scholarly journals Impact of health warning labels communicating the risk of cancer on alcohol selection: An online experimental study

2019 ◽  
Author(s):  
Natasha Clarke ◽  
Emily Pechey ◽  
Eleni Mantzari ◽  
Anna Katherine Mary Blackwell ◽  
Katie De-loyde ◽  
...  
Keyword(s):  
Online Survey ◽  
Warning Labels ◽  
Health Warning ◽  
Alcoholic Drink ◽  
Cancer Breast ◽  
Increased Risk ◽  
Alcoholic Drinks ◽  
Consumption Change ◽  
Risk Of Cancer ◽  
Selection Of

Background and AimsEvidence from tobacco research suggests that health warning labels (HWLs) depicting the adverse consequences of consumption change smoking behaviours, with image-and-text (also known as ‘pictorial’ or ‘graphic’) HWLs most effective. There is an absence of evidence concerning the potential impact of HWLs placed on alcohol products on selection of those products. This study aimed to obtain a preliminary assessment of the possible impact of (a) image-and-text (b) text-only and (c) image-only HWLs on selection of alcoholic versus non-alcoholic drinks. DesignA between-subjects randomised experiment with a 2 (image: present vs absent) x 2 (text: present vs absent) factorial design. SettingThe study was conducted on the online survey platform Qualtrics.Participants Participants (n=6024) were adults over the age of 18 who consumed beer or wine regularly (i.e., at least once a week), recruited through a market research agency. Interventions Participants were randomised to one of four groups varying in the HWL displayed on the packaging of alcoholic drinks: i. image-and-text HWL; ii. text-only HWL; iii. image-only HWL; iv. no HWL. HWLs depicted bowel cancer, breast cancer and liver cancer, which were each displayed twice across six alcoholic drinks. Each group viewed six alcoholic and six non-alcoholic drinks and selected one drink that they would like to consume. MeasurementsThe primary outcome was the proportion of participants selecting an alcoholic versus a non-alcoholic drink.FindingsAlcoholic drink selection was lower for all HWL types compared with no HWL (image-and-text: 56%; image-only: 49%; text-only: 61%; no HWL: 77%), with selection lowest for HWLs that included an image. Image-and-text HWLs reduced the odds of selecting an alcoholic drink compared with text-only HWLs (OR = 0.80, 95% CI = 0.69, 0.92), but increased the odds of selecting an alcoholic drink compared with image-only HWLs (OR = 1.34, 95% CI = 1.16, 1.55).ConclusionsHealth warning labels communicating the increased risk of cancers associated with alcohol consumption reduced selection of alcoholic versus non-alcoholic drinks in a hypothetical choice task in an online setting; labels displaying images had the largest effect. Their impact in laboratory and real-world field settings using physical products awaits investigation.

Impact of Image-and-text and Text-only Health Warning Labels on Selection and Consumption of Food and Alcohol Products: Systematic Review with Meta-analysis

2019 ◽  
Author(s):  
Natasha Clarke ◽  
Emily Pechey ◽  
Daina Kosīte ◽  
Laura M König ◽  
Eleni Mantzari ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Control Group ◽  
Warning Labels ◽  
Health Warning ◽  
Alcoholic Drinks ◽  
Randomised Controlled ◽  
The Impact ◽  
Selection Of

Reducing harmful consumption of food (including non-alcoholic drinks) and alcoholic drinks would prevent much disease. Evidence from tobacco control shows that placing health warning labels (HWLs) on these products reduces their selection and consumption. A systematic review with meta-analysis was conducted using Cochrane methods to assess the impact on selection (including hypothetical selection) or consumption of food or alcoholic drinks with image-and-text (sometimes termed ‘pictorial’) and text-only HWLs placed on these products. Studies were required to be randomised or quasi-randomised controlled trials. Fourteen studies were included, three on alcohol, eleven on food. For our primary outcomes, eleven studies measured selection and one measured consumption (two measured only other secondary outcomes). Meta-analysis of twelve comparisons from nine studies (n=12,635) found HWLs reduced selection of the targeted product compared to a control group with no HWL (RR=0.74 (95% CI 0.68 to 0.80)), with participants 26% less likely to choose a product displaying a HWL. A planned subgroup analysis suggested a larger effect on selection of image-and-text HWLs (RR=0.65 (95% CI 0.54 to 0.80)) than text-only HWLs (RR=0.79 (95% CI 0.74 to 0.85)), but this difference was not statistically significant. These findings suggest significant potential for HWLs to reduce selection of food and alcohol, but all experimental studies to date were conducted in laboratory or online settings with outcomes assessed immediately after a single exposure. Studies in field and more naturalistic laboratory settings are urgently needed to estimate the potential effects of HWLs on food and alcohol.

