红酒养生？我们好像又被骗了……
前两天，后台收到询问：请问你是把这个号卖了吗？
因为有的盆友不是每期都打开，我灰常理解。所以再说一次：我只是在休产假，最近发的文章是我厚脸皮转载的康奈尔大学营养学系的公号FunFoodCorp。内容都与食材、营养有关，也算没有脱离了本公众号的“营业范围”。
本期这篇文章又让我涨姿势了，于是我迫不及待分享给你们。简而言之：饮酒需适量，而高大上的红酒，其实也没有那么多神奇的功效（我想到了某款“红酒面膜”，又是一个坑）……
——————以下为原文——————
红酒养生，骗局还是事实？
过节聚会，无论中西，无酒不成宴。红酒这一舶来品，因其妖娆的色彩、迷醉的芬芳和著名的“ 养生功能”，越来越来被国人推崇。
但是，红酒真的养生吗？
对人体健康而言，红酒会比其他酒精饮料高大上？
本期FunFood将追溯“红酒养生”的前世今生，拨开“营销”迷雾，粉碎 “红酒养生”的谣言。
红酒养生的说法在民间盛行，既非本世纪才有，也不是中国特色，它的养生标签就源自大名赫赫的法国悖论。
上世纪80年代由世界卫生组织 (WHO) 指导的MONICA营养调查1显示：法国人爱奶酪爱鹅肝爱高热量食品，他们摄入的饱和脂肪量同英国、美国人差不多，但冠心病致死率却远低于英美。于是有人指出，这是因为法国人常以红酒佐餐，说明饮红酒有利健康。
然而美国政府似乎并不买账，联邦强制规定在包括红酒的所有酒精饮料包装上须注明孕妇不应该喝酒 (27 U.S. Code § 16.21)2，未满21岁人群禁止饮酒 (23 U.S. Code § 158)3。
那么，民间盛传的红酒养生到底是有据可考还是无稽之谈？
我们喝红酒，到底喝了些什么呢？
谈论红酒时，我们在谈论什么
以赤霞珠 (Cabernet Sauvignon) 为例，美国农业部 (USDA) 营养数据中心显示4，每一杯 (约150ml) 含有86.56%的水， 2.60%的碳水化合物，0.07%的蛋白质。剩下的10.77%几乎全是酒精，和含量极微的酚类物质 (232mg)5。
＊酚类物质极微量未显示
既然“红酒≈ 酒精+极微量的酚类+水+少量蛋白质+少量碳水化合物”，那我们来看看这个组合是否具有养生功能。
降低心血管疾病风险
大量流行病学调查指出适量酒精 (无论酒精来源是啤酒，红/白葡萄酒或烈酒) 摄入有助于降低心血管病风险6。
适量酒精有助于降低心血管风险机理：酒精提高体内高密度脂蛋白 (HDL) 水平。高密度脂蛋白可以运载胆固醇，并最终将其排出体外，从而预防心血管疾病。
这是不是说，酒精蒙冤多年，其实它本来就养生？错！这个陈述忽略了饮酒致癌、引发肝脏疾病的风险。事实上，美国心脏协会 (AHA) 也从没有倡导通过“适量饮酒”来保护心血管健康。合理饮食结构和增加运动量 (每天低强度运动至少150分钟，例如步行等) 才是正确选择7。
任何剂量酒精增加患癌风险
WHO下属的国际癌症研究机构 (IARC) 在2010年指出，酒精饮料的摄入能够导致肝癌、口腔和咽喉癌、食道癌、结直肠癌、女性乳腺癌等癌症8。除此之外，饮酒伤肝，酒精摄入增加女性肝硬化发病风险9，并且对于肝脏有问题的人群，不论何种原因引发及严重程度，都不应饮用酒精饮料10。
与多种疾病有关
来自Jürgen Rehm 等人的综合分析阐述了酒精和多种疾病的关系11。其结论是，不论你有怎样的饮用习惯，酒精总体而言对身体有害，与多种急性病和慢性病的发病有关！
既然酒精在养生中为负分，那么身为保健养生明星的酚类物质能否逆转局势，挽回红酒养生盛誉？
好是好，实在少
红酒里含有多种多酚物质，例如黄酮、花青素、原花色素，以及因红酒而声名鹊起的白藜芦醇等有益成分。说酚类物质是养生的明星队员，的确当之无愧。这些物质本身具有多种生物活性，包括心脏保护，抗炎，抗致癌，抗病毒和抗菌性能12。
白藜芦醇作为抗氧化明星物质，它能清除体内自由基 ，降低患心血管疾病的风险。Magyar等对心血管病人的3个月的临床研究发现，每天服用10 mg白藜芦醇，可以改善病症13。
然而正如其他的保健成分，白藜芦醇的种种功效也是建立在一定剂量的基础上。我们做一个简单的计算。仍然以产自加州的赤霞珠为例，白藜芦醇平均含量为0.9 mg/L，要达到研究中能够改善心血管疾病的有效剂量，我们一天需要饮用约11L 红酒，也就是22瓶，并且天天喝，喝3个月！也就是说靠喝红酒来养生，可能先醉死、撑死、穷死更或者作死……
蛋白质&碳水化合物
相较于组合其他成员，碳水化合物和蛋白质更像是打酱油的。尽管如此，计算饮酒带来的卡路里（每杯约122大卡)4 时，他们可以和酒精一起，成为你囤积脂肪的得力小助手……
红酒不养生
众酒平等，爱酒自由
正如其他酒
在红酒“组合”中，养生明星酚类物质因其含量极低，对健康的作用微乎其微，而酒精之危害却显而易见。
因此，喝红酒并不养生！为了养生喝红酒，才是捡了芝麻丢了西瓜，得不偿失！
那这红酒，还能不能喝？
喝！但这是为了乐趣喝，不是为了虚无缥缈自欺欺人的“养生说”喝。正如康奈尔大学食品科学系的刘瑞海教授所说：为了健康，不要喝；为了气氛，适量喝！ (For health, don’t drink it. For pleasure, just drink it lightly.)
