Calling time on responsible drinking: A qualitative study of perceptions of information on alcohol product labels
This study aimed to explore (a) how people interpret “responsible drinking” messages on alcohol product labels, and (b) the acceptability of including health information on labels.
Face-to-face semi-structured interviews were conducted with 20 people aged 21 to 63 years; 18 were classified high risk alcohol users using AUDIT-C.
They were shown three sets of alcohol product labels:
- one including three “responsible drinking” messages (“drink responsibly”),
- one with three positively worded health messages (“drinking less reduces risks”), and
- one with three negatively worded health messages (“drinking more increases risks”).
Health messages included information about cancer, liver and heart disease.
Thematic analysis identified three themes:
- ambiguity about alcohol labelling;
- identifying oneself as responsible; and
- acceptability of enhanced product labelling.
Participants were critical of “responsible drinking” messages and wary of conflicting health information in the media. They positioned themselves as responsible, knowledgeable alcohol users and distanced themselves from “problem” alcohol users. They did not appear to support the inclusion of health information on labels; however, novel information was considered more impactful.
“Responsible drinking” messages were seen by the researcher’s sample as an alcohol industry ploy.
Although health messages about cancer were seen as potentially impactful, the ability of consumers to position themselves as “unproblematic” alcohol users means that they may not see the information on the label as relevant to themselves.
Understanding factors that increase the personal relevance of messages is needed, alongside an exploration of a wider range of methods for alcohol health communication.
What is already known on this subject?
- To be effective, warning labels on alcohol products should give specific information on health impacts.
- However, in the UK products often include strategically ambiguous messages such as ‘drink responsibly’ or ‘know your limits’.
What does this study add?
- “Responsible drinking” messages are perceived as an industry tool to shift blame.
- Such messages allow alcohol users to feel they are on the right side of a divide between “normal” and “problem” alcohol use.
- Health messages are perceived as more impactful, particularly those relating to cancer.
- However, any information on an alcohol product label may be mistrusted.
Despite 18 of 20 participants being classified as high risk alcohol users, using the AUDIT-C screen for alcohol use problems, they generally positioned themselves as “responsible” and knowledgeable alcohol consumers, distanced from the “problem” alcohol users at which the labels were seen to be aimed.
Dr Emma Davies, Reader in Psychology at Oxford Brookes University, and lead author of the study, said, as per BPS reporting:
Our research has shown that generic messages on ‘responsible drinking’ are unlikely to be effective and that messages need to be more personally relevant to consumers.
Many people who are considered [high risk alcohol users] view themselves as ‘responsible’ and ‘moderate’ in their alcohol consumption, and product labelling is unlikely to be effective unless this view can be challenged.”Dr Emma Davies, Reader in Psychology, Oxford Brookes University, and lead author of the study
Theme 1: ambiguity about alcohol labelling
The theme ‘ambiguity about alcohol labelling’ captured how participants arrived at an understanding of how to interpret information about alcohol. Three subthemes comprise this theme, which were named ‘the meaning of responsible drinking messages’, ‘interpretation of guidelines’ and ‘conflicting media information’.
(1a) The meaning of responsible drinking messages
The phrase ‘drink responsibly’ was familiar and interpreted as being ‘careful’ or avoiding driving under the influence of alcohol. Often, participants viewed such messaging as deliberately ambiguous and were critical of it.
“Responsible” consumption messages also had the benefit of allowing participants to feel they had adopted an appropriate personal alcohol consumption pattern as it did not challenge their behaviour. They tended to define responsibility as equating to the maintenance of socially acceptable behaviour (e.g., not becoming violent). Some participants also thought “responsible drinking” messages sounded condescending, or something to ignore as they felt they already knew how to act responsibly.
(1b) Interpretation of guidelines
When prompted to describe information they had noticed on product labels, participants mentioned alcohol units. This was a further source of uncertainty because it was not clear what this was for.
