Do Alcohol Industry-Funded Organisations Act to Correct Misinformation?
A qualitative study of pregnancy and infant health content following independent analysis
Research article
Background
Corporate misinformation as commercial determinants of health
Access to health information is a crucial component of global population health promotion, with accurate, reliable, and up-to-date content contributing to collective and individual decision making that saves lives. Ensuring universal access to such information requires preventing undue commercial influence. Whilst commercial entities can contribute in positive ways to public health, health-harming industries such as alcohol, tobacco, and ultra-processed food and drink producers are known to try to reframe the health effects of their products in various ways, including by providing health information to the public. Such ‘education’ activities support wider efforts to frame not only the products, but also the industries themselves as socially responsible and were first developed to avoid policies that would negatively impact on profits. This shared ‘playbook’ of practices is one component of what are known as the commercial determinants of health, with profound effects on the extent to which the harms from such products, and the companies producing them, are perceived and addressed.
Alcohol industry front groups as sources of misinformation
The alcohol industry provides health information to the public largely via corporate social responsibility organisations, which include industry-funded charities and nonprofit companies known as ‘social aspects and public relations organisations’ (SAPROs). Part of what distinguishes SAPROs from other industry companies and organisations is their efforts to present themselves as ‘independent’ charities and nonprofit companies despite being almost entirely funded by the alcohol industry.
These efforts appear successful; there is evidence from Australia that the wider public believes these groups are government-funded. As such, SAPROs are framed as ‘part of the solution’ to alcohol harms, whilst performing strategic functions for the industry as part of wider corporate political activities.
Alcohol industry front groups utilise cognitive biases to steer consumers towards industry misinformation. This includes techniques of ‘dark nudges’, which encourage alcohol consumption (for example via social norming or priming of alcohol) and sludge, which makes health information difficult to access and behaviour change harder (for example positioning material in ways difficult to find and reducing the functionality of education materials).
Previous studies have found that the information provided by these industry groups misrepresents the evidence on alcohol harms in relation to cancer, cardiovascular health, and pregnancy and infant health.
The teratogenic effects of alcohol are widely known and uncontroversial. No safe threshold of alcohol consumption during pregnancy has been identified and consistent with many national guidelines, the UK guidance recommends that women do not consume alcohol during pregnancy and when trying to conceive. Despite this common precautionary approach, a previous study found that alcohol industry-funded organisations are less likely than public health websites to state that no amount of alcohol is safe in pregnancy.
A recent survey conducted in Australia found that pregnant women received the majority of information about alcohol use during pregnancy from written/electronic information and health providers, and to a lesser extent, family and friends. The type of information was associated with alcohol use; women who consumed alcohol during pregnancy versus abstainers were more likely to obtain information on alcohol from written/electronic sources (the definition of which included industry). The most commonly recalled source of information was written/electronic information, therefore it is imperative the information they receive supports informed decision making about alcohol. It is important to revisit and review the content, accuracy and framing of industry pregnancy and infant health information because it can change following public health-informed scrutiny. The study by Lim et al. that found misinformation on industry websites (including SAPROs) received extensive media coverage and led to responses by three of the SAPROs studied in the form of rebuttal letters to the journal editor disputing the findings.
To the knowledge of the researchers, there is no longitudinal research tracking how industry responds to independent analysis of their health-related content. The aim of the study was therefore to critically analyse pregnancy and infant health information on alcohol-industry funded organisation websites following the previous independent analysis by Lim et al.
Results
The researchers identified three highly common forms of misinformation across the seven websites of alcohol industry front groups:
- Omission of information,
- functionality problems, and
- the positioning and sequencing of information in ways that framed or obfuscated its meaning.
These types of misinformation were often mixed with (limited) relevant information and were most often found in combination.
Omission of information, functionality problems, and the positioning and sequencing of information in ways that framed or obfuscated its meaning were the most common forms of ‘dark nudges and sludge’ misinformation the study identified across the seven industry-funded websites.
This was often mixed with (limited) relevant information, and different types of misinformation were usually used in combination.
The researchers found substantial pregnancy and infant health information directed towards the consumer on only four of the seven websites (Aware, Éduc’alcool, Drinkaware UK, and DrinkWise).