饮酒小贴士:
举杯为乐，贪杯不可
1.适量饮酒
根据2010年美国膳食指南的定义14，以1杯为单位（就是上图中的一杯），女性每天饮酒不超过1杯，男性每天饮酒不超过2杯称为适量饮酒。若化作纯酒精计算，即男性每天摄入不超过28g，女性不超过14g。
女性一天饮酒超过3杯或者一周超过7杯，以及男性一天饮酒超过4杯或一周超过14杯，就是过量饮酒，是引发各种相关疾病的高风险行为。事实上，中国的饮酒人群的年均饮酒量在国际上排名前三，仅次于我们戏称为战斗民族的塔吉克斯坦人和俄国人15。在这样的背景下，大家更应该关心自己以及身边的人，不要饮酒过量，乐极生悲。
2.选择低浓度酒
无论什么酒都无养生功能。因此，对危害人体健康而言，各种酒精无差。但相比而言，低酒精浓度导致疾病风险较低。
3.不宜饮酒人群
如果你是孕妇或正处于备孕状态的女性、未成年人、正患病且酒精不利于疾病康复或是药物禁忌，那么你不宜饮酒。
点击“阅读原文”，可直达FunFood原文主页。
1. Jost, J. P., et al."Comparison of dietary patterns between population samples in the threeFrench MONICA nutritional surveys." Revue d'épidémiologie et desanté publique 38.5-6 (1989): 517-523.
2. https://www.gpo.gov/fdsys/pkg/CFR-2012-title27-vol1/xml/CFR-2012-title27-vol1-sec16-21.xmlRetrieved on 12/20/2015
3. https://www.gpo.gov/fdsys/pkg/USCODE-2011-title23/html/USCODE-2011-title23-chap1-sec158.htmRetrieve on 12/20/2015
4. http://ndb.nal.usda.gov/ndb/foods/show/4193?man=&lfacet=&count=&max=&qlookup=&offset=&sort=&format=Abridged&reportfmt=other&rptfrm=&ndbno=&nutrient1=&nutrient2=&nutrient3=&subset=&totCount=&measureby=&_action_show=Apply+Changes&Qv=1&Q65=1Retrieve on 12/19/2015
5. Stratil, Pavel,Vlastimil Kuban, and Jitka Fojtova. "Comparison of the phenolic contentand total antioxidant activity in wines as determined by spectrophotometricmethods." Czech Journal of Food Sciences 26.4 (3.
6. Roerecke, Michael,and Jürgen Rehm. "Alcohol intake revisited: risks andbenefits." Current atherosclerosis reports 14.6 (2.
7. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyEating/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.VneUh-ODGkoRetrieved on 12/21/2015
8. IARC (2010). Alcohol consumption and ethylcarbamate. IARC Monogr Eval Carcinog Risks Hum, 96: 1–1428.
9. Rehm, Jürgen, et al."Alcohol as a risk factor for liver cirrhosis: A systematic review andmeta‐analysis." Drugand alcohol review 29.4 (2010): 437-445.
10. Neuman, Manuela G., Maristela Monteiro, and Jürgen Rehm."Drug interactions between psychoactive substances and antiretroviraltherapy in individuals infected with human immunodeficiency and hepatitisviruses."Substance use & misuse 41.10-12 (2006):
11. Rehm, Jürgen, et al. "The relationship of average volumeof alcohol consumption and patterns of drinking to burden of disease: anoverview."Addiction 98.9 (2003): .
12. Baroni, María V., et al. "How good antioxidant is thered wine? Comparison of some in vitro and in vivo methods to assess theantioxidant capacity of Argentinean red wines." LWT-Food Scienceand Technology 47.1 (2012): 1-7.
13. Magyar, K., et al. "Cardioprotection by resveratrol: Ahuman clinical trial in patients with stable coronary arterydisease." Clinical hemorheology and microcirculation 50.3(2012): 179.
14. http://health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdfRetrieved on 12/21/2015
15. https://www.washingtonpost.com/news/wonk/wp//the-rise-and-fall-of-alcohol-consumption-around-the-world-charted/Retrieved on 12/23/2015
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今日搜狐热点Message on a bottle: are alcohol warning... (PDF Download Available)
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21.05Flinders University13.58University of South Australia46.86University of South AustraliaAbstractBackground
Although most Australians are unaware of the risk, there is strong evidence for a direct link between alcohol consumption and many types of cancer. Warning labels on alcohol products have been proposed as a cost-effective strategy to inform the community of this health risk. We aimed to identify how Australians might respond to such an approach.
We conducted a national online survey canvassing responses to four separate cancer warning messages on labels. The graphically presented messages were informed by qualitative data from a series of focus groups among self-identified ‘light-to-moderate’ drinkers. For each label, participants were asked their level of agreement with impact statements about raising awareness, prompting conversation, influencing drinking behaviour and educating others about cancer risk. We analysed responses according to demographic and other factors, including self-reported drinking behaviour (using the 3-item Alcohol Use Disorder Test – AUDIT-C – scores).
Approximately 1600 participants completed the survey, which was open to all Australian adults over a period of 1 month in 2014. Overall, the labels were well received, with the majority (&70 %) agreeing all labels could raise awareness and prompt conversations about the cancer risk associated with alcohol. Around 50 % or less agreed that the labels could influence drinking behaviour, but larger proportions agreed that the labels would prompt them to discuss the issue with family and friends. Although sex, AUDIT-C score and age were significantly associated with agreement on bivariate analysis, multivariate analyses demonstrated that being inclined to act upon warning label recommendations in general was the most important predictor of agreement with all of the impact statements. Having a low AUDIT-C score also predicted agreement that the labels might prompt behaviour change in friends.
