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 effectiveness and acceptability for reducing consumption of alcoholic drinks and energy-dense foods. Aim To describe 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.

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

“…The specific adverse health consequences illustrated by the HWLs were chosen based on the results of another study [30], which aimed to identify the images eliciting the highest levels of negative emotional arousal and the lowest desire to consume the product. The three HWLs selected depicted bowel cancer, breast cancer and liver cancer.…”

“…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.…”