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

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.

Nature and Potential Impact of Alcohol Health Warning Labels: A Scoping Review

“…One paper reported on two studies using different methodologies to study the same variables [50], and four papers reported on different aspects of one intervention [51][52][53][54]. The remaining papers were individual studies (with a complete or partial focus on alcohol HWL labelling), although some of them were part of the same research line of label development and testing (e.g., [55][56][57][58][59][60]) or studied the same labels (e.g., [61,62]).…”

“…In terms of study aims and studied independent variables, five papers (19%) compared only new or enhanced labels with no or regular labels [51][52][53][54]63]. Focusing on label content, eight papers (30%) compared text-only labels with text and image labels [55,56,61,62,[64][65][66][67], twelve studies (44%) compared text message characteristics (e.g., content, specificity, framing, source, use of causal language) [57][58][59][60][67][68][69][70][71][72][73][74] and three (11%) compared image characteristics [57,66,75]. Four (15%) papers compared label formats, such as size, position, colour or branding [50,64,70,76].…”

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

“…Based on mean acceptability scores, the majority of HWLs (aside from image-and-text HWLs without calorie information) had a score higher than four (out of seven), which indicates participants viewed them as somewhat acceptable. Another recent study demonstrated similar acceptability ratings for image-and-text HWLs ( Pechey et al, 2020 ). Due to the higher acceptability for text-only HWLs, and evidence of their effectiveness, it may be that HWLs in text form are the most promising labels for initial implementation.…”

“…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 ).…”

“…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 ). Evidence also suggests that communicating the effectiveness of HWLs may increase policy support ( Donnelly et al, 2018 ), a finding that aligns with results of a recent meta-analysis ( Reynolds, Stautz, Pilling, Linden, & Marteau, 2020 ).…”