some countries to reduce the attractiveness of alcohol marketing (e.g., the Evin law in France), this research also aims to explore whether such regulations can improve the effectiveness of warnings.
Method: In-depth interviews were conducted with 26 French people aged 15-29. The effectiveness of health warnings was assessed in terms of recall, noticeability, credibility, comprehension, responsiveness and ability to encourage moderate drinking and abstinence during pregnancy. Participants were shown advertisements and bottles that either followed or challenged content regulations. The data was analysed using double manual coding and NVivo software.
Results: While both warnings suffered from a lack of visibility and noticeability due to their size, location, outdatedness and because of competition from marketing design elements, the warning on the advertisement that followed content regulations was most visible. Both warnings were considered to be informationally vague, lacking in credibility and ineffective in terms of making participants feel concerned and influencing consumption habits.
Conclusion: Current French warnings are ineffective and require modification. Improvements are suggested regarding the design and content of warnings to help increase their effectiveness.
Like the tobacco industry, the alcohol industry, with the support of governments in alcohol exporting nations, is looking to international trade and investment law as a means to oppose health warning labels on alcohol. The threat of such litigation, let alone its commencement, has the potential to deter all but the most resolute governments from implementing health warning labeling.
Background:
Public sector bodies have called for policies and programmes to shift collective social norms in disfavour of the harmful use of alcohol. This article aims to identify and summarize the evidence and propose how policies and programmes to shift social norms could be implemented and evaluated.
Design:
Review of reviews for all years to July 2017.
Data sources:
Searches on OVID Medline, Healthstar, Embase, PsycINFO, AMED, Social Work Abstracts, CAB Abstracts, Mental Measurements Yearbook, Joanna Briggs Institute EBP, Health and Psychosocial Instruments, International Pharmaceutical Abstracts, International Political Science Abstracts, NASW Clinical Register and Epub Ahead of Print databases.
Eligibility:
All reviews, without language or date restrictions resulting from combining the terms ((review or literature review or review literature or data pooling or comparative study or systematic review or meta-analysis or pooled analysis) and (social norms or culture) and (alcohol drinking)).
Results:
Two relevant reviews were identified. One review of community-based interventions found one study that demonstrated small changes in parental disapproval of under-age drinking. One review stressed that collective social norms about drinking are malleable and not uniform in any one country. Three factors are proposed to inform programmes: provide information about the consequences of the harmful use of alcohol, and their causes and distribution; act on groups, not individuals; and strengthen environmental laws, regulations and approaches.
Conclusions:
Purposeful policies and programmes could be implemented to change collective social norms in disfavour of the harmful use of alcohol; they should be evidence-based and fully evaluated for their impact.
Objectives
Alcohol is a significant source of dietary calories and is a contributor to obesity. Industry pledges to provide calorie information to consumers have been cited as reasons for not introducing mandatory ingredient labelling. As part of the Public Health Responsibility Deal (RD) in England, alcohol retailers and producers committed to providing consumers with information on the calorie content of alcoholic drinks. This study examines what was achieved following this commitment and considers the implications for current industry commitments to provide information on alcohol calories.
Study design
Analysis of RD pledge delivery plans and progress reports. Assessment of calorie information in supermarkets and in online stores.
Methods
(i) Analysis of the content of pledge delivery plans and annual progress reports of RD signatories to determine what action they had committed to, and had taken, to provide calorie information. (ii) Analysis of the availability of calorie information on product labels; in UK supermarkets; and on online shopping sites and websites.
Results
No information was provided in any of 55 stores chosen to represent all the main UK supermarkets. Calorie information was not routinely provided on supermarkets' websites, or on product labels.
Conclusions
One of the stated purposes of the RD was to provide consumers with the information to make informed health-related choices, including providing information on the calorie content of alcoholic drinks. This study indicates that this did not take place to any significant extent. The voluntary implementation of alcohol calorie labelling by industry needs to continue to be carefully monitored to determine whether and how it is done.
Background
Public support for policies to reduce alcohol consumption and harms generally has an inverse association with policy effectiveness: policies with greatest evidence for effectiveness, such as pricing and availability, are often the least popular. Internationally, awareness of alcohol as a risk factor for cancer has been shown to be associated with higher levels of support for increased price, volumetric taxation, fewer alcohol outlets, banning sports sponsorship, guideline labelling, and health warning labels, suggesting that the acceptability of politically contentious public health policies might vary with understanding of relevant health risks. This study aimed to examine the association between awareness that alcohol can cause cancer and public support for policies relevant to current UK alcohol policy debates.
Methods
An online survey of 2100 adults was conducted in England in July, 2015, with population-representative quota sampling for age, sex, region, and education. Support for 21 alcohol policies in the domains of pricing, availability, drink-driving countermeasures, health services, industry responsibility, labelling, and advertising or marketing were assessed on a 5 point Likert scale (“strongly oppose” to “strongly support”). Logistic regression analyses tested whether sociodemographic characteristics (sex, age, region, education, income), alcohol use, tobacco use, and knowledge of the alcohol–cancer link were associated with support for six key policies previously investigated in Australia (ie, increased price, volumetric taxation, fewer outlets, banning sports sponsorship, guideline labelling, health warning labels).
Findings
Support was highest for displaying the number of alcohol units on labels and lowest for increasing alcohol prices (73·6% and 26·6%, respectively, endorsing “support” or “strongly support”). Level of alcohol use was inversely related to policy support. Previous international findings of a significant association between cancer knowledge and support for six alcohol policies were replicated in this sample, with the odds of respondents who were aware of the link between alcohol and cancer being supportive of policies (compared with those who were not aware) ranging from between 1·3 for compulsory guideline labelling and 1·7 for taxation according to alcohol by volume.
Interpretation
Support for alcohol policies may be greater when health risks are understood.
Funding
Policy Research Centre for Cancer Prevention, Cancer Research UK. The authors are solely responsible for the content of this paper.
