JMIR Publications

ABSTRACT

Background:

Alcohol warning labels (AWL) are a promising, well-targeted strategy to increase public awareness of alcohol-related health risks. However, evidence of their effectiveness in real-world settings remains limited and inconclusive.

Objective:

This paper presents the protocol for a real-world study examining the population-level impact of enhanced AWLs with a cancer message, national drinking guidelines, and standard drink information on attention, processing, and alcohol-related behaviours among drinkers in Canada. Post-implementation modifications to the original protocol due to interference by national alcohol industry representatives are also described.

Methods:

This quasi-experimental study design involved partnering with local governments in two northern Canadian territories already applying AWLs on alcohol containers for sale in liquor stores. The eight-month intervention consisted of three new enhanced, rotating AWLs 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 in both sites to measure changes in awareness and processing of label messages and alcohol-related knowledge, and behaviours. Liquor store transaction data were collected from both sites to assess changes in population-level alcohol consumption. The intervention was successfully implemented for one month before it was paused due to complaints from the alcohol industry. The government in the intervention site allowed the study to proceed after a two-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 two-month pause to capture any impact of the cancer label.

Results:

This study protocol describes a real-world quasi-experimental study which aimed to test the effectiveness of enhanced AWLs 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 design was modified to enable completion.

Conclusions:

Findings from this study will directly inform alcohol labelling policies in Canada and internationally and provide further insight into alcohol industry attempts to disrupt research in this area. Additional unimpeded real-world evaluations of enhanced alcohol warning labels are recommended.