On one further website, the researchers could only find one short paragraph on the topic (Drinkaware IE). They could not find any pregnancy and infant health information directed to the consumer on the remaining sites (FAAR and IARD). The researchers could not find information on miscarriage or breastfeeding on the Aware site, nor information on fertility, miscarriage, or breastfeeding on the Drinkaware IE site.
Omission of, or limited pregnancy and infant health information
Omission of information on pregnancy and infant health was common across all seven sites.
When searching for information, the researchers identified statements across all sites describing either general aims of the organisation or indications of the types of information available.
In all cases, these statements gave the impression that the sites provided general information and advice about alcohol and health. It is therefore reasonable to assume this would include information about alcohol, pregnancy, and infant health for the consumer.
However, the researchers could only find substantial pregnancy and infant health information for the consumer on four of the seven SAPRO websites studied (Drinkaware UK, DrinkWise, Éduc’alcool and Aware). On one site, they could only find one short paragraph on the topic (Drinkaware IE). They could not find any pregnancy and infant health information directed to the consumer on the remaining sites (FAAR and IARD).
On the five sites where the researchers found pregnancy and infant health information, all explicitly mentioned pregnancy and fetal alcohol spectrum disorder. They could not find information on miscarriage or breastfeeding on the Aware site, nor information on fertility, miscarriage, or breastfeeding on the Drinkaware IE site.
This created a ‘meta’ form of stimulus incompatibility, where the reader is prompted to expect (via the purported aims of the organisations) general information about health, but there was limited information on three of the sites, and mixed levels of information on specific topics.
Functionality: website search tools
A search tool was available for six of the seven websites.
The researchers found no search terms that consistently identified relevant information across all the websites. “Pregnancy” was the term that produced at least one directly relevant result (out of the top three results) across most websites (four out of seven), although the top result was not always relevant. The researchers found no relevant results for the search term “infant health” across any of the sites. Éduc’alcool’s search function was not visible on the homepage.
For all sites where a search tool was available, the tool did not seem to identify common terms (e.g. “fetal alcohol spectrum disorder”) and produced results for each word instead, which produced a large number of irrelevant results.
- For example, on the FAAR site the only result for this term was ‘curbing high-risk impaired drivers: DWI courts are leading by example’, and
- On the Drinkaware UK site, 465 results were produced, with only two of the top three directly relevant.
This also meant that results were often not in order of most to least relevant. Even where the tool identified a suggested term, the very large number of irrelevant results indicated that the search was still retrieving results based on individual words.
- In one case (FAAR), the tool seemed to search for individual letters. For example, searching “fertility” produced results that highlighted the word “fertilised” and a search for “FASD” produced results that highlighted the words “fast” and “faster”.
- On the Drinkaware UK and IARD websites, when searching ‘pregnancy’, each SAPROs rebuttal to Lim et al. [13] was the first (Drinkaware UK) and second (IARD) result. That is, health information aimed at the consumer came after a response to public health critique in Drinkaware UK’s case, and as part of three irrelevant (not directed towards consumer) results in the case of IARD.
Positioning and sequencing of information
The study identified positioning and sequencing misinformation across all five sites with pregnancy and infant health information. The order of information matters for three reasons:
- the reader’s response to information on alcohol harm is shaped by the first thing they read/see, to the extent that subsequent information is mostly wasted;
- isolated instances do not necessarily constitute misinformation, whereas repeated patterns do; and
- it affects how the reader engages with and processes the information.
The researchers identified several pregnancy and infant health pages on the Drinkaware UK website, although the main page with actual advice (rather than links to other pages, or general tips about cutting down on alcohol intake) was quite difficult to find.
- For example, when clicking the link ‘health effects of alcohol’, fertility and pregnancy was sixth out of nine listed effects.
- Above that was a link to ‘alcohol and the body’, where the researchers could find no relevant information, and a section on ‘alcohol and gender’. The latter did not provide any information on that page, but provided links to two further separate pages (one for men, one for women) which did have relevant information.
Patterns of positioning and sequencing misinformation were common at the webpage, paragraph, and even sentence level, with the most important information often coming last:
Through the evidence-based Australian guidelines to reduce health risks from drinking alcohol, the National Health and Medical Research Council (NHMRC) provide Australians with evidence-based advice on the health effects of drinking alcohol. The guidelines advise that to prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby.”
