Calling time on low-risk drinking guidelines: An evaluation of alternative methods to communicate risks of alcohol use to consumers.

Background: Current epidemiological analyses suggest there is no risk-free level of alcohol consumption. Awareness remains low and consumption levels high. There is limited research on the types of alcohol warning label (AWL) messages to address this concern.

Aims: We tested alternative AWL messages with young adults to identify effective methods of communicating Canada's 2023 Guidance on Alcohol and Health.

Methods: We recruited 332 young adults attending two Canadian universities who drank at least monthly. Participants' knowledge of health risks from alcohol was assessed. Six AWLs were developed to communicate (a) traditional "low risk" limits, (b) alcohol's cancer risk, (c) guidelines to keep mortality risk below 1 %, (d) reduced life expectancy in minutes per drink, (e) reduced life expectancy in months or (f) a "drink less" message. AWLs were rated for impact on purchasing, clarity, discomfort and degree of annoyance caused. Mixed regression was used to analyse the rated scores all compared with a control message which recommended consumers drink responsibly. T-tests were used to test for significance between the impact ratings of the AWLs. The AWLs were also discussed by a focus group.

Results: Participants correctly identified liver cirrhosis (93.37 %) and pancreatitis (85.84 %) as caused by alcohol, fewer identified throat (38.25 %) or breast cancer (24.70 %). All six experimental AWLs were rated as significantly more impactful on purchasing behaviour than the control. The highest mean ratings were received for the 'Cancer Risk' (3.09, 95 % CIs: 2.95-3.25), the '5 Minutes of Life Lost per Drink' (3.01, 95 % CIs: 2.87-3.16) and 'Three Months of Life Lost' (2.96, 95 % CIs: 2.82-3.11) AWLs. Traditional drinking guideline messages and a '1 % mortality risk' message performed relatively poorly. These results were confirmed by qualitative analysis of the focus group discussion.

Conclusions: Health communications, including AWLs, may be more effective if they highlight specific, tangible risks from alcohol consumption such as cancer and potential impacts on life expectancy.