Alcohol pictorial health warning labels: the impact of self-affirmation and health warning severity

Abstract

BackgroundWe examined whether enhancing self-affirmation among a population of drinkers, prior to viewing threatening alcohol pictorial health warning labels, would reduce defensive reactions and promote reactions related to behaviour change. We also examined how health warning severity influences these reactions and whether there is an interaction between self-affirmation and severity.MethodsIn this experimental human laboratory study, participants (n = 128) were randomised to a self-affirmation or control group. After the self-affirmation manipulation was administered, we tracked participants’ eye movements while they viewed images of six moderately-severe and six highly-severe pictorial health warning labels presented on large beer cans. Self-reported responses to the pictorial health warning labels were then measured, including avoidance, reactance, effectiveness, susceptibility and motivation to drink less. Finally, participants reported their self-efficacy to drink less and their alcohol use.ResultsThere was no clear evidence that enhancing self-affirmation influenced any outcome. In comparison to moderately-severe health warnings, highly-severe health warnings increased avoidance and reactance and were perceived as more effective and increased motivation to drink less.ConclusionsThese findings call into question the validity of the self-affirmation manipulation, which is purported to reduce defensive reactions to threatening warnings. We discuss possible explanations for this null effect, including the impact of participants’ low perceived susceptibility to the risks shown on these pictorial health warning labels. Our finding that highly-severe health warnings increase avoidance and reactance but are also perceived as being more effective and more likely to motivate people to drink less will inform future health warning design and have implications for health warning label theory.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-6243-6) contains supplementary material, which is available to authorized users.

Impact of health warning labels communicating the risk of cancer on alcohol selection: an online experimental study

“…alcohol increases your risk of cancer) [26,27]. Image‐and‐text HWLs can slow consumption [21] and reduce intention to drink [22,28] and exert larger effects on quitting and consumption intentions than text‐only HWLs [22]. However, one study suggests image‐and‐text and text‐only HWLs are equally effective at reducing speed of consumption [21].…”

“…Warnings including shocking or explicit pictures are most likely to be believed and are rated as more effective than those with less severe pictures [29]. The former, however, may also increase reactance and avoidance behaviours [28] and may be less acceptable [30]. It is therefore important to assess the potential efficacy of a variety of HWLs, as well as levels of reactance and avoidance, and acceptability.…”

Impact of health warning labels on snack selection: An online experimental study

“…The same may be true for reactance based on findings in the current study - image-and-text HWLs increased reactance more than text-only HWLs, but were more effective at reducing selection. However, these studies are often based on single-item subjective measures which may not be sufficient in assessing defensive reactions ( Sillero-Rejon et al, 2018 ). Future studies should include both objective and subjective defensive reaction measures.…”

“…annoyance at or deliberately not engaging with the HWL) ( Maynard et al, 2014 ; McCloud, Okechukwu, Sorensen, & Viswanath, 2017 ), although these behaviours do not necessarily interfere with quitting behaviours ( Brewer et al, 2019 ; Cho et al, 2016 ). HWLs placed on alcoholic beverages that include shocking or explicit pictures are rated as more effective than those with less severe pictures ( Maynard, Gove, Skinner, & Munafò, 2018 ), but have been shown to increase reactance and avoidance behaviours ( Sillero-Rejon et al, 2018 ) and may be less acceptable ( Clarke et al, 2020b ; Pechey et al, 2020 ). Initial studies suggest that text-only HWLs on SSBs ( Roberto, Wong, Musicus, & Hammond, 2016 ) and image-and-text HWLs on energy-dense snacks are generally accepted ( Pechey et al, 2020 ).…”

Impact of health warning labels on snack selection: an online experimental study

“…annoyance at or deliberately not engaging with the HWL) (Maynard et al, 2014;McCloud, Okechukwu, Sorensen, & Viswanath, 2017), although these behaviours do not necessarily interfere with quitting behaviours (Brewer et al, 2019;Cho et al, 2016). HWLs placed on alcoholic beverages that include shocking or explicit pictures are rated as more effective than those with less severe pictures (Maynard, Gove, Skinner, & Munafò, 2018), but have been shown to increase reactance and avoidance behaviours (Sillero-Rejon et al, 2018) and may be less acceptable (Clarke et al, 2020b;Pechey et al, 2020). Initial studies suggest that text-only HWLs on SSBs (Roberto, Wong, Musicus, & Hammond, 2016) and imageand-text HWLs on energy-dense snacks are generally accepted (Pechey et al, 2020).…”