DrinkWise, ‘Pregnant, planning a pregnancy or breastfeeding?’ Accessed by the researchers August 11, 2022
Mixing misinformation with relevant information
Part of what makes misinformation difficult to identify and analyse is that it can be mixed with relevant information (defined here as information on pregnancy and infant health aligned with the best available current evidence). This may be a deliberate strategy. Re-analysis of the content of the seven sites previously studied by Lim et al. (see Table 3) identified that relevant information was mixed with misinformation across the websites.
However, relevant information was limited: of the five relevant information indicators the study assessed, only one was found on all five sites (a biological explanation of how alcohol affects the foetus during pregnancy on their main pregnancy and infant health page).
This kind of information was most often mixed in with the types of misinformation indicators outlined. For example, on the Drinkaware UK website, relevant information was sequenced in a way where the advice not to consume alcohol was positioned towards the end of the paragraph, and there was no direct imperative (e.g. ‘you should not drink alcohol’):
Drinking alcohol at any stage during pregnancy can cause harm to your baby – and the more you drink, the greater the risk. That’s why the UK Chief Medical Officers’ low risk drinking guidelines advise that if you’re pregnant or think you could become pregnant, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Not drinking alcohol is the safest approach.”
Drinkaware UK, ‘Alcohol and pregnancy’, accessed by the researchers July 28, 2022
Although ‘your baby’ was referenced, the last sentence included no direct instruction to the reader personally. Subtle differences in presentation can have a significant impact on how people perceive a problem and whether they think the information is relevant to them.
Combinations of misinformation strategies
The researchers outlined the key types of misinformation separately but they were commonly used in combination across the front group websites.
The study contains three illustrative examples. One of them is:
Q: I enjoy a glass of wine with a good meal. Do I have to change my habits during my pregnancy?
R: To date, researchers have not been able to determine the exact amount of alcohol that is completely safe for the development of the foetus, even though there is no evidence that the occasional drink has any harmful effect. We do know, however, that the risk of miscarriage, birth defects, growth retardation and mental disorders increases the more drinks the mother has on each occasion, and the more frequently she drinks. The scientific community believes that abstaining from drinking is the safest choice. In any case, you can always discuss your drinking with your doctor and get help if you need it.”
Éduc’alcool, ‘Pregnancy and drinking: your questions answered’, accessed by the researchers August 16, 2022
Misinformation strategies used here include priming alcohol use (‘enjoy a glass of wine with a good meal’), positioning and sequencing (the advice to abstain is the second to last sentence), framing (‘in any case’ dilutes the risk and overall message provided), presenting scientific evidence as ‘belief’, encouraging uncertainty (‘researchers have not been able to determine the exact amount…there is no evidence…’) and omission (the comment that the risk of miscarriage and other harms increase the more a mother drinks alcohol is misleading, because it is not stated that any amount increases the risk).
Given that these SAPROs are funded by a trillion-dollar industry that claims to be acting to address the harms associated with alcohol use, the ongoing dissemination of misinformation is inexcusable and contradicts the stated aims and purpose of the organisations they fund.”
Mitchell, G., Baker, C., Schalkwyk, M.C.v. et al. Do alcohol industry-funded organisations act to correct misinformation? A qualitative study of pregnancy and infant health content following independent analysis. Global Health 21, 68 (2025). https://doi.org/10.1186/s12992-025-01125-4
Conclusion
The study findings show that misinformation about alcohol, pregnancy, and infant health continues on the websites of alcohol industry front groups.
The types of misinformation identified by the study are often subtle, and it is the pattern both across and within the websites that demonstrates a lack of effective measures taken by the alcohol industry or its funded organisations to address the issue.
This is despite a previous, independent study highlighting the problem in a peer-reviewed, academic journal, which received media coverage and negative responses from the industry.
Given that these SAPROs are funded by a trillion-dollar industry that claims to be acting to address the harms associated with alcohol use, the ongoing dissemination of misinformation is inexcusable and contradicts the stated aims and purpose of the organisations they fund.
Similarly, the ‘sludge’ the study identified via the poor functionality across the websites and how difficult (or impossible) the researchers found it to identify pregnancy and infant health information cannot reasonably be explained by a lack of resources. Most consumers will not use the study methods, therefore it is likely that they receive even less information on detailed aspects of pregnancy and infant health than the researchers identified.
