Role of labeling in prevention of alcohol abuse.
Article Type: Editorial
Subject: Alcoholism (Prevention)
Patient package inserts (Health aspects)
Author: Sharma, Manoj
Pub Date: 12/01/2009
Publication: Name: Journal of Alcohol & Drug Education Publisher: American Alcohol & Drug Information Foundation Audience: Academic; Professional Format: Magazine/Journal Subject: Health; Psychology and mental health; Social sciences Copyright: COPYRIGHT 2009 American Alcohol & Drug Information Foundation ISSN: 0090-1482
Issue: Date: Dec, 2009 Source Volume: 53 Source Issue: 3
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 218817573
Full Text: On-product labeling is a common method of providing information to the consumer. For some products labeling can also serve as an important means for imparting health-related messages. For example, packaged processed foods have been mandated to provide nutrition labels and cigarette warning labels have been required in the United States since 1965 (Engs, 1989).

In the case of alcohol, warning labels have been mandated by authorities in many countries to inform consumers and deter alcohol abuse. Besides the warning label on alcohol products, information about alcohol content is also important as it can help users monitor their intake (International Center for Alcohol Policies [ICAP], 2008). In the United States, the wine label must include: brand identification or brand name, class or type of wine, name and address of the bottler or producer, appellation of origin, varietal labeling, vintage labeling, alcohol content, volume of contents, declaration of sulfites, and government health warning (WineSearcher.com, 2009). The government health warning label was implemented in United States in 1989 (Agnostinelli & Grube, 2002) and is usually as follows: (1) According to the Surgeon General women should not drink alcoholic beverages during pregnancy because of the risk of birth defects; (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems. In addition to on-product labeling several states in the United States also require the display of health warning posters at places where alcohol is sold. In the United States the labeling laws are enforced by the Alcohol and Tobacco Tax and Trade Bureau (TTB). However, many countries such as Australia and New Zealand do not have warning labels on alcohol as of 2009 (Stockley, 2001; Wilkinson & Room, 2009).

The utility of health warnings has been challenged by researchers, policy makers and the public. Engs (1989) has raised several questions about the effectiveness of warning labels as educational tools. She questions whether people read them, whether warning labels can work either alone or if supported by existing school, media or other public health programs. She questions whether warning labels are sufficient to change behavior or whether they merely provide a false sense of security. On the other hand, Smart (1990) presents a case in favor of warning labels and notes that research on health warnings on cigarettes as well as on prescription and nonprescription drugs supports the use of labels as effective methods to prevent their abuse.

Warning labels are a form of counter-advertising. In the literature, an Elaboration Likelihood Model (ELM) has been presented to understand counter-advertising (Agnostinelli & Grube, 2002; Petty & Cacioppo, 1986). This model delineates two ways in which counter advertising works. One is the central way and the second is the peripheral way. In the central way "issue relevant thinking," is where people receiving the message evaluate that message based on their knowledge, which may result in changing of their behavior. In the peripheral way there is no "issue relevant thinking" and things such as the credibility of the messenger may sway the recipient to change his or her stance. The change that takes place through the central way is longer lasting. This model is useful in understanding how warning labels might work.

An issue with warning labels is whether or not these labels are actually read by consumers. Kaskutas and Greenfield (1992) telephonically interviewed people six months before and six months after the enactment of the warning label law in 1989 and found that only a little over one fifth of the respondents saw the labels. Laughery and colleagues (1993) also conducted a study to examine this issue. They found that most warning labels are not noticed by consumers. Some of the factors that make it difficult for warnings labels to be read include blending with the background, muddling with several items, a vertical placement on the bottle, and placement on the sides as opposed to front of the bottle. Noticing and reading the warning label is one of the most important aspects of the effort toward deterring alcohol abuse. Clear labeling in a font that can be easily read and which stands out must be the goal of all warning labels. The judicious use of color and pictorials can also improve the appeal of the warning label thereby making it more easily noticed.

Another issue with warning labels is that in isolation they are not sufficient for behavior change. They must be combined with other educational tools. Education in schools, through media, and through public health programs must be used to address the complex issue of alcohol abuse. Behavior change requires messages from multiple channels and multiple sources. Effective use of these multifarious approaches must be the goal of any alcohol abuse prevention program.

An additional issue with alcohol warning labels is that few studies have studied their effectiveness. While several studies have been done with warning labels on cigarettes, and they have shown that those labels are effective, not many studies have been done with alcohol. There is a need for rigorous evaluations of alcohol warning labels (Wilkinson & Room, 2009). Alcohol warning labels should be evaluated in terms of their effects on attitudes and behavior. More robust studies should be planned that study the effectiveness of warning labels placed on alcohol in a variety of target populations. High school students, college students, women, and minorities are groups to consider.

To conclude, warning labels on alcohol are an important strategy in the repertoire of available approaches. They must be strengthened by making the labeling clear and combining it with other educational interventions. There is a need for additional research to evaluate the effectiveness of alcohol warning labels.

REFERENCES

Agnostinelli, G., & Grube, J. W. (2002). Alcohol counter-advertising and the media. A review of recent research. Alcohol Research and Health, 26(1), 15-21.

Engs, R. C. (1989). Do warning labels on alcoholic beverages deter alcohol abuse? Journal of School Health, 59(3), 116-118.

International Center for Alcohol Policies [ICAP]. (2008). Informing consumers about beverage alcohol. ICAP Reports 20. Washington, DC: ICAP.

Kaskutas, L. & Greenfield, T. K. (1992). First effects of warning labels on alcoholic beverage containers. Drug and Alcohol Dependence, 31(1), 1-14.

Laughery, K. R., Young, S. L., Vaubel, K. P., & Brelsford, J. W. J. (1993). The noticeability of warnings on alcohol beverage containers. Journal of Public Policy and Marketing, 12(11), 38-56.

Petty, R. E., & Cacioppo, J. T. (1986). The elaboration likelihood model of persuasion. In L. Berkowitz (Ed.) Advances in experimental social psychology. Vol. 19. (pp. 123-205). New York: Academic Press.

Smart, R. G. (1990). Health warning labels for alcoholic beverages in Canada. Canadian Journal of Public Health, 81(4), 280-284.

Stockley, C. S. (2001). The effectiveness of strategies such as health warning labels to reduce alcohol-related harms. An Australian perspective. International Journal of Drug Policy, 12(2), 153-166.

Wilkinson, C. & Room, R. (2009). Warnings on alcohol containers and advertisements: international experience and evidence on effects. Drug and Alcohol Review, 28(4), 426-435.

Wine-searcher.com (2009). USA wine label information. Retrieved August 14, 2009 from http://www.wine-searcher.com/wine-labelusa.htm

Manoj Sharma, MBBS, CHES, Ph.D.

Editor, Journal of Alcohol & Drug Education

University of Cincinnati

526 J Teachers College

PO Box 210068

Cincinnati, OH 45221-0068
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