scholarly journals Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability

2020 ◽  
Author(s):  
Emily Pechey ◽  
Natasha Clarke ◽  
Eleni Mantzari ◽  
Anna Blackwell ◽  
Katie De-loyde ◽  
...  
Keyword(s):  
Emotional Arousal ◽  
Field Studies ◽  
Tobacco Consumption ◽  
Bowel Cancer ◽  
Free Text ◽  
Label Free ◽  
Warning Labels ◽  
Potential Effectiveness ◽  
Health Warning ◽  
Alcoholic Drinks

Abstract Background Health warning labels (HWLs) using images and text to depict the negative health consequences of tobacco consumption are effective and acceptable for changing smoking-related outcomes. There is currently limited evidence concerning their potential use for reducing consumption of alcoholic drinks and energy-dense foods. The aim of this research was to describe the potential effectiveness and acceptability of image-and-text (also known as pictorial or graphic) HWLs applied to : i. alcoholic drinks and ii. energy-dense snack foods. Methods Two online studies were conducted using between-subjects designs with general population samples. Participants rated one of 21 image-and-text HWLs on alcoholic drinks (n=5528), or one of 18 image-and-text HWLs on energy-dense snacks (n=4618). HWLs comprised a graphic image with explanatory text, depicting, respectively, seven diseases linked to excess alcohol consumption, and six diseases linked to excess energy intake. Diseases included heart disease and various cancers. Outcomes were negative emotional arousal, desire to consume the labelled product, and acceptability of the label. Free-text comments relating to HWLs were content analysed. Results For both alcoholic drinks and energy-dense snacks, HWLs depicting bowel cancer generated the highest levels of negative emotional arousal and lowest desire to consume the product, but were the least acceptable. Acceptability was generally low for HWLs applied to alcohol, with 3 of 21 rated as acceptable, and was generally high for snacks, with 13 of 18 rated as acceptable. The majority of free-text comments expressed negative reactions to HWLs on alcohol or energy-dense snacks. Conclusions Image-and-text health warning labels depicting bowel cancer showed greatest potential for reducing selection and consumption of alcoholic drinks and energy-dense snacks, although they were the least acceptable. Laboratory and field studies are needed to assess their impact on selection and consumption.

scholarly journals Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability

2019 ◽  
Author(s):  
Emily Pechey ◽  
Natasha Clarke ◽  
Eleni Mantzari ◽  
Anna Katherine Mary Blackwell ◽  
Katie De-loyde ◽  
...  
Keyword(s):  
Emotional Arousal ◽  
Field Studies ◽  
Tobacco Consumption ◽  
Bowel Cancer ◽  
Free Text ◽  
Label Free ◽  
Warning Labels ◽  
Potential Effectiveness ◽  
Health Warning ◽  
Alcoholic Drinks

BackgroundHealth warning labels (HWLs) using images and text to depict the negative health consequences of tobacco consumption are effective and acceptable for changing smoking-related outcomes. There is currently limited evidence concerning their effectiveness and acceptability for reducing consumption of alcoholic drinks and energy-dense foods. AimTo describe potential effectiveness and acceptability of image-and-text (also known as pictorial or graphic) HWLs applied to: i. alcoholic drinks and ii. energy-dense snack foods.Methods Two online studies were conducted using between-subjects designs with representative UK samples. Participants rated one of 21 image-and-text HWLs on alcoholic drinks (n=5528), or one of 18 image-and-text HWLs on energy-dense snacks (n=4618). HWLs comprised a graphic image with explanatory text, depicting, respectively, seven diseases linked to excess alcohol consumption, and six diseases linked to excess energy intake. Diseases included heart disease and various cancers. Outcomes were negative emotional arousal, desire to consume the labelled product, and acceptability of the label. Free-text comments relating to HWLs were content analysed. ResultsFor both alcoholic drinks and energy-dense snacks, HWLs depicting bowel cancer generated the highest levels of negative emotional arousal and lowest desire to consume the product, but were the least acceptable. Acceptability was generally low for HWLs applied to alcohol, with 3 of 21 rated as acceptable, and was generally high for snacks, with 13 of 18 rated as acceptable. The majority of free-text comments expressed negative reactions to HWLs on alcohol or energy-dense snacks. Conclusions Image-and-text health warning labels depicting bowel cancer showed greatest potential for reducing selection and consumption of alcoholic drinks and energy-dense snacks, although they were the least acceptable. Laboratory and field studies are needed to assess their impact on selection and consumption.

scholarly journals Health warning labels and alcohol selection: an experiment in a naturalistic shopping laboratory