Conclusions
The findings suggest that providing detailed warnings about cancer risk on alcohol products is a viable means of increasing public awareness of the health risks associated with alcohol consumption. Further research is needed to explore the ability of such warnings to influence behavioural intentions and actual drinking behaviour.Discover the world's research15+ million members100+ million publications700k+ research projectsFigures
R E S E A R C H A R T I C L E Open AccessMessage on a bottle: are alcohol warninglabels about cancer appropriate?Emma R. Miller1*, Imogen J. Ramsey1, Genevieve Y. Baratiny2and Ian N. Olver3AbstractBackground: Although most Australians are unaware of the risk, there is strong evidence for a direct link betweenalcohol consumption and many types of cancer. Warning labels on alcohol products have been proposed as acost-effective strategy to inform the community of this health risk. We aimed to identify how Australians mightrespondtosuchanapproach.Methods: We conducted a national online survey canvassing responses to four separate cancer warning messages onlabels. The graphically presented messages were informed by qualitative data from a series of focus groups amongself-identified ‘light-to-moderate’drinkers. For each label, participants were asked their level of agreement with impactstatements about raising awareness, prompting conversation, influencing drinking behaviour and educating othersabout cancer risk. We analysed responses according to demographic and other factors, including self-reported drinkingbehaviour (using the 3-item Alcohol Use Disorder Test –AUDIT-C –scores).Results: Approximately 1600 participants completed the survey, which was open to all Australian adults over a periodof 1 month in 2014. Overall, the labels were well received, with the majority (&70 %) agreeing all labels could raiseawareness and prompt conversations about the cancer risk associated with alcohol. Around 50 % or less agreed thatthe labels could influence drinking behaviour, but larger proportions agreed that the labels would prompt them todiscuss the issue with family and friends. Although sex, AUDIT-C score and age were significantly associated withagreement on bivariate analysis, multivariate analyses demonstrated that being inclined to act upon warninglabel recommendations in general was the most important predictor of agreement with all of the impact statements.Having a low AUDIT-C score also predicted agreement that the labels might prompt behaviour change in friends.Conclusions: The findings suggest that providing detailed warnings about cancer risk on alcohol products is a viablemeans of increasing public awareness of the health risks associated with alcohol consumption. Further research isneeded to explore the ability of such warnings to influence behavioural intentions and actual drinking behaviour.Keywords: Alcohol, Cancer prevention, Warning labelsBackgroundAlcohol is the most widely used drug in Australia [1] andhas been identified as a Class 1 carcinogen [2]. Drinkingalcohol at any level increases the risk of developing analcohol-related cancer [3]. There is evidence for a dose-response relationship between alcohol and cancer risk,such that the level of cancer risk increases proportionatelyto the level of alcohol consumption [4–6]. A comprehen-sive review of the scientific evidence by the World CancerResearch Fund and the American Institute for CancerResearch reported a causal relationship between alcoholconsumption and development of a number of cancers,including cancers of the mouth, larynx, oesophagus, phar-ynx, bowel, breast and liver [3, 6]. It is estimated thataround 5000 cases of cancer per year in Australia are at-tributable to long-term use of alcohol [6] and nearly 340thousand deaths worldwide are the result of alcohol-attributable cancers [7].Although there is growing awareness in the Australianpopulation of the dangers of heavy episodic alcohol con-sumption and drinking during pregnancy, there is littleunderstanding of the health risks associated with ‘light’to‘moderate’alcohol consumption [8] which, in Australia,* Correspondence: emma.miller@flinders.edu.au1Discipline of Public Health, Flinders University, GPO Box 2100, Bedford Park5001, South AustraliaFull list of author information is available at the end of the article(C) 2016 Miller et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Miller et al. BMC Public Health
( DOI 10.-016-2812-8
has been classified as drinking less than two standarddrinks per day for men and women [9]. Surveys show thatmost Australian adults drink alco about half do so atlevels that increase their risk of alcohol-related harm inthe short-term, and about one-quarter at levels that in-crease their risk of alcohol-related harm in the long-term[8]. The 2013 National Drug Strategy Household Survey[10] explored awareness of health risks related to alcoholconsumption among Australian men and women. Thesurvey found that 54 % of men and 68 % of women hadthe perception that they could drink one to two standarddrinks every day for many years without adversely affect-ing their health. Recent evidence shows that even rela-tively low levels of alcohol consumption are associatedwith the development of a range of soft tissue cancers [3].As we have previously noted [11], this evidence essentiallychanges the known cancer risk status for a significant pro-portion of the Australian population, to now include thosewho drink at light-to-moderate levels.That a substantial proportion of light-to-moderatedrinkers may be unknowingly placing themselves at riskhas underscored the need for strategies to inform the pub-lic of the cancer risk associated with alcohol [12]. Man-dated health warnings on alcohol products have beenproposed as a cost-effective way to convey this informa-tion, which could be worthwhile if part of a multi-prongedpublic health initiative [13, 14]. Although evaluations ofthe warning label approach have demonstrated positiveeffects on knowledge and attitudes [7], there is limited re-search on how aspects of message content and audiencecharacteristics may influence public perceptions about theeffectiveness of cancer-specific warning labels. Further-more, despite studies reporting support for the introduc-tion of mandated warnings on alcoholic products inAustralia [15], little information is available to guide thedevelopment of effective warning messages.Informed by qualitative findings from a series of focusgroups in South Australians who self-identified as‘light-to-moderate’drinkers, we developed a nationalonline survey to investigate the impact of cancer warn-ing messages on alcohol products and to inform effortsto provide information regarding alcohol-related cancerrisk in the Australian context.Unique to this study is the inclusion of Australiandrinkers not ordinarily considered at risk, namely, light-to-moderate dr and the consideration of healthmessages addressing the long-term, rather than the short-term, harms associated with alcohol.MethodOur national online survey was developed using Qualtrics(R)survey software and was open for a 1-month period inmid-2014 (30th July to 2nd August). The