Alcohol product warning labels to deter alcohol misuse and prevent alcohol-related diseases: a call to action in Canada

Alcohol is consumed by 80% of the Canadian population, making it one of the most commonly used substances (1). 15% of alcohol users consume amounts greater than those recommended by the Canada’s Low Risk Drinking Guidelines, with young adults (those aged between 18 and 24 years) making up the largest proportion of these risk-taking drinkers (2). Short-term outcomes of alcohol use include motor vehicle accidents, violence, alcohol intoxication and withdrawal syndromes, risky sexual behaviour, alcoholic hepatitis, and fetal alcohol syndrome; and long-term health effects are not limited to liver, cardiac, oncological, and psychiatric diseases, some of which may be terminal (3,4). In 2017, 249 people per 100,000 were hospitalized as a result of alcohol use, and in 2014, 14,836 deaths were caused by alcohol misuse (2). Moreover, alcohol made up 36.2%, or $16.6 billion, of the total costs of substance use in 2017 (5). During the COVID-19 pandemic, 18% of those who stayed at home reported that their alcohol consumption increased (6). It is clear that alcohol use is a major public health and socio-economic concern in Canada (7).

Given these statistics, it is not surprising that the level of awareness of the negative health effects of alcohol is low among the general population. A survey conducted by the Canadian Cancer Society showed that only 28% of Ontario residents were aware of the linkage between alcohol and cancer (8). Two-thirds of those who were unaware claimed that they would decrease their alcohol consumption if they were informed about the linkage (8). In Prince Edward Island, only 22.3% of residents knew about the Low Risk Drinking Guidelines (9). Alcohol consumption, even excessive, was also rated as completely socially acceptable on a 5-point Likert scale by 56% of 9,215 participants in another Canadian survey (10).

As such, education is key to addressing this issue. One of the many actions that can be taken is to add warning labels to alcoholic products. Currently, no province has made these labels mandatory (11). However, studies conducted in Canada on the efficacy of warning labels show promising results. An interrupted study reported a 6.31% decrease in total per capita sales when labels on cancer risk, low-risk drinking guidelines, and standard drink information were introduced in Whitehorse, Yukon (12). Labels also increased awareness of and conversations about alcohol-related health effects and decreased consumption among participants in a quasi-experimental study (13). Graphic warning labels have been found to increase motivation to reduce alcohol consumption, with severe health warning labels being more effective than moderately severe ones (14,15). Studies in other countries have also shown positive effects of warning labels in combating alcohol use. In the United Kingdom, a randomized controlled trial found that participants preferentially selected non-alcoholic rather than alcoholic drinks when alcoholic beverages contained warning labels (16). More than 50% of women who participated in a cross-sectional survey in New Zealand agreed that warning labels provided a good source of information about the adverse effects of alcohol during pregnancy (17). Hence, strong evidence supports the fact that warning labels can be effective in reducing the burden caused by alcohol use when implemented properly.

In addition, it is important that warning labels are well designed. To achieve maximal benefits, labels should have clear messages about the health and social consequences of alcohol use, be attractive or attention grabbing, communicate a diverse set of messages instead of being repetitive, and make reference to others or the public in addition to the drinkers themselves (18,19). Larger-sized warning labels were shown to be associated with decreased ratings for alcoholic products among 440 adults in Nova Scotia (20). In addition to having health warnings on labels, a review suggested that the number of calories and a list of ingredients are useful information for drinkers (21).

However, warning labels cannot be expected to solve such a substantial societal issue on their own, and therefore additional educational initiatives will be necessary (18,19,22). Large-scale media campaigns have been successful in increasing awareness about the relationship between alcohol and cancer and increasing support for alcohol-related policies among the public (23). In Manitoba, a 30-second advertisement broadcast on television for about 2 months also increased awareness of the health effects of alcohol during pregnancy (24). School-based prevention programs are also effective in reducing rates of alcohol use (25,26). A combined and integrated approach that involves all of these initiatives increases the chances of bringing about significant behavioural and attitude changes.

It is hoped that rates of alcohol misuse among Canadians will improve, just as dramatic declines were seen in smoking rates through similar mass awareness campaigns, preventive programs, and policy changes, including mandatory warning labels on tobacco packaging (27). It is now the duty and responsibility of public health agencies and policy-makers to ignite and implement needed interventions to protect and save Canadians who are currently ignorant of the many harms of alcohol. At the very least, a product warning label on a bottle of alcohol will inform consumers that a higher authority (ie, the government) takes the risks seriously enough to require a safety label; for some, it may be the only source of information they see. As with cigarette product warnings, the benefits may not be appreciated for years or even decades, but any long journey must begin with a first step, and this first step is long overdue.

Funding:

No funding was received for this article.

Disclosures:

There are no disclosures to declare.