PROJECT ABSTRACT
Nearly 1 in 3 American adults exceed the recommended limit for alcohol consumption, increasing their risk of
health problems including hypertensive heart disease, injuries, and several types of cancer. Most adults are
not aware of the harms of alcohol consumption. Evidence-based warnings on alcohol containers that are
displayed prominently on the front of the package, include pictorial elements such as icons, and rotate their
content over time could inform consumers and discourage unhealthy alcohol consumption. The overarching
objective of this proposal is to evaluate the impact of evidence-based alcohol warnings on alcohol
consumption. In Aim 1, we will use existing research and expert review to optimize warning statements
describing the health harms of alcohol consumption. We will then test an array of evidence-based warnings in
a randomized experiment with a nationally representative sample of 910 adult regular alcohol consumers. The
main product of Aim 1 will be the selection of 4 evidence-based warnings that participants endorse as effective
for use in Aim 2. In Aim 2, we will evaluate the impact of these evidence-based alcohol warnings on alcohol
consumption in a longitudinal RCT. We will recruit 786 adult regular alcohol consumers. Participants will be
randomly assigned to a warnings arm or a control arm. In a 4-week study, participants in the warnings arm will
receive the 4 unique evidence-based warnings affixed to their alcohol containers, allocated in random order. In
the control arm, no new labels will be applied. We will assess whether the evidence-based alcohol warnings
reduce number of drinks consumed (measured using daily diaries) and examine whether this effect varies by
baseline alcohol use, gender, age, and education. We will also evaluate how warnings influence potential
psychological mediators (measured in weekly surveys). The final product of Aim 2 will be an estimate of the
impact of evidence-based alcohol warnings on alcohol consumption. In Aim 3, we will validate a model of how
alcohol warnings influence alcohol consumption. We will conduct in-depth interviews with participants in the
warnings arm of Aim 2’s RCT to elicit insights about the mechanisms through which the trial warnings
influenced their behavior. Then, we will apply mediation analyses to the longitudinal daily diary and survey data
collected in Aim 2’s RCT to identify mediators of the impact of the trial warnings on alcohol consumption. The
final product of Aim 3 will be a model of how evidence-based alcohol warnings influence alcohol consumption.
This research is responsive to NOT-AA-21-028 by conducting causal analyses of an alcohol-reduction
policy and advancing methods by implementing an innovative RCT with naturalistic exposure to warnings.
Our findings will create an evidence base to inform development of effective alcohol warnings as well as other
communication campaigns. Ultimately, new evidence-based alcohol warnings could reduce unhealthy alcohol
consumption and address rising rates of alcohol-attributable disease and death in the US and globally.