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. 2020 Apr 2;20(1):376.
doi: 10.1186/s12889-020-8403-8.

Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability

Emily Pechey  1 , Natasha Clarke  1 , Eleni Mantzari  1 , Anna K M Blackwell  2 , Katie De-Loyde  2 , Richard W Morris  3 , Theresa M Marteau  1 , Gareth J Hollands  4
Affiliations

Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability

Emily Pechey et al. BMC Public Health. .

Abstract

Background: Health warning labels (HWLs) using images and text to depict the negative health consequences of tobacco consumption are effective and acceptable for changing smoking-related outcomes. There is currently limited evidence concerning their potential use for reducing consumption of alcoholic drinks and energy-dense foods. The aim of this research was to describe the potential effectiveness and acceptability of image-and-text (also known as pictorial or graphic) HWLs applied to: i. alcoholic drinks and ii. energy-dense snack foods.

Methods: Two online studies were conducted using between-subjects designs with general population samples. Participants rated one of 21 image-and-text HWLs on alcoholic drinks (n = 5528), or one of 18 image-and-text HWLs on energy-dense snacks (n = 4618). HWLs comprised a graphic image with explanatory text, depicting, respectively, seven diseases linked to excess alcohol consumption, and six diseases linked to excess energy intake. Diseases included heart disease and various cancers. Outcomes were negative emotional arousal, desire to consume the labelled product, and acceptability of the label. Free-text comments relating to HWLs were content analysed.

Results: For both alcoholic drinks and energy-dense snacks, HWLs depicting bowel cancer generated the highest levels of negative emotional arousal and lowest desire to consume the product, but were the least acceptable. Acceptability was generally low for HWLs applied to alcohol, with 3 of 21 rated as acceptable, and was generally high for snacks, with 13 of 18 rated as acceptable. The majority of free-text comments expressed negative reactions to HWLs on alcohol or energy-dense snacks.

Conclusions: Image-and-text health warning labels depicting bowel cancer showed greatest potential for reducing selection and consumption of alcoholic drinks and energy-dense snacks, although they were the least acceptable. Laboratory and field studies are needed to assess their impact on selection and consumption.

Keywords: Alcohol; Cancer; Food; Graphic health warning labels; Image-and-text warning labels; Pictorial health warning labels.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Example labelled products. The HWL was presented on beer or wine depending on participants’ stated preference. The drinks used in the study were branded, but product branding is covered here for copyright reasons. A single brand of wine or beer was used consistently across participants – to ensure effects would be due to different HWLs and not due to different brands. Image permissions from Shutterstock (https://www.shutterstock.com)
Fig. 2
Fig. 2
Example labelled product. The snack used in the study was a popular branded chocolate bar, but product branding is covered here for copyright reasons. A single brand was used consistently across participants – to ensure effects would be due to different HWLs and not due to different brands. Image permissions from Shutterstock (https://www.shutterstock.com)
Fig. 3
Fig. 3
Alcohol: Negative emotional arousal by HWL consequence1
Fig. 4
Fig. 4
Food: Negative emotional arousal by HWL consequence.1 1Centre lines show the medians; box limits indicate the 25th and 75th percentiles; whiskers extend 1.5 times the interquartile range from the 25th and 75th percentiles (no data points exceed this distance, therefore the whiskers are the minimum and maximum values); crosses represent sample means; grey bars indicate 95% confidence intervals of the means. Sample sizes are listed above the x axis
Fig. 5
Fig. 5
Affective content of comments relating to Effectiveness and Acceptability of image-and-text HWLs on Alcohol and Snack foods. 1. Percentages are of total number of effectiveness and acceptability comments
See this image and copyright information in PMC

References

    1. Brown KF, Rumgay H, Dunlop C, Ryan M, Quartly F, Cox A, et al. The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015. Br J Cancer. 2018;118(8):1130. doi: 10.1038/s41416-018-0029-6. - DOI - PMC - PubMed
    1. Rehm J, Gmel GE, Sr, Gmel G, Hasan OSM, Imtiaz S, Popova S, et al. The relationship between different dimensions of alcohol use and the burden of disease—an update. Addiction. 2017;112(6):968–1001. doi: 10.1111/add.13757. - DOI - PMC - PubMed
    1. WHO . Obesity and overweight. Fact sheet. 2018.
    1. Roberts C, Steer T, Maplethorpe N, Cox L, Meadows S, Nicholson S, et al. National Diet and nutrition survey: results from years 7 and 8 (combined) of the rolling Programme (2014/2015–2015/2016) 2018.
    1. Canadian Cancer Society. Cigarette package health warnings: international status report; 2018. http://www.cancer.ca/~/media/cancer.ca/CW/for%20media/Media%20releases/2.... Accessed July 2019.

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