2020 ◽  
Author(s):  
Natasha Clarke ◽  
Anna Katherine Mary Blackwell ◽  
Katie De-loyde ◽  
Emily Pechey ◽  
Alice Hobson ◽  
...  
Keyword(s):  
Bayes Factor ◽  
Emotional Arousal ◽  
Warning Labels ◽  
Health Consequences ◽  
Excessive Alcohol Consumption ◽  
Health Warning ◽  
Adverse Health ◽  
Alcoholic Drinks ◽  
Excessive Alcohol ◽  
The Impact

Background and aims Health warning labels (HWLs) on tobacco products reduce smoking. There is an absence of evidence concerning the impact of alcohol HWLs on selection or purchasing in naturalistic settings. Using a commercial-standard naturalistic shopping laboratory, this study aimed to estimate the impact on selection of alcoholic drinks of HWLs describing adverse health consequences of excessive alcohol consumption.DesignA between-subjects randomised experiment with three groups: Group 1: image-and-text HWL; Group 2: text-only HWL; Group 3: no HWL.SettingA commercial-standard naturalistic shopping laboratory. Participants Adults (n=399) over the age of 18, who purchased beer or wine weekly to drink at home. InterventionsParticipants were randomised to one of three groups varying in the HWL displayed on the packaging of the alcoholic drinks: i. image-and-text HWL; ii. text-only HWL; iii. no HWL. Participants completed a shopping task, selecting items from a range of alcoholic and non-alcoholic drinks, and snacks. MeasurementThe primary outcome was the proportion of alcoholic drinks selected. Secondary outcomes included HWL ratings on negative emotional arousal and label acceptability.FindingsThere was no clear evidence of a difference in the HWL groups for the percentage of drinks selected that were alcoholic compared to no HWL (44%): image-and-text HWL: 46% (OR=1.08, 95%CI=0.82,1.42); text-only HWL: 41% (OR=0.87, 95%CI=0.67,1.14). Concordant with there being no difference between groups, there was extreme evidence in favour of the null hypothesis (Bayes factor [BF] < 0.01). Negative emotional arousal was higher (p< 0.001) and acceptability lower (p< 0.001) in the image-and-text HWL group, compared to the text-only HWL group. ConclusionsIn a naturalistic shopping laboratory, health warning labels describing the adverse health consequences of excessive alcohol consumption did not change selection behaviour.

scholarly journals The impact on selection of non-alcoholic vs alcoholic drink availability: an online experiment

2019 ◽  
Author(s):  
Anna Katherine Mary Blackwell ◽  
Katie De-loyde ◽  
Gareth J Hollands ◽  
Richard Morris ◽  
Laura A Brocklebank ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Factorial Design ◽  
Time Pressure ◽  
Online Experiment ◽  
Cognitive Resource ◽  
Alcoholic Drink ◽  
Alcoholic Drinks ◽  
Resource Conditions ◽  
The Impact ◽  
Selection Of

Background Increasing the availability of healthier food increases its selection and consumption. However, there is an absence of evidence related to alcohol. This study aimed to estimate the impact of increasing the absolute and relative availability of non-alcoholic compared to alcoholic drinks on selection. We also assessed whether effects were modified by cognitive resource.Methods UK adult weekly alcohol consumers (n=808) were recruited to an online experiment with a hypothetical drink selection task. Participants were randomly assigned to one of eight conditions, in a 4 (availability) x 2 (cognitive resource) factorial design. The four availability conditions were: i. Reference 1 (two non-alcoholic, two alcoholic drinks); ii. Reference 2 (four non-alcoholic, four alcoholic drinks); iii. Increased non-alcoholic drinks (six non-alcoholic, two alcoholic drinks); iv. Increased alcoholic drinks (two non-alcoholic, six alcoholic drinks). The two cognitive resource conditions were: a. Low (high time pressure); b. High (low time pressure). Logistic regression was used to assess selection of a non-alcoholic drink. Results49% of participants selected a non-alcoholic drink in the Increased non-alcoholic drinks condition, compared to 36% in Reference 1, 39% in Reference 2, and 26% in the Increased alcoholic drinks condition. Non-alcoholic drink selection was similar between Reference 1 and 2 when the total number of drinks increased (absolute availability) but the proportion of non-alcoholic compared to alcoholic drinks (relative availability) was unchanged (OR = 1.15, 95% CI 0.77, 1.73). In contrast, the odds of selecting a non-alcoholic drink were 71% higher when both absolute and relative availability of non-alcoholic compared to alcoholic drinks was increased from Reference 1 to the Increased non-alcoholic drinks condition (OR: 1.71, 95% CI 1.15, 2.54), and 48% higher when increased from Reference 2 to the Increased non-alcoholic drinks condition (OR: 1.48, 95% CI 0.99, 2.19). There was no evidence of an effect of cognitive resource.ConclusionsGreater availability of non-alcoholic drinks, compared to alcoholic drinks, increased their online selection, an effect that may be larger when changing their relative availability, i.e., increasing the proportion of non-alcoholic drinks. Naturalistic studies are needed to determine the impact of availability interventions on reducing alcohol purchasing and consumption.