anonymous sur-vey was open to all Australian residents aged 18 years andover, regardless of alcohol consumption. The survey waspromoted on Facebook (filtered to exclude members agedunder 18 years and those not based in Australia), in com-munity newspapers in all Australian capital cities and wasalso available on the web pages of a number of communitybased organisations and government agencies. Represen-tativeness of the sample was not assumed as the methodof recruitment was by self-selection. For this reason, weincluded a range of demographic data in the survey andaimed to recruit a sufficiently large population as to allowfor meaningful stratified analysis according to these char-acteristics. The entry page to the survey included detailedinformation about the survey including the study aims,potential risks and expected benefits. All individuals wererequired to consent to participation by acknowledgingtheir understanding of the information provided beforethe survey could open. By leaving their contact details viaa separate link provided at the end of the survey, partici-pants were able to enter a lottery to win one of three $100shopping vouchers.The surveyThe survey collected demographic data and informationabout participants’usual patterns of drinking behaviour,and included the 3-item Alcohol Use Disorder Identifica-tion Test (AUDIT-C), which provides a total score out of12 across three categories of drinking frequency andquantity [16] and has been found to perform well in gen-eral population surveys and among young adults [17]. Weapplied the widely used cut off score of 4 and above toindicate for problematic alcohol use in both men andwomen. A cut off score of 4 is able to identify hazardousdrinking in men with a sensitivity of 0.86 and a specificityof 0.72 [18] with a lower sensitivity of 0.48 but very highspecificity of 0.99 in women [19].In addition to questions concerning attitudes towardswarning labels in general, the survey contained specificquestions on the proposed warning messages. Four warn-ing messages were included, graphically presented as labelson three different types of alcohol bottles representingwine, spirits and beer. The four cancer warning statementspresented on the labels are provided in Table 1. For eachof the four labels, participants were asked to rate theirlevel of agreement (on a Likert scale ranging from “stronglyagree”to 5 “strongly disagree”) with impact statementsabout raising awareness, prompting conversation, influ-encing drinking behaviour and educating others aboutcancer risk. The full impact statements are also pre-sented in Table 1.Participants were also asked their level of agreementwith a series of statements about responses to warninglabels in general. These included ‘I always read productlabels when I see them’;‘There are too many productwarning labels, I tend to ignore them’;‘Most productMiller et al. BMC Public Health
Page 2 of 10
warning labels aren’t relevant to me’;‘I prefer to haveproduct warning labels so I know what all the risks are’;and ‘I usually reassess my behaviour according to theproduct warning label.’Data analysisIn our analyses, Likert scale agreement categories weredichotomised to “agree”and “disagree”(excluding the “nei-ther agree nor disagree”responses) for each statement andlabel. The variables were further condensed to create unani-mous label agreement and disagreement categories for eachstatement. For instance, the new outcome variable foragreeing the labels would raise awareness contained onlythose agreeing or disagreeing with on this statement aboutall four labels. These agreement outcomes were then com-pared to all demographic variables and responses to generalwarning labels and AUDIT-C score. As AUDIT scores(range 1 to 12) were not normally distributed, they weredichotomised at the threshold of four, which is the con-sidered the level indicative of potential alcohol disor-ders [9, 16]. Age was also not normally distributed inour sample and recoding the data into ordinal age cat-egories did not make it possible to demonstrate differ-ences (using Chi-Square and Cramer’s V). For this reason,age was dichotomised to above and below the median asan appropriate cut off.We developed agreement ratios with confidence inter-vals using univariate and multivariate techniques whereappropriate. Age and sex were included in all multivari-ate models to control for potential confounding and tocontrol for over representation in the sample. Missingdata were excluded from the analyses given the relativecompleteness of the responses. Data were analysed usingStata (release 13, Stata Corporation, College Station, TX,USA). This project was approved by The University ofAdelaide Human Research Ethics Committee.ResultsOne thousand, five hundred and forty-seven people com-pleted the survey and their characteristics are presented inTable 2. The median age of study participants was 43 yearsand 72 % were female. Seventy-nine per-cent of surveyrespondents were born in Australia and 2 % identified asIndigenous Australian. The most common fields of em-ployment or study reported by participants were educa-tion and training, health, social welfare and retail. Only2 % of participants identified ‘Alcohol Production andDistribution’as a main area of work or study (35/1547)but when these were combined with hotel and hospitalityworkers, approximately 15 % reported working in an ‘alco-hol-related industry’. The majority (78 %) of survey re-spondents reported a tertiary education, which was ahigher proportion than in the Australian population aged25–64 (24 %) [20]. The majority of participants (91 %)identified as current drinkers and, of these, 56 % scoredfour or above on the AUDIT-C, placing them within the‘high risk’range of scores on this measure.Overall, the labels were well received, with the majorityof respondents (&77 %) agreeing that all four labels couldraise awareness about the link between regular alcoholconsumption and cancer. There was also majority agree-ment that the labels would prompt conversations aboutthe cancer risk involved in drinking regularly (&70 %) andprompt participants to educate their children about thecancer risk associated with alcohol (&74 %). There wasgreater agreement across all impact statements for mes-sages referring to a specific kind of cancer (Labels 1, 3 and4) than for the message referring to cancer in general(Label 2). More than 80 % of respondents agreed that thethree cancer-specific labels would raise awareness of andprompt conversation about the link between alcohol con-sumption and cancer. About 50 % of respondents or feweragreed that the labels could influence drinking behaviour,but larger proportions (&58 %) agreed that the labelswould prompt them to discuss the issue with family andfriends. Figure 1 presents the proportion of total state-ment agreement (‘agree’and ‘strongly agree’combined) forall four labels.As indicated in Fig. 1, there were similar patterns ofresponse to the four separate labels, therefore unani-mous agreement or disagreement to the respective im-pact statements in all labels was combined. The medianage of this subgroup was similar to the total sample(44 years, interquartile range 31–54) as was the propor-tion of participants scoring ≥4 on the Audit-C (53 %).The proportion of females was higher than the totalTable 1 Alcohol warning labels statementsLabel warning statementsaLabel 1 Three drinks a day increases your chance ofbowel cancer by 20 %Label2 Alcohol causes cancerLabel 3 Two or more drinks a day can increase yourrisk of mouth and throat cancer by over 50 %Label 4 1 in 5 breast cancers are caused by alcoholImpact statementsIS 1 Raise awareness about the link betweenregular alcohol consumption and cancerIS 2 Prompt conversations about the cancer riskinvolved in drinking alcohol regularlyIS 3 Prompt me to drink alcohol less oftenIS 4 Prompt my friends to drink alcohol less oftenIS 5 Prompt me to talk to my family and/or friendsabout the cancer risk associated with alcoholIS 6 Prompt me to educate my children about thecancer risk associated with alcoholaIARC, World Cancer Report [39]; Fedirko et al. [40]; Tramacere et al. [41]; Allen et al.[4] Clarke et al. [42]Miller et al. BMC Public Health
