A Qualitative Investigation of Australian Young Adult Responses to Pictorial and Graphic Alcohol Product Warnings

• Author: Alexa Hayley,Caterina Giorgi,Peter G. Miller,Kerri Coomber
• Date: 01 October 2017
• Published date: 01 October 2017
• DOI: 10.1177/0022042617719443
• Subject Matter: Articles

https://doi.org/10.1177/0022042617719443

Journal of Drug Issues

2017, Vol. 47(4) 622 –637

© The Author(s) 2017

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DOI: 10.1177/0022042617719443

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Article

A Qualitative Investigation of

Australian Young Adult Responses

to Pictorial and Graphic Alcohol

Product Warnings

Kerri Coomber1, Alexa Hayley1, Caterina Giorgi2,

and Peter G. Miller1

Abstract

This qualitative study aimed to understand whether pictorial and graphic alcohol warnings would

be an effective intervention to reduce alcohol-related harms among young adult drinkers. Four

focus groups (n = 26) were conducted examining impressions, reactions, and thoughts about five

pictorial warnings and five graphic warnings. Students (58% female) from Melbourne, Australia,

aged 18 to 25 years who consumed alcohol participated. The warnings used in this study elicited

strong negative emotional reactions, including avoidance. While the use of images increased the

salience of the warnings, participants discussed the likelihood of habituation, indicating warning

rotation is needed. Targeted messages and statistics appealed to the participants. However,

they were unlikely to change their drinking behavior due to the warnings. Consistent with

tobacco warning literature, and in line with behavior change and message persuasion theory,

warning labels with photographic images and targeted statistics were found to have the most

persuasive impact against risky drinking within this sample.

Keywords

alcohol warnings, graphic, young adults, qualitative, reactions

Introduction

Within Australia and internationally, those aged 18 to 24 years are the most likely to drink at

harmful levels on a single occasion at least weekly, and to be victims of alcohol-related physical

harm (Australian Institute of Health and Welfare, 2014; McAlaney & McMahon, 2006; Naimi

et al., 2003). The use of warnings on alcohol products, in the context of a comprehensive set of

interventions, can be used to inform consumers of the likely harms of risky drinking and how

they might reduce their risk (Anderson, Chisholm, & Fuhr, 2009; Foundation for Alcohol

Research and Education [FARE], 2011; Wilkinson & Room, 2009).

1Deakin University, Geelong, Victoria, Australia

2Foundation for Alcohol Research and Education, Deakin, Australian Capital Territory, Australia

Corresponding Author:

Kerri Coomber, Faculty of Health, School of Psychology, Deakin University, Locked Bag 20001, Geelong, Victoria

3220, Australia.

Email: k.coomber@deakin.edu.au

719443JODXXX10.1177/0022042617719443Journal of Drug IssuesCoomber et al.

research-article2017

Coomber et al. 623

Message persuasion theory and research proposes that for warnings to be effective they must

get the attention of a consumer, be easily understood, and contain a memorable message that

incentivizes the consumer to change their behavior (Cameron, 2009; Hovland, Janis, & Kelley,

1953). The effectiveness of warnings depends on consumers’ attending to the warnings, reading

and comprehending the messages in the warnings, recalling the information presented, making

accurate judgments regarding risk when using the product, and changing behavior due to the

warning (Argo & Main, 2004). Therefore, the use of simple warnings that stand out from the sur-

rounding label and convey new information to the consumer are more likely to be persuasive and

lead to behavior change.

Behavior change theory suggests the introduction of legislation to implement alcohol warn-

ings with persuasion based messages could increase the motivation of consumers to decrease

the amount they drink (Michie, van Stralen, & West, 2011). Following the theory outlined in

the behavior change wheel (Michie, Atkins, & West, 2014; Michie & Johnston, 2012; Michie

et al., 2011), effective warning label legislation would work to increase the knowledge and

understanding of consumers about the negative health effects of alcohol, and persuade con-

sumers to take action by inducing negative feelings about drinking. Over time, the use of warn-

ing labels may lead to a reduction in consumer risky drinking behavior, thus leading to

environmental restructuring (i.e., a change in the social context of drinking). Effective warn-

ings for alcohol could be developed and tested based on such message persuasion and behavior

change theories.

Health warnings, as implemented on tobacco products, provide an example of a “best practice”

base for alcohol warnings (Al-hamdani, 2014; Wilkinson & Room, 2009). Some have argued that

mandatory alcohol warnings should not use tobacco warnings as an exemplar due to perceived

lack of harms with low-to-moderate consumption, the social role alcohol plays, and limited evi-

dence for the effectiveness of alcohol warnings (Eliott & Miller, 2014; Louise, Eliott, Olver, &

Braunack-Mayer, 2015). However, alcohol is a causal factor in more than 200 diseases and inju-

ries, with 25% of total deaths among those aged 20 to 39 years attributable to alcohol worldwide

(World Health Organization [WHO], 2015). Globally, alcohol represents an equivalent risk factor

of disability-adjusted life years to that of tobacco, with expectations that this burden attributable

to alcohol will continue to increase (Rehm, Taylor, & Room, 2006). Furthermore, within Australia,

alcohol use causes 15 deaths and 430 hospitalizations each day (Gao, Ogeil, & Lloyd, 2014).

Despite the disease and injury risk associated with alcohol use, consumers are typically unaware

of the consequences of both short-term and long-term alcohol consumption (Coomber, Mayshak,

Curtis, & Miller, 2017; Hasking, Shortell, & Machalek, 2005; Sanderson, Waller, Jarvis,

Humphries, & Wardle, 2009). Therefore, alcohol warnings that use factors known to be effective

in the field of tobacco control are one measure that can increase consumer awareness of the health

consequences of drinking and lead to an informed choice regarding their drinking behaviors

(Wilkinson & Room, 2009).

Graphic tobacco warnings are highly successful at changing attitudes and behaviors of smok-

ers (Azagba & Sharaf, 2013; Hammond, 2011). Tobacco warnings increase quit attempts by

increasing smokers’ perceptions of smoking risks and health-related concerns (Yong et al., 2014),

reflective of behavior change theory. In line with message persuasion theory, this effect is

strengthened when the warnings are more salient and engaging, achieved by increasing the size

and making them more graphic (Hammond, 2011; Hammond et al., 2007; Yong et al., 2014).

Theory suggests that the impact of warnings can be assessed through salience to consumers,

changes in consumer knowledge of harms, intentions to stop smoking, and actual behavioral

change (such as a quit attempt; Hammond et al., 2007).

Unlike tobacco warnings, current alcohol warnings do not have a significant impact on

drinking behavior, but can generate discussions of drinking and increase awareness of the

negative health effects (Greenfield & Kaskutas, 1993; Stockwell, 2006; Wilkinson & Room,