Does Radioactive Iodine Therapy for Hyperthyroidism Cause Cancer?

2021 ◽  
Author(s):  
Brian W Kim
Keyword(s):  
Radioactive Iodine ◽  
Therapeutic Option ◽  
Cancer Breast ◽  
Increased Risk ◽  
Effective Therapeutic Option ◽  
Autonomously Functioning Thyroid Nodules ◽  
Observational Cohort ◽  
The Subject ◽  
Risk Of Cancer

Abstract Radioactive iodine has been considered a safe and effective therapeutic option for hyperthyroidism secondary to Graves disease and autonomously functioning thyroid nodules since the mid-20th century. The question of whether I-131 at the doses used for hyperthyroidism might increase the risk of cancer has been investigated in a number of observational cohort studies over the years, with the preponderance of evidence being reassuring as to its safety. In particular, the 1998 Cooperative Thyrotoxicosis Therapy Follow-up Study (CTTFUS) has been widely cited as compelling evidence that I-131 is safe in hyperthyroidism therapy with respect to carcinogenesis. However, in 2019, a study by Kitahara and colleagues re-analyzed the CTTFUS cohort, extending the follow-up time and applying a novel dosimetric model for estimating tissue absorbed doses of radiation. This new analysis concluded that radioactive iodine was associated with an increased risk for mortality from overall cancer, breast cancer, and non-breast solid cancers. Reaction to this study was vociferous and particularly negative in the nuclear medicine literature. This mini-review was inspired by the 2019 CTTFUS controversy, and it is intended to provide the necessary context for clinicians to provide nuanced advice to their patients on the subject. To that end, the pre-2019 literature is surveyed, the 2019 CTTFUS study and a 2020 follow-up are discussed, and lessons from the literature and critical commentaries are considered.

scholarly journals Impact of health warning labels communicating the risk of cancer on alcohol selection: an online experimental study

Addiction ◽  
2020 ◽  
Vol 116 (1) ◽  
pp. 41-52 ◽  
Author(s):  
Natasha Clarke ◽  
Emily Pechey ◽  
Eleni Mantzari ◽  
Anna K.M. Blackwell ◽  
Katie De‐loyde ◽  
...  
Keyword(s):  
Experimental Study ◽  
Warning Labels ◽  
Health Warning ◽  
Risk Of Cancer

scholarly journals Image-and-text health warning labels on alcohol and food: potential effectiveness and acceptability

2020 ◽  
Author(s):  
Emily Pechey ◽  
Natasha Clarke ◽  
Eleni Mantzari ◽  
Anna Blackwell ◽  
Katie De-loyde ◽  
...  
Keyword(s):  
Emotional Arousal ◽  
Field Studies ◽  
Tobacco Consumption ◽  
Bowel Cancer ◽  
Free Text ◽  
Label Free ◽  
Warning Labels ◽  
Potential Effectiveness ◽  
Health Warning ◽  
Alcoholic Drinks

Abstract Background Health warning labels (HWLs) using images and text to depict the negative health consequences of tobacco consumption are effective and acceptable for changing smoking-related outcomes. There is currently limited evidence concerning their effectiveness and acceptability for reducing consumption of alcoholic drinks and energy-dense foods. Aim To describe potential effectiveness and acceptability of image-and-text (also known as pictorial or graphic) HWLs applied to : i. alcoholic drinks and ii. energy-dense snack foods. Methods Two online studies were conducted using between-subjects designs with general population samples. Participants rated one of 21 image-and-text HWLs on alcoholic drinks (n=5528), or one of 18 image-and-text HWLs on energy-dense snacks (n=4618). HWLs comprised a graphic image with explanatory text, depicting, respectively, seven diseases linked to excess alcohol consumption, and six diseases linked to excess energy intake. Diseases included heart disease and various cancers. Outcomes were negative emotional arousal, desire to consume the labelled product, and acceptability of the label. Free-text comments relating to HWLs were content analysed. Results For both alcoholic drinks and energy-dense snacks, HWLs depicting bowel cancer generated the highest levels of negative emotional arousal and lowest desire to consume the product, but were the least acceptable. Acceptability was generally low for HWLs applied to alcohol, with 3 of 21 rated as acceptable, and was generally high for snacks, with 13 of 18 rated as acceptable. The majority of free-text comments expressed negative reactions to HWLs on alcohol or energy-dense snacks. Conclusions Image-and-text health warning labels depicting bowel cancer showed greatest potential for reducing selection and consumption of alcoholic drinks and energy-dense snacks, although they were the least acceptable. Laboratory and field studies are needed to assess their impact on selection and consumption.