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sample (84 % versus 72 %), which was controlled for inthe following analyses.There was 93 % (825/883) total agreement that the labelswould raise awareness about the link between alcohol andcancer. There was 86 % (624/724) total agreement that thelabels would prompt conversation about the cancer riskinvolved in drinking regularly and 84 % (616/734) totalagreement that they would prompt respondents to educatetheir children about the cancer risk associated with alcoholconsumption. Fewer participants agreed that the labelsFig. 1 Agreement with impact statements for all four labels. Note. Impact statements are abbreviated to the following: Aware = “Raise awarenessabout the link between regular alcohol consumption and cancer”. Talk = “Prompt conversations about the cancer risk involved in drinking alcoholregularly”. Myself = “Prompt me to drink alcohol less often”. Friend = “Prompt my friends to drink alcohol less often”. Family = “Prompt me to talkto my family and/or friends about the cancer risks associated with alcohol”. Kids = “Prompt me to educate my children about the cancer riskassociated with alcohol”Table 2 Participant characteristics (N= 1545)Male n= 435 Female n= 1110 Total n= 1545Age –median years (IQ range) 44 (31–56) 43 (30–53) 43 (30–54)[Missing data] [Nil] [Nil] [Nil]Born in Australia 338 (78 %) 887 (80 %) 1110 (72 %)[Missing data] [2 (1 %)] [Nil] [2 (0 %)]Indigenous Australiana12 (3 %) 14 (2 %) 26 (2 %)Tertiary educated 312 (72 %) 892 (81 %) 1204 (78 %)[Missing data] [3 (1 %)] [4 (0 %)] [7 (1 %)]Common employment fields:Education and training 117 (27 %) 421 (38 %) 538 (35 %)Health 48 (16 %) 256 (23 %) 304 (20 %)Social Welfare 38 (9 %) 173 (16 %) 211 (14 %)Retail 50 (12 %) 156 (14 %) 206 (13 %)In alcohol-related industryb65 (15 %) 164 (15 %) 229 (15 %)[Missing data] [Nil] [Nil] [Nil]Current alcohol consumption 393 (92 %) 1006 (91 %) 1399 (91 %)[Missing data] [9 (2 %)] [7 (1 %)] [16 (1 %)]AUDIT-C score ≥4c288 (74 %) 491 (49 %) 779 (56 %)[Missing data] [4 (1 %)] [5 (1 %)] [9 (1 %)]Note: missing data excluded from all analysesaAboriginal or Torres Strait IslanderbIncludes those working in alcohol production/distribution, hotels and hospitalitycProportion of current drinkers onlyMiller et al. BMC Public Health
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could influence drinking behaviour. There was 36 % (195/538) total agreement that the labels would prompt the par-ticipants themselves to drink alcohol less often, and 30 %(133/446) total agreement that the labels would promptparticipants’friends to drink alcohol less often.Factors that were associated with agreement with eachimpact statement are presented in Table 3. There weresignificant univariate associations between being femaleand agreement with all six impact statements. For eachimpact statement, a low AUDIT-C score (&4) was alsosignificantly associated with agreement. The participantswho scored as ‘low-risk’drinkers (i.e. received an overallAUDIT-C score & 4) expressed more agreement with theimpact statements than the participants who identifiedas ‘high-risk’drinkers. Those aged 43 years (median age)and above were more likely than younger participants toagree that the labels would influence the drinking behav-iour of their friends or would prompt them to discuss al-cohol and cancer with their friends and/or family. Finally,participants who reported working in an alcohol-relatedindustry (i.e. alcohol production/distribution, hotels orhospitality) were less likely than those working in otherareas to agree that the labels would prompt them to talkto family and/or friends, or to educate their children aboutthe cancer risk associated with alcohol.A series of Chi square tests were conducted for the as-sociation between agreement with the impact statementsand preference for warning labels in general (e.g. “Ialwaysread product warning labels when I see them”). Agreementwith the impact statements was significantly associatedwith attitudes towards warning labels in general (all ana-lyses yielded P&0 .001), which included being inclined toread warning labels and reassess behaviour based on theirrecommendations, and preferring to be informed aboutrisks. Disagreement with the impact statements was as-sociated with the tendency to ignore warning labels ingeneral or perceiving most labels as being personally ir-relevant (see Table 3).In additional analyses, participants aged 43 years andabove, low-risk drinkers (AUDIT-C score &4) and femaleswere most likely to report that they always read warninglabels, preferred knowing risks and would usually reassesstheir behaviour according to product warnings. Males,high-risk drinkers and participants aged less than43 years were least likely to agree with the statement“There are too many warning product warning labels, Itend to ignore them”. Being female and median age orabove were also significantly associated with having alow-risk AUDIT-C score.Multivariate analysesWe built log binomial models to find independent predic-tors of agreement with each label impact statement.Collinearity between two potential explanatory variableswas assessed using Chi-square and Phi. All models in-cluded age and sex and various combinations of AUDIT-Cscore, working in an alcohol-related industry and educa-tion level, as well as reported responses to warning labelsin general. After adjusting for sex, a low AUDIT-C scorewas no longer associated with agreement that the labelswould raise awareness about the cancer risk involved inconsuming alcohol regularly or prompt participants todrink alcohol less often. Neither education level nor work-ing in the alcohol industry significantly predicted agree-ment with any of the impact statements after adjustmentfor sex, age and AUDIT-C score.In models including participants’preference to readwarning labels in general, being female continued to bea significant predictor of statement agreement on five ofthe six impact statements. Being female was no longerassociated with participant agreement that the labelswould prompt them to drink alcohol less often, once ad-justed for