Warning: Alcohol causes cancer. Examining public responses to alcohol warning labels

Abstract

Alcohol is a carcinogen. It is classified as a Group-1 carcinogen—the highest classification of causality, indicating the strongest association with cancer. It is estimated that one in four cancers are attributable to alcohol consumption worldwide. However, public understanding of the cancer risks associated with alcohol consumption is limited. One way of increasing public awareness is through health warning labels on alcohol beverage containers. The cultural and social significance of consuming alcohol, and labelling effectiveness, however, are significant considerations for the success of this public health measure. The aim of this thesis was to investigate what is known about alcohol warning labelling as a public health approach to reduce alcohol-related harm and how Australians might respond to the message that alcohol ‘causes cancer.’ I considered the cultural ideologies and practices relevant to the Australian public with respect to alcohol-related cancer risk and proposed alcohol warning labels. A qualitative study design was employed, with two separate phases conducted: a scoping review and focus group research. Phase 1 was a scoping review of international literature on the effectiveness of alcohol warning labels, focusing particularly on how effectiveness is assessed in the literature, and the design characteristics that influence effectiveness of alcohol warning labels. Findings from the review suggested that warning labels are not an effective strategy for reducing alcohol-related harm. In Phase 2, I conducted focus groups to examine how Australian adults responded to alcohol-related cancer messages. This research comprised of focus groups with people who self-identified as light-to-moderate alcohol consumers, and people who perceived themselves as having an increased risk of cancer compared with the general public. The findings are reported in three research papers. The first paper explored the social and cultural significance of consuming alcohol and the ways in which participants resisted any implied need to alter personal alcohol consumption to reduce the risk of cancer. In the second paper, I illustrated how participants challenged both the legitimacy of alcohol-related cancer messages and the entities responsible for disseminating health information. The findings highlight the role alcohol plays within an Australian culture and the likely opposition to ‘alcohol causes cancer’ warnings. In the third paper, I investigated how participants used their experiences with smoking-related cancer risk to understand and negotiate warnings of alcohol-related cancer risk. These findings suggested that campaigns warning of cancer risk for a popular commodity like alcohol may benefit from applying the strategies proven to be successful in anti-tobacco campaigning. Findings in this thesis provide public health advocates with information about relevant factors associated with current public health messaging, and considerations for future public health campaigns. The research findings are also relevant for policy makers and their efforts to reduce alcohol-related harms—including cancer.