Online Randomized Experiment Evaluating the Perceived Effectiveness of Alcohol Warning Labels
Phase: NA
Conditions: Alcohol Drinking
Sponsor: University of North Carolina, Chapel Hill

Complete Title: Online Randomized Experiment Evaluating the Perceived Effectiveness of Alcohol Warning 
Labels   
 
 
 
 
Short Title: Impacts of Alcohol Warning Labels: An Online Experiment   
FDA IND/IDE (if applicable): N/A 
Sponsor: National Institute on Alcohol Abuse and Alcoholism (NIAAA) 
Protocol Version: 4/10/2024 
Last Approved by IRB: 7/24/25 
 
 
 
 
 
 
 
 
 
Study Principal Investigators:  
 
Marissa G. Hall 
University of North Carolina 
312 Rosenau Hall 
Chapel Hill, NC 27599 
(919) 445-1310 
email: mghall@unc.edu 
 
Anna H. Grummon  
Stanford University 
email: agrummon@stanford.edu  
 
 
 
 
 
 
 
 

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Table of Contents 
PROTOCOL SYNOPSIS ..........................................................................................................................................3 
BACKGROUND AND RATIONALE .......................................................................................................................5 
INVESTIGATIONAL PLAN ....................................................................................................................................7 
STUDY PROCEDURES ...........................................................................................................................................8 
STUDY EVALUATIONS AND MEASUREMENTS .................................................................................................9 
STATISTICAL CONSIDERATIONS .......................................................................................................................9 
STUDY INTERVENTION (DEVICE, DRUG, OR OTHER INTERVENTION) ..................................................... 11 
STUDY INTERVENTION ADMINISTRATION (IF APPLICABLE) .................................................................... 11 
SAFETY MANAGEMENT ..................................................................................................................................... 12 
DATA COLLECTION AND MANAGEMENT ...................................................................................................... 12 
RECRUITMENT STRATEGY ............................................................................................................................... 12 
CONSENT PROCESS ............................................................................................................................................ 12 
REFERENCES ....................................................................................................................................................... 13 
 
 
 
 
 
 
 
 
 
 
 
 
 

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PROTOCOL SYNOPSIS 
  
Study Title 
Online Randomized Experiment Evaluating the Perceived 
Effectiveness of Alcohol Warning Labels 
Funder 
NIAAA 
Clinical Phase 
N/A 
Study Rationale 
• Policymakers and public health organizations are 
increasingly interested in communicating alcohol’s harms to 
the public, including through mandated warning labels as 
well as mass media campaigns.  
• Communicating alcohol’s harms could increase consumer 
understanding of these harms and reduce alcohol 
consumption and alcohol-related health harms.   
• Alcohol contributes to more than 200 health harms, giving 
policymakers and public health organizations many options 
to choose from when selecting topics to include in messages 
about alcohol-related harms.  
• However, it remains unknown which of these topics should 
be prioritized in communication efforts.   
Study Objective(s) 
Primary  
• To evaluate whether alcohol warnings about different topics 
elicit higher perceived message effectiveness than control 
messages.  
 
Secondary 
• To evaluate whether alcohol warnings about different topics 
elicit higher reminding of alcohol’s harms than control 
messages.    
• To evaluate whether people are more likely to learn 
something new from alcohol warnings about different topics 
compared to control messages.  
Test Article(s) 
(If Applicable) 
N/A 
Study Design 
 
Randomized experiment. 
Subject Population 
key criteria for 
Inclusion and Exclusion: 
Inclusion Criteria 
1. Age 21 and older 
2. Reside in the United States 
3. Able to complete a survey in English 
4. Consumed alcohol at least once per week during the past 4 
weeks 

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Exclusion Criteria 
1. Under the age of 21 
2. Reside outside of the United States 
3. Unable to complete a survey in English 
4. Consumed alcohol less than once per week during the past 4 
weeks 
Number Of Subjects  
 
1,000 
Study Duration 
Each subject’s participation will last approximately 15 minutes. 
The enrollment period is expected to last ~2 weeks. 
Study Phases 
Screening 
Study Treatment 
Follow-Up   
There are two phases: 
(1) Screening: screening for eligibility and obtaining consent and  
(2) Intervention: study intervention/experimental treatment. 
Efficacy Evaluations 
The primary outcome is perceived message effectiveness for 
encouraging people to drink less alcohol. It is measured with 1 item 
adapted from prior studies. The secondary outcomes are reminding 
of alcohol’s harms and learning something new. 
Statistical And Analytic 
Plan 
Primary outcome 
• We will use mixed effects linear regression to examine the 
effect of each alcohol warning topic on perceived message 
effectiveness compared to the control topic. 
 
