Alcohol and cancer: Warnings needed to be seen to be effective

Introducing prominent health warnings on alcohol products could be effective in increasing awareness of the potential harms of drinking, according to a new study involving young adult drinkers.

“Led by the University of Stirling, the research found that the study participants considered the limited health information currently provided by manufacturers on some alcohol products to have little to no value in shaping or informing consumer decisions,” wrote University of Stirling in the beginning of March 2021.

One of the warnings discussed with the participants was “Alcohol causes cancer”, and this is something we wanted to know more about, so we turned to Daniel Jones, the lead author of the study.

Lauri Beekmann: Do you have an overall estimate, what is the awareness level of alcohol and cancer link in Scotland? In other words, would these warnings act mainly as informative (about something that they didn´t know about) or as reminders of something that they do already know?

Daniel Jones: From the article: “Low awareness of the alcohol-cancer link has been found in other countries (Bates et al. 2018; Scheideler and Klein 2018; Thomsen et al. 2020; Weerasinghe et al. 2020), highlighting the potential role that well-designed warnings on alcohol packaging could have in improving awareness of alcohol-related harms and informing consumers (WHO 2020a).”. I am not aware of any Scotland-specific research on alcohol-cancer awareness, but here is a study from England showing low levels of unprompted awareness, increasing when prompted. As such, it is likely that similarly low levels of unprompted awareness exist in Scotland, i.e. no evidence to suggest otherwise.

I think the primary role of specific health warnings (e.g. ‘alcohol causes mouth cancer’) would be informative until the point that public awareness is large enough for them to become reminders.


Daniel Jones, Institute for Social Marketing and Health, University of Stirling

What were the main reactions to cancer warnings? 

Participants took them seriously and were somewhat taken aback by seeing them on alcohol products. Participants noted the seriousness and relatability of cancer and some thought the image helped to visualise what could happen. A few people disputed/were unsure whether alcohol caused cancer and wondered whether it would be useful to include ‘cut-off’ points, i.e. how much alcohol could/will cause cancer. I am not recommending this last point, but it was something that some participants felt might be useful. Maybe it opens the door for a warning such as ‘there is no safe level of alcohol consumption’ or something to that effect.

What would an ideal warning look like to potentially be effective in changing consumers behaviour? 

The groups thought that the most effective warnings would be designed to be prominent with realistic messages relevant to real life: large, front-of-pack, image-and-text warnings with specific/useful message content. Warnings needed to be seen to be effective and the images complemented the message by showing consumers what might happen in a way that required little cognitive processing.

How important is, in your personal view, the consumers right-to-know argument, even if these warnings wouldn´t change actual behaviour? 

In my personal view, I think that is the fundamental reason for including prominent/salient warnings on alcohol packaging. By providing important alcohol-related health information at the point of purchase and consumption, consumers are better informed about the potential risks and are in a better position to make more informed choices. People can still choose to drink and at what level they want, but with more accessible and accurate information at their fingertips so to speak. I think providing information needs to be the starting point, given that current alcohol packaging is suboptimal and failing to inform consumers (as argued in the paper). By bridging that gap, it offers consumers a more informed choice and may help to change drinking behaviours (evidence provided in the paper).

In your conclusions, you refer to a need for a global response. As Ireland has adopted the cancer warning regulations, although without implementation yet, what should be the following steps worldwide? 

More research is needed on what constitutes effective warnings, how consumers perceive and use the information, messaging, and warnings on current alcohol packaging, different categories of drinkers (e.g. age, sex, frequency), and what role warnings may play in increasing awareness and changing drinking behaviours. There is a huge pre-existing body of knowledge to adapt/learn from tobacco packaging warnings research, and many of the same features are coming out in alcohol warnings research re. optimal warning design and potential roles of warnings. This all has to be considered within the wider alcohol policy field, as warnings will be one tool in helping to inform consumers and potentially reduce alcohol-related harms.

Read the paper ‘Health information, messaging and warnings on alcohol packaging: a focus group study with young adult drinkers in Scotland’