One more reason to try dry January: Public health researchers find increasing public awareness about alcohol as a carcinogen strengthens support for higher prices

January 10/2020

Fewer than 25 per cent of Canadians who consume alcohol are aware that alcohol can cause cancer.

However, people who learned that alcohol is a carcinogen were almost two times more likely to support policies that raise the price of alcohol, according to one of the first international studies and the first study in Canada led by public health researchers at the University of Toronto and the University of Victoria.

“Alcohol regulations — particularly regulations that increase the price of alcohol — tend to be unpopular in Canada, but improving public awareness of alcohol-related health harms like cancer, using tools such as adding warning labels to alcohol containers that link consumption and cancer risk for example, increases public receptiveness to alcohol control policies,” said Erin Hobin, Assistant Professor of Epidemiology at the Dalla Lana School of Public Health and senior author on the study.

This is important as research shows that policies increasing the price of alcohol are the most effective intervention for reducing alcohol use and harms, harms that cost Canadians more than $14 billion annually.

According to Health Canada, 78 per cent of Canadians currently drink alcohol, which is more than their international peers. Alcohol policies in Canada vary between provinces and territories and current trends in many jurisdictions favour deregulation, which are particularly visible in Ontario where beer and wine are now sold in hundreds of grocery stores and the buck-a-beer promise.

Hobin and her research team aim to change the narrative around alcohol. This paper, Improving Knowledge that Alcohol Can Cause Cancer is Associated with Consumer Support for Alcohol Policies: Findings from a Real-World Alcohol Labelling Study, published on January 7, 2020 in the International Journal of Environmental Research and Public Health, found that people who learn that alcohol can cause cancer are almost two times more likely to support alcohol pricing policy.

The paper described a Health Canada-funded study in Yukon that is part of a larger experiment testing three different tri-coloured alcohol labels: one with a cancer warning (linking alcohol use with breast and colon cancer), the second advising on safer levels of consumption or Canada’s low risk drinking guidelines, and the third label illustrated the number of standard drinks per beverage container.

Yukon and the Northwest Territories have the highest alcohol consumption in Canada and their governments have applied alcoholic beverage labels since 1991 with warnings against drinking during pregnancy, and an additional message in Northwest Territories cautioning about drinking and driving.

The research team planned an eight-month intervention. Three days after the intervention launched in Yukon in late 2017, alcohol industry representatives requested the labels be removed, inciting significant international media coverage. In the media coverage, the industry denied the causal link between alcohol and cancer, and the legitimacy of using labels to communicate health information. The intervention was paused after the first month, but two months later, the study resumed on the condition that the label that linked alcohol consumption and cancer was removed from shelves.

For more than 30 years, the World Health Organization has classified alcohol as a group one carcinogen, the same as tobacco smoke and asbestos. Drinking alcohol is known to increase the risk of at least seven different cancer types, even at low doses. For example, in terms of lifetime cancer risk, drinking one bottle of wine per week is the equivalent of smoking 10 cigarettes in a week for a non-smoking women and five cigarettes in a week for a non-smoking man.

Despite the interference from the alcohol industry, the research team completed the study that followed individuals over time and demonstrated that increasing consumer knowledge about the risks of alcohol is associated with an increase in acceptance of strong preventive measures that can effectively curb alcohol use and harms. Just like with tobacco control, increasing pricing is the strongest mechanism to reduce the harms associated with drinking alcohol.

“Our ultimate goal with this study was to determine if well-designed alcohol labels are an effective tool for supporting consumers in making more informed and safer alcohol decisions,” said Hobin.

“It’s time to change the story around alcohol, which is deeply ingrained in Canadian culture, and well-designed warning labels that provide new information to consumers about its serious health risks may be an important first step in denormalizing alcohol in Canada,” said Hobin.

Hobin’s research team is also examining if this intervention shifted population-level alcohol consumption patterns using alcohol sales data and has a number of follow-up studies slated for publication later this year.

“With Ontario and other jurisdictions weakening alcohol regulations, we’re seeing increased availability and consumption, which ultimately leads to more harms caused by alcohol. Given the high prevalence of alcohol use in Canada and the perceptions of alcohol as a relatively benign substance, we need innovative approaches to increase public understanding of alcohol risk factors, similar to what we saw as cigarette use and tanning became less socially acceptable because of the risks these behaviours pose for cancer,” said Hobin.