Does Believing Alcohol Causes Cancer Moderate the Relationship Between Consumer Awareness of the Alcohol–Cancer Link and Support for Alcohol Policies? Findings From a Canadian Cross-Sectional Study
Original paper
Summary
- Believing alcohol causes cancer moderates the relationship between consumer awareness of alcohol as a carcinogen and support for alcohol availability and marketing policies.
- Results also indicate believing alcohol causes cancer moderates the relationship between consumer awareness and support for alcohol labelling policies, although this did not remain significant after accounting for multiple comparisons.
- These findings highlight consumer awareness of alcohol as a carcinogen may not be sufficient and further interventions to enhance belief or acceptance that alcohol is carcinogenic may be required to strengthen public support for alcohol policies.
- Future studies should conduct longitudinal, real-world research to investigate if public health information-based interventions communicating alcohol–cancer messaging can effectively raise consumer awareness, increase knowledge and gain acceptance over time.
Background
Alcohol is used by around two billion people worldwide, with global consumption projected to rise by 17% by 2030. Alcohol is a leading risk factor for disease and premature death and contributes to more than 230 health conditions, including at least seven types of cancer. There is a clear dose–response relationship: already low levels of alcohol use increase cancer risk. In 2020, alcohol was responsible for an estimated 741,000 new cancer cases globally, alongside substantial economic costs that exceed 1% of GDP in many high- and middle-income countries.
Despite this burden, public awareness that alcohol causes cancer remains low. In some settings, as few as 13% of people are aware of the link, and surveys in high-income countries show awareness typically ranges from 26% to 56%, depending on the cancer type. The World Health Organization identifies alcohol industry messaging that portrays alcohol as acceptable and “safe” as a key reason for this low awareness, compounded by limited public health information campaigns. Importantly, higher awareness of the alcohol–cancer link is consistently linked with higher public support for effective alcohol policies, including measures on pricing, marketing, and availability – policies that are among the most cost-effective tools to prevent and reduce alcohol harm but often lack public and political support.
Research suggests that changing social norms and perceptions of alcohol-related health risks is a critical step toward preventing reducing alcohol harm. Information-based interventions that clearly communicate the causal link between alcohol and cancer, and that are repeatedly and widely disseminated, can help counter alcohol industry narratives, increase message acceptance, and build a more supportive environment for evidence-based alcohol policy.
Building on this evidence, the study examines whether accepting the fact that alcohol causes cancer influences how awareness of this risk translates into support for alcohol policies among alcohol consumers in Canada.
Main Findings
More than half of participants were younger adults aged 18/19–40 (50.6%) and female (51.0%). Approximately 4 in 10 participants were from Ontario (38.5%), Canada’s most populous province. More than half of participants (54.6%) were either not aware or not sure of national alcohol guidance. More than half of participants had an education level lower than a Bachelor degree (53.4%). The majority of participants were heterosexual (83.1%) and approximately three-quarters identified as White (74.5%). Beer was the most preferred alcohol type (31.2%). Over half of the sample (59.3%) had an AUDIT-C score ≥ 3 or 4.
Awareness of Alcohol as a Carcinogen
Consumer awareness of the alcohol–cancer link in this sample was 29.3%.
Of those who were aware of this link, 83.6% believed this information, 11.7% did not believe and 4.5% were unsure.
Among those who were not aware or unsure of this information, 58.2% believed this information, 16.7% did not and 25.1% were unsure.
(b) Belief that alcohol causes seven types of cancer among those aware (N = 1513) and unaware/Don’t know (N = 3656) that alcohol causes cancer. Number of participant exclusions among those aware (N = 1) and unaware/Don’t know (N = 5) alcohol causes cancer due to missing responses.
Links Between Awareness That Alcohol Causes Cancer and Socio-Demographic and Alcohol-Related Characteristics
Higher odds of awareness of the alcohol–cancer link were observed among consumers who were aware of national alcohol guidance, with a higher level of education, and resided in British Columbia compared to Ontario.
Participants identifying as Asian had lower odds of awareness of the alcohol–cancer link compared to participants identifying as White. No other covariates were linked with awareness.
Links Between Believing That Alcohol Causes Cancer and Socio-Demographic and Alcohol-Related Characteristics
Higher odds of believing alcohol causes cancer were found
- among younger adults compared to older adults,
- women compared to men,
- those with an AUDIT-C score < 3/4 compared to those with a score ≥ 3/4,
- those who were aware compared to not aware of national alcohol guidance, and
- those having an education at a Bachelor degree or above compared to lower education levels.
Women and those with an AUDIT-C score < 3/4 also had higher odds of reporting ‘Don’t know’ for this link compared to men and those with an AUDIT-C score ≥ 3/4, respectively. Lower odds of reporting ‘Don’t know’ were observed among younger adults compared to older adults.