Secondary outcomes 
• We will use mixed effects linear regression to examine the 
effect of each alcohol warning topic on reminding of 
alcohol’s harms compared to the control topic. 
• We will use mixed effects logistic regression to examine the 
effect of each alcohol warning topic on learning something 
new compared to the control topic. 
DATA AND SAFETY 
MONITORING PLAN 
• The principal investigators are responsible for data quality 
management and ongoing assessment of safety.   
 
 
 
 
 
 
 

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BACKGROUND AND RATIONALE  
Introduction 
Alcohol consumption remains a pressing public health problem in the US. Alcohol consumption is a 
leading cause of death in the US, accounting for nearly 100,000 deaths each year.1,2 Alcohol-related 
deaths have risen over the past 25 years in the US among both men 
and women3 (Figure 1). Alcohol consumption contributes to both 
short- and long-term health harms. Acute alcohol intoxication 
can result in injuries, poisoning, and motor vehicle accidents.4-9  
Longer-term alcohol consumption contributes to chronic diseases 
such as hypertensive heart disease and liver cirrhosis.10 Alcohol 
consumption is also the third leading modifiable cause of cancer 
in the US.11 Even moderate drinking carries health harms, 
particularly for cancer risk.9,12,13 For these reasons, federal 
guidelines indicate that “drinking less is better for health than 
drinking more.”14 However, many adults in the US consume 
unhealthy levels of alcohol. More than 30% of US adults 
consume more than the recommended daily limit for alcohol15 
and 1 in 4 report binge drinking in the past month.16 One 
potential explanation for high rates of unhealthy alcohol 
consumption is that many American adults are unaware of the harms related to alcohol 
consumption.12,17-20 There is a critical need for research to design and evaluate interventions that inform 
consumers about alcohol’s risks and reduce harmful alcohol consumption.  
The current alcohol warnings in the US are out of date. The US has required the same warning 
label on alcohol containers for 33 years.21 Studies of the current US warning suggest that it has had 
limited impact on overall alcohol consumption.22,23 The limited effectiveness could be because the 
current US warning lacks the key elements of an evidence-based warning: it is shown in small text, 
typically appears on the back or side of product packaging, and does not include any pictorial elements. 
Moreover, the warning is static: its content never rotates. In addition to being poorly designed, the 
current warning also does not reflect the latest alcohol epidemiology: it discusses only 3 risks 
despite evidence that alcohol is associated with more than 200 health harms including cancer. Updating 
the current warning to discuss these health harms could better inform consumers and more effectively 
discourage alcohol consumption, but no research has examined which harms are most effective to 
include in alcohol warnings. We will evaluate consumer reactions to evidenced-based alcohol warnings 
that communicate a range of health harms linked to alcohol. 
The goal of this current experiment is to examine responses to alcohol warning messages about 10 
different topics among US adult alcohol consumers. The main questions this experiment aims to answer 
are: 
Which warning topics make alcohol consumers in the US want to drink less alcohol? Which warning 
topics remind alcohol consumers in the US of alcohol's harms? Which warning topics help alcohol 
consumers in the US learn something new? We developed 2 warning messages about 8 warning topics 
(e.g., liver cancer, throat and mouth cancer). We also developed 2 control messages. Finally, the stimuli 
included the current US alcohol warning, for a total of 19 messages (16 new warning messages, 2 
control messages, and the current US alcohol warning). Participants will view 10 messages shown in 
random order, each about a different topic: nine messages about warning topics and one about a control 
topic. For the control topic and all warning topics except the current US warning (for which there is only 
1 message), participants will view 1 of the 2 messages developed for that topic, selected at random. 
Figure 1. Age-standardized alcohol-
induced deaths in the US, 2000-2016 

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Participants will rate each message on how much it makes them want to drink less alcohol, reminds 
them that drinking can be harmful, and teaches them something new. 
Name and Description of Investigational Product or Intervention  
Participants will view and rate 10 messages shown on alcohol containers. 
Arm 
Assigned Interventions: 
Experimental: Alcohol Messages 
Behavioral: Liver Cancer 
Participants will view messages about the risk of 
liver cancer from alcohol consumption. 
 
