Young adult drinkers are more likely to perceive alcohol products as "unappealing" and "socially unacceptable" if they display prominent health warnings, according to new research.

The University of Stirling study—based on a survey of 1,360 drinkers living in the UK aged between 18 and 35 years old—found two-fifths (40.1%) of participants reported rarely or never seeing health-related information, messages, or warnings on alcohol packaging.

The research found that participants "strongly agreed" that alcohol packaging should display a range of product and health-related information, and "agreed" there should be warnings.

Participants were shown a range of warnings on packaging and felt the warnings would catch their attention when buying alcohol and make them aware of potential health risks. Larger warnings were particularly effective in reducing product appeal and social acceptability, the research team found.

Daniel Jones, of the Institute for Social Marketing and Health at Stirling, led the research and believes packaging could be an effective means of delivering health messaging.

He said: "Alcohol misuse is a key risk factor for illness, disability, and death. It is implicated in more than 200 diseases and responsible for approximately 3.3 million deaths annually.

"Our study provides an important insight into the thoughts and attitudes of young adult drinkers toward alcohol packaging and the inclusion of product information and health warnings.

"We found that alcohol packaging could have an important role in delivering health messaging. Large pictorial or text warnings in particular may help to counteract the appeal and social acceptability of alcohol products, while increasing awareness of risks. The findings of this research and previous studies indicate that warnings could, potentially, lead to a reduction in consumption and related harms."

Currently, the only product and health-related information legally required on alcohol packaging in the UK is volume, strength of alcohol by volume, and presence of common allergens.

The new study aimed to assess a sample of young drinkers' exposure to, and engagement with, current messaging on packs; support for displaying product and health-related information; and reactions to front-of-pack warnings, in terms of product appeal, social acceptability, and cognitive and behavioral impact. The research team asked the group, who all identified as current drinkers, to complete an online survey and experiment between September and October 2020.

Most participants (59.9%) reported "always," "often" or "sometimes" seeing health-related information, messages or warnings on alcohol packaging, with 40.1% saying they "rarely" or "never" did. The majority (69.9%) said they "rarely" or "never" read or looked closely at such information.

Participants largely supported displaying a range of product and health-related information on packaging, such as units, ingredients, drinking guidelines and calories.

"It is unsurprising that most participants reported not reading or looking closely at health-related information on packaging, as previous research, including studies in the UK, have suggested that current messaging is unlikely to meaningfully engage or inform consumers, for example through ambiguous messaging or small fonts positioned on the back of packs," Mr. Jones said.

To compare the perceived impact of health warning designs, participants were randomly allocated to a group and shown a vodka bottle containing either no warnings or front-of-pack small text warnings, large text warnings, or pictorial warnings. The warning sets included a general message stating "Alcohol damages your health" and two specific warnings, "Alcohol causes liver disease" and "Alcohol causes mouth cancer." Those in the pictorial warnings group were shown images that reflected each warning—a blood pressure test, an image of a person clutching their liver, and an image of a CT scanner in a hospital.

Participants who viewed products with warnings were significantly more likely to perceive the products as unappealing and socially unacceptable, compared to those who viewed products without such a warning. Those who viewed products with warnings were also significantly more likely to report positive cognitive and behavioral impacts, such as increased awareness of health risks and wanting to drink less alcohol, compared to those who did not.

Mr. Jones said: "This sample of young adult drinkers were influenced by warnings on alcohol packaging. As expected, participants who viewed the product with no warnings had the highest social appeal and acceptability ratings for the alcohol product shown, and the lowest reported impact on cognition and behavior.

"Larger warnings—with or without an image—were particularly effective in reducing product appeal and social acceptability. This supports previous research which indicates that prominent warnings on alcohol packaging may help capture attention, counteract positive product perceptions and reduce consumption intentions.

"Surprisingly, we did not find statistically significant differences between warning designs in terms of positively impacting cognitions and behaviors. This contrasts with tobacco where we know larger warnings with images are more effective at positively influencing smoking-related thoughts and behaviors, compared to smaller, text-only warnings. Moreover, the sample size was modest and the images used in the study were somewhat benign. Other alcohol and tobacco studies suggest that more severe images can evoke stronger reactions from consumers and may have a greater impact on cognitions and behaviors."

He added: "Salient warnings with specific health-related messages, as used in our study, can positively influence consumer attention, comprehension, recall, judgment and behavioral compliance."

Alison Douglas, chief executive of Alcohol Focus Scotland said, "It's vitally important that we have all the facts to make informed choices, yet because of bizarre exemptions from food and drink labeling rules there is more information required on a pint of milk than a bottle of wine. At present, the alcohol industry can decide what information it will and won't include on its products. This study shows that health information and warnings could be useful in reducing how much we drink, and that people want information about what it is in their drinks provided on products where it can usefully inform their decisions.

"We need the chief medical officers' low-risk weekly drinking guidelines as well as health information and warnings on labels, but unless labeling requirements are set out in law, we will continue to be kept in the dark about what is in our drinks."

Mr. Jones was supported on the research by Stirling colleagues Dr. Crawford Moodie, Dr. Richard Purves, Professor Niamh Fitzgerald, and Dr. Rachel Crockett.

The paper, "The role of alcohol packaging as a health communications tool: An online cross-sectional survey and experiment with young adult drinkers in the United Kingdom," is published in Drug and Alcohol Review.