Believing Moderates Awareness That Alcohol Causes Cancer and Support for Alcohol Policies
Those aware that alcohol causes cancer had higher odds of support for
- availability (OR 1.10),
- pricing (OR 1.12),
- marketing (OR 1.07) and
- labelling (OR 1.08) policies, although these results were not statistically significant.
People who were aware that alcohol causes cancer were slightly more likely to support alcohol policies that limit availability, raise prices, regulate marketing, or require health warning labels compared to people who were not aware. The odds ratios (ORs) above 1 (ranging from 1.07 to 1.12) indicate a positive link – awareness moved attitudes in the direction of greater policy support.
However, the effects were small and not statistically significant. This means the differences observed could reasonably be due to chance, and the study cannot confidently conclude that awareness alone leads to higher policy support in the wider population.
When belief is considered, those both aware of and believing that alcohol causes cancer had higher odds of support for
- availability (OR 1.76),
- marketing policies (OR 1.75), and
- labelling policies (OR 1.59) compared to those who were not aware of the link and did not believe, although results concerning labelling were not significant following the Benjamini–Hochberg adjustment.
The researchers do not explain why support for alcohol pricing policies shrinks among respondents who are aware of and believe the fact about the alcohol-cancer link compared to those who are “just” aware.
This study highlights that believing alcohol causes cancer moderates the relationship between consumer awareness of alcohol as a carcinogen and support for alcohol policies limiting availability and marketing among a large sample of alcohol consumers in Canada. Government-mandated health warning labels on alcohol containers are a recommended intervention by the WHO for boosting awareness of alcohol-related health risks, such as increased cancer risk. Longitudinal, real-world research is needed to test if interventions, such as alcohol warning labels, can raise both consumer awareness and enhance beliefs and acceptance of the alcohol–cancer link.
Meaning
Overall, the findings show that simply knowing that alcohol causes cancer is often not enough to build strong public support for alcohol policies. The study therefore suggests that additional efforts are needed to help people accept and believe the link between alcohol and cancer in order to increase support for effective alcohol policy measures.
The study shows that belief matters, not just awareness. Being aware that alcohol causes cancer was linked to stronger support for alcohol pricing, availability, marketing, and labelling policies only when people also believed or accepted that the cancer risk is real. Awareness alone was often insufficient to translate into policy support. This finding suggests that strengthening acceptance of the alcohol–cancer link is essential for building public support for effective alcohol policies.
Only around 30% of participants were aware that alcohol is a carcinogen, confirming persistently low awareness levels in Canada. Higher education was associated with greater awareness, but other demographic patterns seen in earlier studies were not observed – possibly because this study used a more specific measure (awareness that alcohol causes multiple cancer types).
Notably, belief often followed awareness: many participants believed alcohol causes cancer even if they initially reported being unaware of the link. This indicates that increasing awareness has the potential to also strengthen belief and acceptance. However, more than 40% of those unaware of the link did not believe or were unsure that alcohol causes cancer, reflecting resistance to new information that challenges established norms and personal behaviours.
The findings point to the need for repeated, well-designed public health communication to reduce resistance and increase acceptance of alcohol’s cancer risk. The World Health Organization identifies government-mandated health warning labels on alcohol containers as a key tool for this purpose. Evidence from real-world settings shows that repeated exposure to clear cancer warnings increases awareness, influences intentions, and can reduce alcohol use. Further research is needed to better understand how such warnings affect belief and acceptance of the alcohol–cancer link.
Abstract
Introduction
Extending research observing an association between awareness that alcohol causes cancer and support for alcohol policies, this study examined if believing or accepting alcohol causes cancer moderates the relationship between awareness of alcohol as a carcinogen and policy support.
Methods
Adult alcohol consumers (n = 5180) in Canada completed an online survey in March–April 2023. Four separate logistic regression models were conducted with policy support affecting alcohol availability, pricing, marketing and labelling as outcomes to assess if believing alcohol causes seven types of cancer moderates the relationship between awareness of the alcohol–cancer link and support for alcohol policies. An interaction between awareness and belief was included as a predictor, adjusting for covariates.
Results
Overall, 29.3% were aware alcohol causes seven types of cancer and, of those aware, 83.6% believed this link. Those both aware of and believing that alcohol causes cancer had higher odds of supporting policies restricting alcohol availability (OR 1.76) and marketing (OR 1.75) than those not aware and did not believe. Consumers who were both aware of and believed the alcohol–cancer link had higher odds of supporting labelling policies (OR 1.59), although this was not significant after adjusting for multiple comparisons.
Discussion and Conclusions
This study highlights that believing alcohol is a carcinogen moderates the relationship between awareness of the alcohol–cancer link and support for policies restricting alcohol availability and marketing. Future longitudinal studies are needed to test interventions for effectively raising awareness and strengthening belief and acceptance of alcohol-related cancer risks.