Behavioral: Throat and Mouth Cancer 
Participants will view messages about the risk of 
throat and mouth cancer from alcohol 
consumption. 
 
Behavioral: Colorectal Cancer 
Participants will view messages about the risk of 
colorectal cancer from alcohol consumption. 
 
Behavioral: Multiple Cancers 
Participants will view messages about the risk of 
multiple cancers from alcohol consumption. 
 
Behavioral: Liver Disease 
Participants will view messages about the risk of 
liver disease from alcohol consumption. 
 
Behavioral: Hypertension 
Participants will view messages about the risk of 
hypertension from alcohol consumption. 
 
Behavioral: Dementia 
Participants will view messages about the risk of 
dementia from alcohol consumption. 
 
Behavioral: Drinking Guidelines 
Participants will view messages about guidelines 
for alcohol consumption. 
 
Behavioral: Current Warning 
Participants will view the current warning that is 
required on most alcoholic beverage containers 
sold in the US. 
 
Behavioral: Control 
Participants will view neutral messages unrelated 
to the harms of alcohol consumption. 

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STUDY OBJECTIVES 
 
Primary Objective 
The purpose of this study is to evaluate whether alcohol warnings about different topics elicit higher 
perceived message effectiveness than control messages. 
 
Secondary Objectives 
Additionally, this study will evaluate whether alcohol warnings about different topics elicit higher 
reminding of alcohol’s harms than control messages. This study will also evaluate whether people are 
more likely to learn something new from alcohol warnings about different topics compared to control 
messages. 
 
INVESTIGATIONAL PLAN (brief overview) 
Study Design 
This study is a within subjects online randomized experiment with single group assignment.  
This study will consist of 2 phases—Screening and Intervention. During the Screening phase, potential 
participants will be screened for eligibility and complete informed consent procedures. During the 
Intervention phase, participants will take part in the experimental treatment.  
There will not be a follow-up phase, nor a plan to deal with unscheduled visits since this study will be 
taking place during a one-time online experiment.  
Allocation to Treatment Groups and Blinding 
All participants will be in a single arm experiment. Within this arm, participants will view and rate 
messages shown on alcohol containers. Participants will view 10 messages shown in random order, each 
about a different topic: nine messages about warning topics and one about a control topic. For the 
control topic and all warning topics except the current US warning (for which there is only 1 message), 
participants will view 1 of the 2 messages developed for that topic, selected at random. Participants will 
rate each message on how much it makes them want to drink less alcohol, reminds them that drinking 
can be harmful, and teaches them something new. There is no blinding.  
 
Study Duration, Enrollment and Number of Subjects 
This study will take place entirely online via an online survey programmed in Qualtrics over the course 
of about 2 months. NORC will recruit roughly 1,000 US adults to participate in this study.  
  
Study Population 
The survey research company NORC at the University of Chicago will recruit a sample of 1,000 people.  
Additionally, in order to be eligible for this study, participants must meet all of the following criteria: 
• 
Age 21 or older 
• 
Reside in the United States 
• 
Able to complete a survey in English 
• 
Consumed alcohol at least once per week during the past 4 weeks. 
 

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If any of the following are true, a participant is ineligible for participation: 
• 
Under the age of 21 
• 
Reside outside of the United States 
• 
Unable to complete a survey in English 
• 
Consumed alcohol less than once per week during the past 4 weeks 
 
 
STUDY PROCEDURES  
Screening/Baseline Visit procedures 
Participants will reside in the US, speak English, be 21 years of age or older, and have consumed at least 
1 alcoholic drink per week over the past 4 weeks. The screener questions at the start on the online study 
will assess these eligibility criteria via self-report.  
 
