Monday, 30 January 2017

Junk plain packs research, this time for alcohol

The Observer ran an article yesterday about plain packaging for alcohol...

It’s enough to make Jared Brown spill his drink. The co-founder and master distiller behind Sipsmith, the micro-distillery in the vanguard of the craft gin movement in the UK, is contemplating the possibility of graphic warning photographs and plain packaging appearing on bottles of alcohol, akin to the restrictions on tobacco that assume full force in May.

“Are they considering similar labels for bacon? Fish and chips? Crisps?” he demands. “It’s an absurdity. It will crush the craft side of the industry. It will shift the business back to the industrial producers, who will be very happy to move people back to mass-produced drinks. If something like this comes through we won’t be able to weather it.”

They can't say we didn't warn them.

In December, a report from the government advisory body Public Health England suggested that bottles of alcohol could be sold in plain packaging and carry larger health warnings, including photographic warning labels. This month, public health groups called for a ban on all alcohol advertising in the UK and a study published last week by the University of Liverpool recommended placing warning labels on the front of bottles and using plain packaging to emphasise the risks associated with excessive drinking.

The study from Liverpool didn't get much attention from the media, but it is worth examining to see how the same pseudo-science is being used in Phase Two of the plain packaging crusade as was used against tobacco in Phase One.

It was produced by two researchers at the junk science factory of the UK Centre for Tobacco Studies which is now known as the UK Centre for Tobacco and Alcohol Studies (hello, slippery slope). They showed photos of alcohol labels to sixty people from Liverpool University and used eye-tracking technology to monitor how long they looked at the health warnings.

Each photo was shown for 15 seconds and each person spent an average of one second per photo looking at the warning.

They then did the same experiment with 120 people, half of whom were given a brief intervention before viewing the photos. The researchers hypothesised that a brief intervention would lead people to spend more time looking at the warning and that more time spent looking at the warning would increase the individual's motivation to cut down their drinking. However, this didn't happen...

In study 1, we demonstrated that self-reported motivation to reduce drinking reduced attention to both branding and warning labels on alcohol packaging. Although we did not replicate this association in study 2, we did demonstrate that a brief alcohol intervention reduced attention to branding, although this effect was not specific for alcohol packaging and the brief alcohol intervention did not influence participants’ motivation to reduce drinking. Contrary to hypotheses, our experimental manipulation that encouraged participants to focus their attention on warning labels did not affect their drinking intentions for the subsequent week.

In other words, neither the brief intervention nor greater attention to warnings led people to express a desire to reduce their drinking.

Having failed to prove their hypothesis, the authors carry on regardless with their push for graphic warnings and plain packaging. This, of course, was the whole point of doing the experiment.

A possible explanation [for the experiment being a flop] is that participants do not particularly notice warning labels, due to their current design [14, 32]. Our results show that alcohol warning labels on average take up less than 5% of the packaging and that attention to warning labels is roughly proportional to their size. Additionally, our results suggest that large alcohol warning labels attracted more attention, but we did not experimentally test this.

Clutching at straws much?

Indeed, some researchers argue that alcohol warning labels should be more like tobacco warnings and nutrition labels and provide clear information about alcohol-related risks and unambiguous behavioural recommendations in order to increase their effectiveness [37, 38].

You can probably guess where this is heading.

This suggests that alcohol warning labels might need to elicit negative emotions in order to reduce consumption. Future research should explore the effect of label design and content on attention. Increasing the visual salience of warning labels by using plain packaging [9, 10], graphic warnings [26] and front-of-pack labelling [45] might be more effective in attracting and maintaining attention, as shown in tobacco and food research.

And relax. None of these conclusions are derived from their data. They had to resort to speculation based on other people's research, but they got to their preordained conclusion in the end.

The only thing this experiment actually shows is that people spend less time looking at the health warning than they do at the rest of the label. The authors say:

The results showed that people paid minimal attention to warning labels on alcohol packaging (7–8% of total viewing time).

This conclusion is reinforced in the study's abstract:

Alcohol consumers allocate minimal attention to warning labels on alcohol packaging and even if their attention is directed to these warning labels, this has no impact on their drinking intentions.

If one second is 'minimal attention', how long should we expect people to look at the warning? As the authors admit in an endnote, the health advice is not really a 'warning' at all. It just says 'drink responsibly'.

In previous literature, these types of “drink responsibly” labels have been referred to as “warning labels” or “health warnings” [47]. For the sake of consistency, we will refer to the drinkaware labels as health warning labels in this manuscript.

The words 'drink responsibly' can easily be read in less than a second, particularly since it is the same message on every label. The only other health messages that typically appear on alcohol packaging in the UK are the image telling pregnant women not to drink and the Chief Medical Officer's recommendations about safe drinking, both of which are always the same and will be familiar to any drinker. It is important to understand that the participants in this experiment were (falsely) told that they were taking part in a memory test and they were given a bogus memory test after the real experiment had been conducted. Naturally, therefore, people spent more time studying the packaging (which was different every time) than the 'warning'.

The study conspicuously failed to show any relationship between time spent looking at the warning and intention to reduce drinking ('exposure did not significantly affect drinking intentions'), but that does not stop the authors from concluding that policies should be introduced to make people spend more time looking at warnings. No matter what findings had resulted from the experiment, the authors would have called for bigger, bolder health warnings, preferably accompanied by plain packaging. Heads they win, tails you lose.

But even if the experiment had shown what the authors clearly wanted it to show, it would not support the introduction of graphic warnings or plain packaging. Warning labels are supposed to be educational. The only criterion of success should be whether the individual understands and remembers the information, but the authors do not attempt to measure this. Instead, they look for evidence that individuals respond to information by expressing a desire to drink less.

This is not a legitimate goal. Aside from the fact that people's stated preferences are frequently at odds with their revealed preferences, there is no reason to assume that every individual needs to reduce their drinking, even from a health perspective. The implicit assumption in this study is that health information only works if it deters consumption. This is false.

The information in these so-called warnings is 'drink responsibly'. The authors did not bother to ask the participants if they recalled that message (or, if they did, the authors don't mention it in the study). That should have been the primary question. A secondary question could have been whether the participants thought they drank responsibly, or whether they were more likely to agree that people should drink responsibly after seeing the labels, but the authors do not ask that question either. The implicit assumption is that drinking responsibly means drinking less, but this is also false.

Expect much more of this junk in the next couple of years. The floodgates are opening.

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