preference to read warning labels in general.Despite the significant univariate associations observed,neither age nor AUDIT-C score were significant predic-tors of agreement that the labels would raise awarenessand prompt conversation about the cancer risk involvedin consuming alcohol regularly, prompt participants todrink less, or prompt them to educate their children aboutthe cancer risk associated with drinking alcohol, after ad-justment for sex and preference to read warning labels.AUDIT-C score and age did not predict agreement withany of the impact statements after adjusting for sex andreassessing behaviour based on warning labels. When pref-erence to read warning labels was included, our models in-dicated that being female, reading labels and reassessingbehaviour based on general product warnings independ-ently predicted agreement that the alcohol labels wouldraise awareness of and prompt conversation about the can-cer risk associated with alcohol consumption, prompt par-ticipants themselves to drink alcohol less often and promptparticipants to educate their children about the alcohol-cancer link. However, “I always read product labels when Isee them”and “I usually reassess my behaviour accordingto the product warning label”were found to be significantlyassociated with each other, with 90 % agreement (Chi-2 =271.8, p& 0.001) and were also strongly correlated (Phi =0.522). Convergence was difficult to reach when both wereincluded in the most models due to this collinearity. Forthis reason, these factors were included in a series of separ-ate multivariate models with “I usually reassess my behav-iour according to the product warning label”emerging asthemoreimportantfactor.Further investigations of the interrelationships betweenthe attitudes to warning labels in general it emerged that‘tend to ignore product warning labels’and ‘most productwarning labels are not relevant to me’were no longer sig-nificant for any impact statement once controlling forMiller et al. BMC Public Health
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Table 3 Factors univariately associated with total impact statement agreement (n= 883)Statement FactoraAgreement ratio(95 % CI)Agreement difference(95 % CI)X2p-value*Raise awareness about the link betweenregular alcohol consumption and cancerFemale sex 1.12 (1.06, 1.19) 0.10 (0.06, 0.15) 29.44 &0.001AUDIT-C &4 1.05 (1.1, 1.09) 0.04 (0.01, 0.08) 5.48 0.020Reassess 1.35 (1.23, 1.48) 0.26 (0.19, 0.32) 114.41 &0.001Read 1.22 (1.14, 1.31) 0.18 (0.12, 0.24) 82.36 &0.001Ignore 0.77 (0.71, 0.84) -0.22 (-0.29, -0.16) 111.15 &0.001Irrelevant 0.89 (0.84, 0.94) -0.11 (-0.16, -0.06) 29.84 &0.001Risk 1.33 (1.22, 1.45) 0.24 (0.18, 0.31) 137.66 &0.001Prompt conversations about the cancer riskinvolved in drinking alcohol regularlyFemale sex 1.30 (1.18, 1.43) 0.21 (0.14, 0.28) 50.68 &0.001AUDIT-C &4 1.13 (1.06, 1.20) 0.10 (0.05, 0.16) 14.09 &0.001Reassess 1.89 (1.62, 2.20) 0.46 (0.37, 0.54) 175.25 &0.001Read 1.50 (1.34, 2.67) 0.31 (0.24, 0.39) 114.82 &0.001Ignore 0.65 (0.57, 0.74) -0.33 (-0.41, -0.25) 109.65 &0.001Irrelevant 0.78 (0.71, 0.86) -0.20 (-0.27, -0.13) 46.19 &0.001Risk 1.84 (1.59, 2.14) 0.44 (0.36, 0.52) 203.22 &0.001Prompt me to drink alcohol less often Female sex 1.61 (1.22, 2.12) 0.16 (0.08, 0.24) 12.93 &0.001AUDIT-C &4 1.28 (1.03, 1.60) 0.09 (0.01, 0.17) 4.70 0.030Reassess 8.32 (5.00, 13.91) 0.55 (0.48, 0.63) 129.13 &0.001Read 1.66 (1.26, 2.19) 0.17 (0.09, 0.25) 14.74 &0.001Ignore 0.33 (0.23, 0.49) -0.30 (-0.38, -0.23) 45.00 &0.001Irrelevant 0.48 (0.35, 0.66) -0.22 (-0.30, -0.15) 25.16 &0.001Risk 5.11 (3.33, 7.84) 0.41 (0.35, 0.48) 92.55 &0.001Prompt my friends to drink alcohol less often Female sex 1.68 (1.19, 2.36) 0.14 (0.06, 0.22) 9.70 0.002AUDIT-C &4 2.10 (1.53, 2.89) 0.21 (0.12, 0.30) 21.35 &0.001Age ≥43 years 1.36 (1.02, 1.81) 0.09 (0.01, 0.18) 4.45 0.035Reassess 11.58 (6.06, 22.12) 0.56 (0.48, 0.64) 119.66 &0.001Read 3.11 (2.02, 4.81) 0.27 (0.19, 0.34) 34.61 &0.001Ignore 0.28 (0.18, 0.45) -0.38 (-0.36, -0.21) 38.05 &0.001Irrelevant 0.40 (0.27, 0.60) -0.23 (-0.31, -0.15) 25.54 &0.001Risk 12.06 (5.77, 25.21) 0.43 (0.37, 0.50) 95.70 &0.001Prompt me to talk to my family and/or friendsabout the cancer risks associated with alcoholFemale sex 1.61 (1.38, 1.88) 0.30 (0.21, 0.38) 54.77 &0.001AUDIT-C &4 1.34 (1.20, 1.50) 0.20 (0.13, 0.28) 26.54 &0.001Age ≥43 years 1.17 (1.05, 1.29) 0.11 (0.03, 0.18) 8.53 0.004Not working in Alcoholrelated Industryb1.21 (1.02, 1.45) 0.13 (0.02, 0.23) 6.19 0.013Reassess 3.51 (2.71, 4.56) 0.64 (0.57, 0.72) 210.59 &0.001Read 1.66 (1.41, 1.94) 0.31 (0.23, 0.39) 60.71 &0.001Ignore 0.54 (0.43, 0.64) -0.45 (-0.37, -0.29) 79.32 &0.001Irrelevant 0.66 (0.67, 0.77) -0.26 (-0.34, -0.18) 41.94 &0.001Risk 3.51 (2.69, 4.58) 0.61 (0.54, 0.68) 223.18 &0.001Miller et al. BMC Public Health
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‘usually reassessing behaviour.’Significant collinearity wasalso found between “I prefer to have product labels so Iknow all of the risks”and “I usually reassess my behaviouraccording to the product warning label”with 97 % agree-ment (Chi-2 = 487.15, p& 0.001) and were also stronglycorrelated (Phi = 0.700). The models including the stron-ger factor are presented in Table 4, as based on size of theratio and reduction of the significance of other factors inthe model.Our final models are presented in Table 4, and includethe remaining significant factors after adjusting for ageand sex. These analyses indicated that positive responsesto warning labels in general was the single most importantpredictor of agreement with all of the impact statements.Being female continued to predict agreement that the la-bels would raise awareness and prompt behaviour changesin friends, while having a low AUDIT-C score predictedagreement that the labels might prompt behaviour changein friends.DiscussionThis study aimed to canvass responses of the Australianpublic to cancer warning labels on alcohol products.Several studies have demonstrated that there is substan-tial public support for the introduction of alcohol warn-ing labels in Australia [15, 21, 22]. Our findings suggestthat cancer warning statements are unlikely to be re-ceived negatively by the Australian community, with themajority of participants agreeing that all labels couldraise awareness of, and prompt conversations about, thecancer risk associated with alcohol. Similar outcomeswere observed in a recent Australian study, which re-ported that responses to cancer-related warning labelswere generally neutral to positive [7].Our results yielded significant differences in the out-come variables by message and respondent characteristics.Females were more likely to report usually acting uponthe advice of warning labels, with the latter characteristicsindependently associated with agreement that the labelsTable 3 Factors univariately associated with total impact statement agreement (n= 883) (Continued)Prompt me to educate my children aboutthe cancer risk associated with alcoholFemale sex 1.41 (1.27, 1.57) 0.27 (0.2, 0.34) 76.87 &0.001Audit-C &4 1.23 (1.15, 1.32) 0.17 (0.12, 0.23) 35.31 &0.001Reassess 2.15 (1.81, 2.56) 0.52 (0.44, 0.60) 204.60 &0.001Read 1.47 (1.32, 