Testing the Effectiveness of Enhanced Alcohol Warning Labels and Modifications Resulting From Alcohol Industry Interference in Yukon, Canada: Protocol for a Quasi-Experimental Study

Abstract

Background Alcohol warning labels are a promising, well-targeted strategy to increase public awareness of alcohol-related health risks and support more informed and safer use. However, evidence of their effectiveness in real-world settings remains limited and inconclusive. Objective This paper presents a protocol for a real-world study examining the population-level impact of enhanced alcohol warning labels with a cancer message; national drinking guidelines; and standard drink information on attention, processing, and alcohol-related behaviors among consumers in Canada. Postimplementation modifications to the original protocol due to interference by national alcohol industry representatives are also described. Methods This quasi-experimental study involved partnering with local governments in two northern Canadian territories already applying alcohol warning labels on alcohol containers for sale in liquor stores. The study tested an 8-month intervention consisting of three new enhanced, rotating alcohol warning labels in an intervention site (Whitehorse, Yukon) relative to a comparison site (Yellowknife, Northwest Territories) where labelling practices would remain unchanged. Pre-post surveys were conducted at both sites to measure changes in awareness and processing of label messages, alcohol-related knowledge, and behaviors. Liquor store transaction data were collected from both sites to assess changes in population-level alcohol consumption. The intervention was successfully implemented for 1 month before it was halted due to complaints from the alcohol industry. The government of the intervention site allowed the study to proceed after a 2-month pause, on the condition that the cancer warning label was removed from rotation. Modifications to the protocol included applying the two remaining enhanced labels for the balance of the intervention and adding a third wave of surveys during the 2-month pause to capture any impact of the cancer label. Results This study protocol describes a real-world quasi-experimental study that aimed to test the effectiveness of new enhanced alcohol warning labels as a tool to support consumers in making more informed and safer alcohol choices. Alcohol industry interference shortly after implementation compromised both the intervention and the original study design; however, the study design was modified to enable completion of three waves of surveys with cohort participants (n=2049) and meet the study aims. Conclusions Findings from this study will directly inform alcohol labelling policies in Canada and internationally and provide further insight into the alcohol industry’s attempts to disrupt research in this area. Additional unimpeded real-world evaluations of enhanced alcohol warning labels are recommended. International Registered Report Identifier (IRRID) RR1-10.2196/16320

Improving Knowledge that Alcohol Can Cause Cancer is Associated with Consumer Support for Alcohol Policies: Findings from a Real-World Alcohol Labelling Study

“…The study design has been described elsewhere [59]. Briefly, two waves of longitudinal surveys were scheduled among cohort participants in the intervention and comparison sites four months before (wave 1: May-June 2017) and eight-months after (wave 2: May-June 2018) the intervention labels were implemented.…”

“…The standard drink labels were to be introduced shortly thereafter. However, one month into the eight-month study period, the government in the intervention site halted its participation in the study due to significant pressure from Canada's alcohol producers and stopped applying labels [59,60]. Based on the remaining label stock, approximately 47,000 cancer warning labels and 53,000 national drinking guidelines labels were applied to alcohol containers within the one-month period.…”

Use as directed: do standard drink labels on alcohol containers help consumers drink (ir)responsibly? Real‐world evidence from a quasi‐experimental study in Yukon, Canada

“…The final sample consisted of 2049 unique participants. Response rates in the intervention and comparison sites were 8.9% and 8.0%, respectively [32], with 53.2% of participants retained in Wave 2 and 47.5% in Wave 3 (see the study's detailed protocol for the cohort structure) [21]. In total, 836 participants completed Wave 1, 1256 participants completed Wave 2 and 1185 participants completed Wave 3.…”

“…This study used three waves of survey data conducted in both the intervention and comparison sites before and at two time‐points after the alcohol labelling intervention. Full details of the quasi‐experimental study have been published elsewhere [21]. Briefly, this study was conducted among cohort participants recruited in the single government‐run liquor store in Whitehorse, Yukon, Canada (intervention site) and the only two government‐run liquor stores in Yellowknife, Northwest Territories, Canada (comparison site).…”

“…The labels with a cancer warning and drinking guidelines were applied to alcohol containers in the liquor store in the intervention site starting in November 2017, with the SD labels slated to follow shortly thereafter, and were scheduled to continue for 8 months alongside a social marketing campaign that supports the label messages. However, due to pressure from Canada's national alcohol industry [21,27], the intervention site paused their participation in the study and stopped applying labels in December 2017, only 1‐month into the 8‐month intervention period. Based on remaining label stock, approximately 47 000 cancer labels and 53 000 drinking guideline labels were applied between November and December 2017.…”