scholarly journals Impact of health warning labels on snack selection: an online experimental study

2019 ◽  
Author(s):  
Natasha Clarke ◽  
Emily Pechey ◽  
Eleni Mantzari ◽  
Anna Katherine Mary Blackwell ◽  
Katie De-loyde ◽  
...  
Keyword(s):  
Open Science ◽  
Warning Labels ◽  
Health Warning ◽  
Online Setting ◽  
Science Framework ◽  
The Impact ◽  
Energy Dense Food ◽  
Selection Of ◽  
Data Analysis Plan

BackgroundExcessive consumption of energy-dense food increases the risk of obesity, which in turn increases the risk of non-communicable diseases, including heart disease, type 2 diabetes and most non-smoking-related cancers. Health warning labels (HWLs) that communicate the adverse health consequences of excess energy consumption could reduce intake of energy-dense foods. The aim of the current study was to estimate the impact on selection of energy-dense snacks of (a) image-and-text HWLs (b) text-only HWLs and (c) calorie information. Methods A between-subjects, 3 (HWL: image-and-text, text-only, no label) x 2 (calorie information: present, absent), factorial experimental design. Participants (N=4,134) were randomised to view a selection of energy-dense and non-energy-dense snacks with one of five label types or no label. The primary outcome was the proportion of participants selecting an energy-dense snack in a hypothetical vending machine task.ResultsThe proportion of participants selecting an energy-dense snack was reduced in all label groups, relative to the no label group (image-and-text HWL: 37%; image-and-text HWL with calories: 38%; text-only HWL: 48%; text-only HWL with calories: 44%; calories only: 54%; no label: 59%). Participants were least likely to select an energy-dense snack in the image-and-text HWL group and most likely in the no label group (OR = 0.46, 95%CI = 0.40, 0.54, p < 0.001).Conclusions Health warning labels – particularly those including an image and text - have the potential to reduce selection of energy-dense snacks in an online setting. Their impact on selection and consumption in real-world settings awaits testing.Trial registration: The study protocol (https://osf.io/6n7h9, registered: April 1st 2019) and data analysis plan (https://osf.io/zvrs5) were pre-registered on the Open Science Framework. KeywordsHealth warning labels, pictorial labels, graphic warnings, snacks, food, choice architecture, energy-dense

Reclaiming the value of pictorial health warning labels in Jordan

2017 ◽  
Vol 27 (5) ◽  
pp. 589-591
Author(s):  
Nour A Obeidat ◽  
Mai Al-Hadid ◽  
Asma A Hatoqai ◽  
Rawan A Shihab ◽  
Feras I Hawari
Keyword(s):  
Focus Groups ◽  
The Novel ◽  
Warning Labels ◽  
Health Warning ◽  
Inductive Approach ◽  
Graphic Images ◽  
Vicarious Experiences ◽  
The Impact ◽  
Selection Of

BackgroundIn Jordan, four non-graphic pictorial health warning labels (PHWLs) concerning a limited selection of tobacco-caused harms have been used since 2011; however, research suggests that they may be ineffective.ObjectivesTo explore Jordanian smokers’ reactions to novel PHWLs featuring various health themes and/or graphic and symbolic imagery and to discuss existing PHWLs in light of the novel PHWLs.MethodsWe conducted 14 focus groups (FGs) with smokers who assessed 12 novel PHWLs and commented on four existing PHWLs. Data were analysed using an inductive approach.ResultsSix themes emerged from the FG discussions: understanding the overall meaning of PHWLs, the impact of graphic images, magnitude and controllability of harm, personal or vicarious experiences, the futility of quitting and fatalism. PHWLs depicting graphic respiratory and oral tobacco-caused harms resonated with most smokers. Smokers also sought direct, harm-specific taglines when trying to understand the overall PHWL. Some smokers viewed the PHWLs as exaggerated, and while the majority acknowledged that smoking was harmful, they felt that PHWLs would not accomplish their goal of inducing quitting.ConclusionsOur findings support the use of graphic imagery to communicate tobacco-caused harms (particularly respiratory ones) and the use of specific taglines explaining the mechanism of harm depicted.

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