1.64) 0.29 (0.22, 0.37) 92.78 &0.001Ignore 0.60 (0.52, 0.69) -0.37 (-0.45, -0.29) 127.14 &0.001Irrelevant 0.74 (0.66, 0.82) -0.23 (-0.31, -0.16) 55.97 &0.001Risk 2.19 (1.84, 2.62) 0.52 (0.44, 0.60) 248.70 &0.001Notes. Agreement with: generally reassess behaviour based on warning labels is abbreviated to ‘Reassess’; always read product warning labels abbreviated to‘Read’; too many product warning labels so I tend to ignore them abbreviated to ‘Ignore’; most product warning labels are not relevant to me abbreviated to‘Irrelevant’; prefer to have product labels so I know what the risks are abbreviated to ‘Risk’*Chi-Square, 2-tailed tests usedaAgreed with impact statement relative to disagreed with impact statementbIncludes those working in alcohol production/distribution, hotels and hospitalityTable 4 Factors predicting statement agreement: multivariate analysisStatement Factor Agreement ratio(95 % CI)Agreement difference(95 % CI)p-valueRaise awareness about the link between regular alcoholconsumption and cancerFemale sex 1.07 (1.04–1.10) 0.04 (0.01–0.07) &0.001Risk 1.32 (1.22–1.44) 0.24 (0.17–0.30) &0.001Prompt conversations about the cancer risk involved indrinking alcohol regularlyReassess 1.87 (1.61–2.18) 0.45 (0.36–0.53) &0.001Prompt me to drink alcohol less often Reassess 8.59 (5.13–14.40) 0.56 (0.48–0.53) &0.001Prompt my friends to drink alcohol less often ≥43 years 1.40 (1.05–1.86) 0.09 (0.04–0.14) 0.024Risk 9.45 (4.50–19.90) 0.37 (0.30–0.46) &0.001AUDIT-C &4 1.42 (1.06–1.89) 0.11 (0.02–0.16) 0.019Prompt me to talk to my family/friends about the cancerrisks associated with alcoholReassess 3.44 (2.61–4.54) 0.52 (0.22–0.63) &0.001Prompt me to educate my children about the cancer riskassociated with alcoholReassess 14.71 (8.16–26.51) 0.49 (0.41–0.58) &0.001Notes. Agreement that with the statement about generally reassessing behaviour based on warning labels is abbreviated to ‘Reassess’; prefer to have produc tlabels so I know what the risks are abbreviated to ‘Risk’All models included age and sexMiller et al. BMC Public Health
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raise awareness and prompt behaviour changes. Therewas higher agreement across all impact statements formessages referring to a specific type of cancer than for themessage referring to cancer in general. This finding is con-sistent with those of Pettigrew et al. [8], where participantsreported that specific cancer warnings were more believ-able, convincing and personally relevant than general can-cer warnings.Although there was broad agreement about the capacityof the labels to raise awareness and prompt discussionabout alcohol and cancer, it is uncertain whether any im-provements to knowledge resulting from exposure to thelabels will elicit sustained behaviour change. Reviews ofthe literature suggest that alcohol warning messages mayimprove knowledge and attitudes relating to the harmfulconsequences of alcohol use in adults [17]; however, thereis limited evidence of the effects of these messages ondrinking behaviour [13]. In the present study, less thanhalf of all respondents agreed that the warning messagescould influence their own drinking behaviour and evenfewer agreed the messages might influence the drinkingbehaviour of their friends. Similar results have been re-ported in studies conducted in the United States, wherewarning labels about the adverse effects of alcohol onpregnancy, driving ability and health have been mandatorysince November 1989 [17]. In one example, Greenfieldet al. [23] reported that exposure to a warning label wasassociated with modest effects on discussing alcohol-related risks, and small effects on precautionary behav-iours related to the risk of drinking.Similar findings have been reported in adolescent sam-ples. A review of the literature investigating the impact ofalcohol labelling on adolescents’drinking knowledge andbehaviour found that the introduction of warning labelswas associated with improved awareness and recognitionof the warning messages, despite little change in actualbehaviour [21]. Since attitudes regarding alcohol con-sumption are often formed during adolescence [24] andcarcinogenesis is a generally a slow process [25], dealingwith perceptions, attitudes and drinking behaviour duringthis period of development is critical.Our univariate findings suggested that being female andself-reported low-risk drinking status were factors associ-ated with agreement with the impact statements. However,a significantly higher proportion of males than females inthis study were identified as high-risk drinkers based ontheir overall AUDIT-C scores (74 % versus 49 %). This pat-tern is consistent with previous Australian studies thathave reported higher levels of harmful alcohol consump-tion among males than females [26]. Despite the signifi-cant univariate associations observed, final multivariatemodels indicated that the most significant predictor ofagreement with the impact statements was a high level ofresponsiveness to warning labels in general. The resultsindicated that participants with this characteristics werealso more likely to drink at low-risk levels. These findingsare supported by previous research, which has demon-strated a negative association between consumption of al-cohol and the behaviour of reading product warning labels[27].Participants who reported drinking at high-risk levelswere less likely to read product warnings in general orcomply with their recommendations than participantswho reported drinking at low-risk levels. DeCarlo [27]has explained this relationship from the perspective of so-cial judgement theory, which states that lower-involvementindividuals (such as light drinkers) are more likely to payattention to and accept persuasive efforts than high-involvement individuals (such as heavy drinkers). Accord-ing to the theory, behavioural change resulting frompersuasive messages is constrained by the importance andfrequency of the behaviour [25, 28]. On this basis, a be-haviour that is considered important or is frequently per-formed will be resistant to change [25]. This contrasteffect was evident in a study by Bozinoff et al. [29] inwhich the effectiveness of alcohol awareness campaignswas significantly greater for non-drinkers than for heavydrinkers of alcohol. Alternatively, negative responses tospecific alcohol warnings in heavier drinkers could be at-tributed to psychological reactance, in which the threat tofreedom might paradoxically motivate increased alcoholconsumption [30, 31].Our results indicated that high-risk drinkers perceivedthe labels to be less effective in altering drinking behav-iour than light-to-moderate drinkers, and reported theywould be less likely to modify their behaviour based onhealth warnings or read warning labels in general. Thissuggests that alcohol warning label information may bedisregarded by those who are most at risk of harmfuldrinking, which is consistent with previous research [27,32, 33]. However, in light of recent evidence demonstrat-ing an association between regular, low levels of alcoholconsumption and several types of cancer [34] even light-to-moderate drinkers are at risk of developing analcohol-related cancer. Consequently, although cancerwarnings may have less impact on heavier drinkers, theymay positively influence the drinking behaviours of thosewho consume alcohol at more moderate levels and arestill at risk for cancer.As the survey was open to all Australian adults 18 yearsof age and older, the sample differed from the generaladult population in a number of ways. Despite employinga broad range of general and targeted recruitment strat-egies, our respondents were older, more likely to be femaleand more likely to be university educated than the generalAustralian population [35]. Although the number of re-spondents made it possible to control for these differ-ences in our analyses, it is important to considerMiller et al. BMC Public Health