Instead, factors such as product strength and the alcohol consumption occasion were viewed as useful ways of judging a “safe” amount to consume. Few participants could accurately state UK guidelines, but most offered an estimate. When they were given the correct answer, they tended to suggest that they measured their consumption in glasses or bottles instead. Thus, the usefulness of including this information on the label was questioned, particularly if it was not seen as personally relevant.
Some were convinced that units were aimed at other people, for example, pregnant women or older people. Furthermore, some questioned the science behind unit guidelines, contributing to the perception of ambiguity.
(1c) Conflicting media information
Conflicting reports in the media appeared to inform participants’ understanding about what it meant to be a “responsible” alcohol user. A common topic was about red wine being simultaneously good and bad for you. This appeared to demonstrate that scientists disagreed about the effects of alcohol, meaning many had become blasé about what they heard.
Because of these conflicts, participants were unclear about how they should act on health information, even if they believed it, as it seemed that all media information was untrustworthy and so they remained sceptical about the information in the study. Some held the view that the purpose of media coverage was to create a sense of worry, and questioned the value of the science behind the headlines.
Theme 2: identifying oneself as responsible
The theme ‘identifying oneself as responsible’ builds on the first theme to describe the ways that participants were able to position themselves as “responsible”.
Two subthemes were named ‘demonstrating alcohol health knowledge’ and ‘othering heavy alcohol users’.
(2a) Demonstrating alcohol health knowledge
Participants presented themselves as highly knowledgeable about alcohol and health. They reflected on past behaviour to show how their knowledge was gained by previous negative experiences, which now guided their consumption. For example, one participant reported feeling anxious after consuming alcohol, and another experienced palpitations. Observations of how alcohol had affected family and friends also contributed to their understanding.
When reflecting on the labels, emphasis was placed on knowledge about the effects of alcohol on the liver – which was commonly viewed as the most believable and preferable message, regardless of presentation – compared with the other health messages. This may have been reinforced by the label promoting the message of having 2 days off – a realistic and achievable goal for the participants, only one of whom revealed that they consumed alcohol every day.
However, although health knowledge was presented with confidence, there were some gaps in the explanations as to why certain health effects were linked with alcohol consumption.
Many contradictions relating to knowledge and behaviour were present. For example, some participants discussed their knowledge of the health impacts of heavy episodic alcohol use in detail and distanced themselves from this behaviour. However, their descriptions of recent and/or frequent alcohol consumption occasions suggested they commonly engaged in the behaviour. Nonetheless, within the interviews, participants presented themselves as highly health literate.
(2b) Othering heavy alcohol users
Rather than themselves, study participants positioned ‘heavy alcohol users’ and ‘addicts’ as those who needed to heed health information. They presented their own alcohol use patterns in opposition to heavy alcohol users, which cemented their personal identity as “responsible” alcohol users.
Some acknowledged the likelihood that other people were also likely to view themselves as in control and “responsible”, regardless of the amount of alcohol they consumed. For this reason, it was challenging to identify who the intended audience of “responsible drinking” messages were.
This was further revealed in their articulation of specific tastes, in particular for some men in the study this was about craft beers and small, local breweries. Their discussion was suggestive of a possible class/income divide between those with ‘refined’ tastes and those who consumed super-strength products.
Further characteristics such as age and pattern of alcohol use were considered important factors related to who the audience of health-related labels would be. For example, younger participants considered older people more likely to be health aware.
Some talked about intoxication as an infrequent occurrence for them. However, it was common for many to then subsequently describe alcohol consumption patterns that would constitute regular heavy episodic alcohol use. Drawing on their knowledge behaviour, it was still possible to distance from being the target of health messages.
Theme 3: acceptability of enhanced product labelling
The final theme relates to features of the interviews with implications for the acceptability of enhanced product labelling including health information. Three subthemes related to this theme were named ‘industry perceptions’, ‘resistance to health labels’ and ‘resonating messages linking alcohol with cancer’.
