Updated Health Warnings for Alcohol — Informing Consumers and Reducing Harm
Research perspective
Summary
In April 2022, the Centers for Disease Control and Prevention (CDC) released new mortality statistics showing:
- Alcohol consumption now accounts for more than 140,000 deaths per year in the United States or more than 380 deaths per day.
- The COVID-19 pandemic has exacerbated alcohol harm in the United States, with alcohol-related deaths increasing by 25% during the first year of the pandemic as compared with the previous year.
Yet many Americans are not aware of some of alcohol’s most serious health risks. Requiring new, well-designed warning labels on alcohol containers is a common sense strategy for providing information to consumers and reducing the burden of alcohol harm.
- A national survey of U.S. adults, for example, found that nearly 70% are unaware that alcohol consumption increases the risk of cancer.
The risks associated with alcohol consumption are now well documented.
The alcohol industry spends more than $1 billion each year to market its products in the United States; as a result, the most readily available information about alcohol comes from alcohol companies themselves.
The industry has also actively suppressed efforts to educate consumers about the health risks associated with alcohol, including by thwarting attempts by various governments to adopt more transparent alcohol-labeling policies. This information asymmetry may explain why Americans are so poorly informed about alcohol’s health risks.
One strategy for addressing gaps in knowledge could be to update the required warning labels on alcohol containers. Regulators have a large body of evidence available to guide them in developing effective, engaging warning labels for alcohol.
Warning labels are most effective when:
- They are displayed prominently on the front of product packaging,
- Include pictorial elements such as photographs or icons, and
- Rotate the content of their messages to avoid any one message becoming “stale.”
The current alcohol warning in the United States lacks all the key elements of evidence-based warning design.
- It uses small text.
- Typically appears on the back or side of product packaging.
- Doesn’t include any pictorial elements.
- The warning message is also static, having remained unchanged since the label was first implemented more than three decades ago.
The authors believe warnings should also reflect the strongest available research on product harms, meaning that policymakers should regularly update label requirements when new data warrant making changes.
The current U.S. warning label reflects outdated science regarding alcohol’s harms.
- It does not warn against cancer.
- It does not mention alcohol consumption is linked to a wide range of diseases from liver disease to pancreatitis to some types of heart disease.
- The existing label focuses only on risks during pregnancy and the risks associated with operating machinery.
- It only notes that alcohol “may cause health problems,” language that is so understated that it borders on being misleading.
Multiple regulatory and legislative pathways exist for adopting new alcohol warning labels.
- The Alcoholic Beverage Labeling Act of 1988 instructs regulators (in consultation with the U.S. Surgeon General) to recommend that Congress revise alcohol warnings if available scientific information justifies changes.
- Congress can also independently choose to require new warnings on alcohol products, much as it adopted a policy requiring pictorial warnings on cigarette packages in 2009.
Once a policy mandating new alcohol warnings is adopted, the alcohol industry might try to block its implementation on First Amendment grounds, as the tobacco industry did in the case of pictorial warnings for cigarette packages.
Because updated alcohol warnings would provide new risk information to many Americans, the authors believe implementing such warnings would be a sensible policy for addressing industry dominance over alcohol-related information, even if warnings’ effects on consumption are fairly small. Consumers have a right to know about any serious health harms associated with products they might buy.
Alcohol consumption and its associated harms are reaching a crisis point in the United States.
Evidence suggests that new alcohol warnings could empower consumers to make more informed decisions and reduce alcohol-related harm. The authors believe Americans deserve the opportunity to make well-informed decisions about their alcohol consumption. Designing and adopting new alcohol warning labels should therefore be a research and policy priority.
More information on alcohol and cancer
As the authors of the above perspective article highlight, the current alcohol health warning labels in the United States have not been updated since 1988 when the labels were introduced. These labels are based on outdated science and are vague about the potential health risks of alcohol, particularly the increased likelihood of cancer. They only warn against alcohol use during pregnancy or operating vehicles, not about other health risks such as cancer.
Countless scientific studies have found that alcohol causes cancer. Earlier in this year, a large genetic study with 150,000 Chinese participants found a clear causal relationship between alcohol and cancer. Researchers found that those who had two genetic variants that reduce alcohol tolerance consumed less alcohol, and as a result had a reduced risk of cancer compared to those who did not have the genetic variants and consumed more alcohol.
Previously the Lancet has reported that 400,000 deaths of the total 3 million deaths caused by alcohol worldwide are due to cancer.
There are several mechanisms of how alcohol causes cancer.
- The ethanol in alcohol products breaks down to acetaldehyde, a toxic chemical, and probable carcinogen.
- Alcohol impairs the body’s absorption of important nutrients, such as vitamin A, folate, vitamin C, vitamin D, vitamin E, and carotenoids.
- Alcohol increases blood levels of estrogen, which is linked to the risk of breast cancer.
Some alcoholic drinks also may contain other carcinogenic chemicals that are introduced during production.
The COVID-19 pandemic further exacerbated the problem in the United States by increasing alcohol use due to heavy pandemic marketing of the alcohol industry and weakening of alcohol policies during this time. This means a heavier alcohol-related cancer burden in the future if action is not taken urgently.
There is no safe level of alcohol use for cancer prevention. The risk increases with increased use. According to The National Cancer Institute, even people who have only one alcoholic beverage a day have an increased risk for some cancers compared to those who abstain from alcohol.
The National Cancer Institute reports that, compared to those who do not use alcohol:
- People who use alcohol in low doses (so-called moderate users) are
- 1.8 times more likely to develop oral cavity cancers, and
- 1.4 times more likely to develop larynx or voice box cancers.
- The risks are even higher for those who use alcohol heavily.
- Alcohol use of any level is linked to esophageal squamous cell carcinoma, a type of esophageal cancer.
- The risk is 1.3 times higher for those who use alcohol lightly, and
- 5 times higher for those who use alcohol heavily.
- Heavy alcohol use doubles the risk for two types of liver cancer.
- Those who use alcohol in low doses to heavy use have 1.5 times higher risk of colorectal cancer.
- The risk for breast cancer gradually increases with the level of alcohol use with heavy users facing the highest risk.
- Emerging evidence shows that alcohol use could impact the risk of prostate cancer, pancreatic cancer and melanoma.
Since alcohol can cause cancer studies have shown reducing or quitting alcohol use is important for preventing both alcohol-related and all cancers.
Sources
The New England Journal of Medicine: “Updated Health Warnings for Alcohol — Informing Consumers and Reducing Harm“
The Washington Post: “Doctors want alcohol warning labels to flag cancer risks“
Philly Voice: “Alcoholic drinks need stronger – and larger – warnings about cancer risk, doctors say“