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representativeness when generalising our findings tothe whole population.Participants in the study were exposed to four warninglabels presented in the same order, which had the poten-tial to affect overall responses. However, that we observeda similar pattern of reduced impact agreement for thesimple ‘Alcohol causes cancer’message that appeared sec-ond (sandwiched between labels with detailed messages),provides some confidence that responses were not neces-sarily dependent on order of label presentation. Furtherstudy is required to determine whether the responseswould be consistent when such labels were encounteredon alcohol products in a social setting.Our study focused on label messages rather than otheraspects that may have an influence on acceptance andimpact. Future studies of the broad population might ex-plore the impact of label colour, placement and origin ofthe message, including messages originating from thegovernment and from key community organisations.Laughery et al. [36] experimented with various levels ofexplicitness in warning message and determined that ex-plicit messages were likely to be more effective thanvague warnings and, as mentioned, the more detailedmessages were received more positively by our partici-pants. The authors identified many characteristics as keyfor effectively communicating explicit product warninglabels and improving noticeability, including many of thecharacteristics listed above.Further research is required to determine if and how thecancer information conveyed by warning labels is retained.In a study that examined the impact of warning labels upto 5 years after their introduction, it was found that theobserved positive effects on awareness and recognitionwere not maintained over time [37]. Future studies wouldtherefore benefit from the inclusion of follow-up assess-ments, to discern the long-term effectiveness of the warn-ing label approach. The public health consequences ofpotential paradoxical responses due to psychological react-ance [31] should also not be overlooked in future investi-gations of long-term effectiveness. One other issue forfuture research may be to correlate the desire to reducedrinking with the effectiveness of alcohol labels.As Louise et al. [12] discuss, the alcohol warning labelapproach does present ethical issues around relying ongenerating fear in relation to cancer in order to impact onbehaviour. Yet the effective potential effectiveness of alco-hol warning labels may actually depend on the emotion offear rather than simply communicating the health pro-moting message on the link between alcohol and cancer.Generally, the successful ‘fear appeal’message will containthree parts –the emotion of fear, the cognition of threat(i.e. perceived susceptibility), and the perception of self-efficacy to control and respond adequately to the threat[38]. For alcohol warning labels to be effective, it islikely that other methods focussing on all three aspectswill be required.ConclusionAlthough alcohol labels may raise awareness of andprompt discussions about the messages they contain, thewider literature and our own findings suggest they mightproduce only limited effects on drinking behaviour ontheir own. To maximise impact, warning labels should beconsidered for use in conjunction with other avenues forprevention, and incorporated into multi-faceted healthcampaigns.Competing interestsThe author(s) declare that they have no competing interests.Authors’contributionsEM developed and implemented the survey, coordinated the statistical analysisand participated in the drafting of the manuscript. IR participated in the statisticalanalysis and in the drafting the manuscript. GB and IO participated in the designof the study, commented on the analysis and helped draft the manuscript.All authors read and approved the final manuscript.AcknowledgmentsThis study was funded by the Australian Research Council and LinkagePartners, Cancer Council Australia and Drug and Alcohol Services of SouthAustralia (LP ).Author details1Discipline of Public Health, Flinders University, GPO Box 2100, Bedford Park5001, South Australia.2Mt Isa Centre for Rural and Remote Health, JamesCook University, Mt Isa, Queensland.3Samson Institute for Health Research,University of South Australia, Adelaide, South Australia.Received: 13 August 2015 Accepted: 2 February 2016References1. Australian Institute of Health and Welfare. Drugs in Australia 2010: tobacco,alcohol and other drugs. Drug statistics series no. 27. Canberra: AIHW; 2011.2. International Agency for Research on Cancer. 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ArticleMay 2018ArticleFull-text availableDec 2016ArticleAug 2016ArticleJan 2017ArticleFull-text availableFeb 2017ArticleJun 2017ArticleSep 2017ProjectProject[...]Objective neuropsychological assessments and patient self-reports of 'chemo-brain' suggest chemotherapy may lead to cognitive impairment but causal links remain unclear. The duration of such dysfun…& [more]ProjectHave completed data collection phase ProjectArticleDecember 2016 · Objective
This study aimed to investigate factors that inhibit and facilitate discussion about alcohol between general practitioners (GPs) and patients.
Data analysis from a cross-sectional survey.
Setting and participants
894 GP delegates of a national health seminar series held in five capital cities of Australia in 2014.
Main outcome measures
Likelihood of rou... [Show full abstract]ArticleFebruary 2014 · ArticleFebruary 2016 · In response to increasing calls to introduce warning labels on alcoholic beverages, this study investigated the potential
effectiveness of alcohol warning statements designed to increase awareness of the alcohol–cancer link. A national online survey
was administered to a diverse sample of Australian adult drinkers (n = 1,680). Along with attitudinal, intentions and demographic items, the... [Show full abstract]ArticleAugust 2014 · Background
There is growing evidence of the increased cancer risk associated with alcohol consumption, but this is not well understood by the general public. This study investigated the acceptability among drinkers of cancer warning statements for alcoholic beverages.
Six focus groups were conducted with Australian drinkers to develop a series of cancer-related warning statements for... [Show full abstract]Last Updated: 15 May 18}