(3a) Industry perceptions
Perceptions of the alcohol industry seemed to be very strongly linked to perceptions of the tobacco industry. Participants commonly suggested that pictorial messaging analogous to graphic images on tobacco products would be more effective than the text warnings they were shown in the interviews, making this explicit comparison, as well as by discussing the gradual acknowledgement of smoking as harmful. There was a reluctance to consider alcohol to be as harmful as smoking.
Several participants highlighted that the role of the industry in a capitalist neoliberal society is to make money rather than to provide health information, and thus, they felt that labelling was not an appropriate strategy for reducing and preventing alcohol harm. In fact, this was viewed as contradictory and likely to reduce the impact of messaging.
On the contrary, some participants reflected on the harms related to alcohol consumption, such as costs to health services, and almost reluctantly admitted that it was a harmful drug and that perhaps this meant that consumers should be better educated.
However, some of the more ardent sceptics tended to consider labelling self—evidently ineffective, were resistant to behaviour change and felt that others would have a similar view.
(3b) Resistance to health labels
Overall, evidence from these interviews suggested that participants were resistant to the inclusion of health messages on the labels of the alcoholic products that they consumed. For many of them, the label was not the right time or place for health information. At the point of consumption, participants wanted to enjoy their chosen alcoholic beverage and associated occasion.
Including health messages was also seen as a threat to the enjoyment of particular brands, which had interesting or unusual labels. It was also seen as a paternalistic approach to encouraging alcohol reduction and therefore seemed to have the potential to cause reactance.
(3c) Resonating messages linking alcohol with cancer
Finally, although in some ways similarly dismissed to the other health labels, it did appear that the cancer message was perceived as different to the other messages. Because this label was both new and unexpected information, it seemed that the message had the potential to make the participants stop and think.
Further comparisons to tobacco were made by a number of participants in relation to cancer. Although the information labels about heart disease and cancer were both similarly new information to many of the participants, the cancer message appeared to be more surprising.
The study findings underscore the futility of “responsible” alcohol consumption messaging as a means of regulating alcohol use behaviours. Indeed, a systematic review of alcohol industry efforts to influence government policies showed that “responsible drinking” messaging was one of the most important strategies used by the industry to indicate that it is not to blame for alcohol harm.
Therefore, it is time to end this approach that neither the consumer nor the producer believe to be anything other than paying lip service to the notion of informing and educating people who consume alcohol, and replace these messages with something more salient and convincing to consumers.
Research consistently points towards areas where public understanding is limited, including relating to the link between alcohol and cancers. Responses to cancer-related messages suggested that any negative perceptions of the value of messages on labels could be countered if the specific messages were perceived to be unambiguous and relevant. Further to this, if the goal is to change behaviour, we may need to reconsider the drive to understand factors that would increase the effectiveness of alcohol product labelling and instead move towards providing accurate and actionable health information in a wider range of contexts.
It is also important to consider how to address the binary view of “problematic” alcohol users as other from the “responsible” self. People consuming alcohol at heavy levels often underestimate their alcohol consumption and may not seek support due to perceived stigma. These findings highlight an urgent need to explore ways to encourage people to accurately reflect on their alcohol use.
There is a lack of theoretically driven research on alcohol labelling, and moderators of intervention impacts more broadly are under-researched. This study’s findings may also have theoretical implications. The extent to which individuals identify as ‘prototypical responsible drinkers’ and the impact of such identification on receptivity to health messages and alcohol use plans could be explored using the Prototype Willingness Model as a framework. Alternatively, the use of Protection Motivation Theory may illuminate the extent to which people appraise personal level of threat posed by information on alcohol labels. For example, ascertaining how effective someone thinks reducing alcohol consumption would be at reducing their likelihood of developing cancer, heart disease or liver disease, or if reducing consumption incurs response costs, like missing out on social gains from consuming alcohol socially. Future studies could apply these theoretical models to predict variability in decision-making linked to alcohol labelling.