A key component of misinformation is that it can be mixed in with (limited) relevant information. Where this occurs, it is a function of misinformation, rather than an exception to it, and it may echo the shift similar to fossil fuel companies moving from ‘hard’ to ‘soft’ denialism because outright denial of climate change is no longer tenable. Health-harming industries are known to share the same ‘playbook’ of strategies; outright denials that alcohol is not harmful are also not credible.
Instead, a growing body of evidence suggests a whole population approach to prenatal alcohol exposure is required that also addresses alcohol consumption by non-pregnant women and men and provides the long overdue recognition of pregnancy among transgender non-binary, and gender-expansive people. Creating health environments that support healthy pregnancies is key to any prevention agenda.
Further, continuing to allow and enable the dissemination of alcohol industry-funded information as a source of advice about alcohol, pregnancy, and infant health risks undermining the promotion of women’s health and exacerbating gender or social inequities in access to high quality health promotion.
While health misinformation is not new, what is new is the sheer size and scale of transnational companies and the power that gives them to allocate resources to promote commercial rather than public health interests. Alcohol companies fund front groups to support a framing of the industry as an essential economic and social actor and force for good.
The study findings demonstrate the opposite, and add to recent studies of other alcohol industry front group activities that are in direct opposition to public health:
- the wider promotion of misinformation; efforts to promote ineffective self-regulation measures rather than effective interventions to address alcohol harms;
- public-private (SAPRO) partnerships that result in interventions that do not align with evidence-based recommendations; and
- alcohol industry youth education programmes, which were found to promote alcohol consumption and industry interests in several countries regardless of whether they were sponsored by a SAPRO, alcohol company, or charity with extensive connections to the alcohol industry.
On the basis of this growing body of evidence, this study adds to existing calls for public health actors to both stop referring people to industry-funded sources for supposed health information and to avoid any health-information related partnerships with SAPROs, and for the public to be warned to avoid such sources due to their potential for harm.
The researchers also argue that more should be done to raise awareness of who funds SAPROs, as there is evidence from Australia that the wider public believes such organisations are government-funded.
The provision of high-quality health information – a key pillar of universal health coverage – should not be outsourced to health-harming industries like the alcohol industry whose interests are in direct conflict with global health and equity goals. Alcohol industry SAPROs should be regulated as the industry-funded and industry-friendly organisations they are, rather than as the ‘independent’ charities and not-for-profit companies they present themselves to be.
Abstract
Background
Access to reliable, accurate, and up-to-date health information is a crucial component of global population health. Like other health-harming industries, the alcohol industry is known to provide misinformation to the public, including on alcohol, pregnancy, and infant health. It is unknown whether industry information changes following independent public health analysis.
Methods
The researchers extracted data using the homepage, menu, and search tool functions (where available) from seven industry-funded charity and nonprofit company websites that have previously been found to misrepresent the evidence on alcohol, pregnancy, and infant health.
These alcohol industry front groups are:
- Aware, South Africa,
- Drinkaware, Ireland,
- Drinkaware, United Kingdom,
- Éduc’alcool, Canada,
- DrinkWise, Australia,
- Foundation for Advancing Alcohol Responsibility, United States, and
- International Alliance for Responsible Drinking (IARD).
The researchers conducted a qualitative, thematic analysis using a published framework of ‘dark nudges and sludge’ misinformation techniques.
Results
Omission of information, functionality problems, and the positioning and sequencing of information in ways that framed or obfuscated its meaning were the most common forms of misinformation identified.
These types of misinformation were often mixed with (limited) relevant information and were most often found in combination.
The study found pregnancy and infant health information for the consumer on five of the seven websites studied (Drinkaware, Ireland; Drinkaware, UK; DrinkWise; Éduc’alcool; and Aware).
Information on pregnancy and fetal alcohol spectrum disorder was found on these five sites, although they did not all provide information on miscarriage, breastfeeding, or fertility.
The researchers could not find any pregnancy and infant health information directed to the consumer on the remaining sites (Foundation for Advancing Alcohol Responsibility and International Alliance for Responsible Drinking).
Six of the seven websites had a search tool function; these often produced irrelevant information.
Conclusions
Following independent public health analysis of their informational outputs, misinformation about pregnancy and infant health remains present on alcohol industry-funded websites.
Warnings to the public to avoid alcohol industry-funded information sources should form an essential part of the global effort to tackle health misinformation.