Health warnings on alcohol containers
Consideration of a possible requirement for health warning labels on alcohol containers was included in the terms of reference for the 1996 Liquor Review, but not considered by that committee on the grounds that it had been raised with the ANZFA by Australian applicants. When it was not included in the Sale of Liquor Amendment Bil, an MP put forward a Supplementary Ordern in 1999, following by a Private Member's Bill in 2000. Neither gained sufficient support to be passed.
The following is the Alcohol & Public Health Research Unit's
Health Warnings on Alcoholic Beverages
The Alcohol & Public Health Unit is a multi-disciplinary research unit which aims to carry out high quality research which enhances knowledge about health promotion and is responsive to the health promotion needs of the people of New Zealand and the South Pacific. It receives programme funding from the Health Research Council and the Alcohol Advisory Council.
The Alcohol & Public Health Research Unit wishes to support the introduction of health warnings on alcohol containers, each with a single message from a rotated set of several alcohol-related health risks. This support is based on available research which indicates that alcohol health warnings on containers can be an effective, low cost and publicly supported mechanism for raising awareness about alcohol related harm and influence the social climate in which drinking occurs.
Alcohol container labels have been introduced in the United States (as well as Mexico and India) warning of the risks of drinking while pregnant, driving a vehicle and other health problems. Public Law No.110-690, 1988, mandated a health warning label about foetal alcohol syndrome, from November 1989, based on research evaluation of other health labelling, notably on tobacco products (Holder 1993). The introduction of alcohol labelling gradually on new packaging and new products, and the passage of time required for maximum awareness to develop among consumers, necessitated longitudinal evaluation, carried out in a series of research projects by the Alcohol Research Group and the Department of Psychiatry of the University of California, San Francisco. The results from this have now emerged and lead to the following conclusions which make container labels an attractive harm reduction intervention for governments (Greenfield, forthcoming).
1. Product health warning labels are a mechanism which reaches the appropriate 'target groups'.
Alcohol labelling in the United States is reaching its intended target of those who are at elevated risk of harm, as those who consume the most alcohol open the most containers. Over four fifths of the heaviest consuming men reported seeing the label 3.5 years after its introduction. Over a third of those under 30 opening even a moderate number of containers recalled seeing the message about drink driving.
2. Label messages can focus on practical, plausible preventative actions and has been shown to influence behaviour.
As the first message on US containers label, and that least promoted elsewhere, the pregnancy risk message attracted the highest recall rates among all participants in the US surveys. Ninety-six percent of women surveyed who had been pregnant in the past year reported a maximum of two drinks or less per occasion. Two-thirds of those who recalled the pregnancy risk label message indicated that they had reduced their usual consumption level while pregnant. Similarly those who recalled the label's drink driving message were significantly more likely to report limiting their driving after drinking, while those who limited their drinking when intending to drive were also more likely to recall the message.
These findings are consistent with the intention of the United States legislation, showing that the appropriate groups are being reminded of risks relevant to them and those most exposed to the message (by number of containers opened) are more likely than others to report adopting reduction strategies.
3. Labelling is a low cost intervention.
Labelling legislation, once enacted, need only involve costs to government in administration and enforcement. Costs to industry are also low. There are costs in initial design, but the label becomes part of normal packaging production costs. In the United States strong initial opposition from industry did not continue after enactment. The labelling requirement has not had much impact on overall sales, which continue a slightly downward trend, and may have been perceived to offer some legal protection against negligence suits for failure to inform (Greenfield, forthcoming).
4. Labelling is based on consumers' 'right to know' and is a policy which draws high public support.
Labelling offers consumers brief but accurate information on which to base their choices about the use of alcohol. Attitudinal surveys in both the US and Ontario showed labelling as a policy measure which enjoyed around 90 percent support, over a 5 year period in which support for some other alcohol policies declined (Greenfield, forthcoming). The public did not have high expectations that heavy drinkers would be affected by labelling but 18 months after enactment 55 percent of moderate drinkers reported an influence on their own drinking. As the message on labels 'grew old', this reported influence on personal behaviour declined to 42 percent in 1994, but endorsement of labelling policy continued to increase.
5. Impact of labelling at a societal level
As well as impacting on individuals, warning labels can impact at a societal level by helping to give some problems associated with alcohol a higher profile. This agenda setting function (Casswell 1995) helps to counter processes of normalisation, whereby through mechanisms such as alcohol advertising people are encouraged to focus on the benefits of drinking and not the associated problems. Warning labels will help to provide a more balanced flow of information, to allow more informed choice.
The introduction of warning labels by a government also provides a meta-message to society that it is taking alcohol issues seriously. This would be best conveyed if labelling covered the range of alcohol related health risks, rather than foetal alcohol syndrome alone.
Potential for improved effectiveness of labelling in Australia and New Zealand
A number of lessons from the United States experience can be drawn on to improve the effectiveness of alcohol warning labels if such a policy measure was introduced in Australian and New Zealand. US researchers note that the findings and recommendations from a comprehensive literature review of experience with other products were insufficiently implemented in the alcohol labelling law, meaning that the policy did not fulfil its full potential as an effective preventative intervention. There were no requirements for an attention-getting format (Greenfield, forthcoming); labels currently on products were not 'conspicuous and prominent (Malouff et al 1992) and warning messages were not strongly worded (MacKinnon 1993). Gradual product-by-product implementation was felt to have had less public impact than could have been achieved by requiring health warnings on all alcohol containers by the same date, as had been recommended by the prior comprehensive literature review . This gradual introduction was unsupported by the recommended media or community campaigns complementing the label (Greenfield, forthcoming).
Greenfield noted that lack of regulation about size and placement has led some producers to be 'ingenious in disguising' the required label. Research by Malouff et al (1992) shows that rates and recall of labels can be increased by making them more 'prominent and conspicuous' through use of a contrasting colour, minimum type size, horizontal placement. Psychology research on alcohol labelling (MacKinnon 1993) shows that some warnings, such as the words 'poison', 'toxic' or 'causes cancer' have a powerful avoidance effect, while the inclusion of qualifier words such as 'may' or 'should' render labels less effective. The need for strongly worded statements has been identified by Slater and Domenech (1995).
Greenfield (forthcoming) gives evidence of greater recall of the first risk mentioned and a reduced response as the US label 'grows old' and is tuned out; they suggest rotating the messages in the label. Other research suggests that warning of a single risk is likely to be more effective than including several issues in the one label (McKinnon 1993).
These findings suggest that a higher rate of label reading, recall and preventative behaviour will result from an alcohol labelling policy which lays down clear requirements as to size and format for a strongly worded health warnings on alcohol containers. Each label should one message about a single health risk, rotated from an approved set of warnings on several alcohol-related health risks.
Support for Alcohol Health Warning Policy
The Alcohol & Public Health Research Unit fully supports legislation requiring government health warning labels on all alcohol product containers. It recommends the use of a single-risk message on each label, drawn from a rotated set of approved alcohol health warnings. Implemented as part of a health promotion campaign on alcohol issues, this would be an effective means of reminding drinkers of alcohol related risks, and influencing both social behaviour and the choices of individual consumers.
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