Intervention/Treatment procedures (by visits) 
Participants will rate each message on its perceived effectiveness using 1 item from the UNC Perceived 
Message Effectiveness Scale, a measure that has been used extensively in similar experiments to 
identify the potential impact of warning labels on consumers. Perceived effectiveness is a measure that 
is sensitive enough to detect small differences between warnings yet is also predictive of messages’ 
ability to change actual behaviors. Participants will also rate messages on secondary outcomes (e.g., 
reminding of harms, learning something new). All outcomes will be measured with Likert-type response 
scales ranging from 1 to 5, except learning something new which is binary (yes/no). Participants will 
respond to survey questions programmed in Qualtrics and will receive incentives in the form of cash, 
points, or other prizes in accordance with the NORC’s standard protocols.  
 
Follow- up procedures (by visits) 
N/A—there will not be follow up.  
 
Unscheduled visits 
N/A  
 
Subject Completion/Withdrawal procedures 
A participant will be considered complete when they complete the online survey. At the end of the 
survey, participants will be rerouted back to the AmeriSpeak homepage, where NORC is responsible to 
providing compensation in the form of cash, points, or other prizes in accordance with the panel 
company’s standard protocols, equivalent to $2 USD.  
 
We currently do not have any criteria that would involve withdrawing an individual subject. Although 
unlikely, any potential withdrawals will be considered by the PI on a case-by-case basis, considering 
risk to the participant. 
 
Screen failure procedures 
If a potential participant fails to meet eligibility criteria and/or fails to give consent for participation, the 
online experiment is programmed to redirect respondents to the AmeriSpeak website with a message 
informing the respondent that they are not eligible for this particular study.  

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STUDY EVALUATIONS AND MEASUREMENTS   
All evaluations will be collected via an online survey programmed in Qualtrics lasting roughly 15 
minutes. All data collected is self-reported.  
 
Primary Outcome: Perceived Message Effectiveness 
The study will assess perceived message effectiveness using 1 item: "How much does this message 
make you want to drink less alcohol?" Response options will range from "not at all" (coded as 1) to "a 
great deal" (coded as 5). Higher scores indicate more perceived message effectiveness.  
 
Secondary Outcome: Reminding of Alcohol’s Harms 
The study will assess reminding of alcohol's harms using 1 item: "How much does this message remind 
you that drinking alcohol can be harmful?" Response options will range from not at all (1) to a great deal 
(5). Higher scores indicate greater reminding of alcohol's harms.  
 
Secondary Outcome: Learning Something New 
The study will assess learning something new with 1 item: "Did you learn something new from this 
message?" Response options will be yes (1) and no (0). Proportion of participants who endorsed 
learning something new (i.e., answered 1).  
 
 
STATISTICAL CONSIDERATIONS  
 
General Principles 
We will use a two-sided critical alpha of 0.05 to conduct all statistical tests. All confidence intervals 
presented will be 95% and two-sided. We will use complete case analysis to handle any missing data in 
analyses of the primary and secondary outcomes. In all analyses, we will use survey weights to account 
for NORC AmeriSpeak’s sampling design and enable results to be representative of the US population 
of drinkers ages 21+. 
 
Primary Endpoint 
The primary outcome is perceived message effectiveness for encouraging people to drink less alcohol. 
We will measure perceived message effectiveness with 1 item adapted from prior studies: “How much 
does this message make you want to drink less alcohol?” Response options will range from not at all (1) 
to a great deal (5).  
 
Hypothesis 1. We hypothesize that all warning topics elicit higher perceived message effectiveness 
ratings than the control topic.  
 
Secondary Endpoints 
The secondary outcomes are reminding of alcohol’s harms and learning something new. We will 
measure reminding of alcohol’s harms with 1 item: “How much does this message remind you that 
drinking alcohol can be harmful?” Response options will range from not at all (1) to a great deal (5). We 

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will measure learning something new with 1 item: “Did you learn something new from this message?” 
Response options will be yes (1) and no (0).  
 
Hypothesis 2. We hypothesize that that all warning topics elicit higher reminding of alcohol’s harms 
than the control topic.  
 
Hypothesis 3. We hypothesize that all warning topics elicit higher likelihood of learning something new 
than the control topic.  
 
 
Statistical Methods 
 
Analyses of the primary outcome: 
a. We will use mixed effects linear regression to evaluate the effect of each warning topic 
compared to the control topic on the primary outcome of perceived message effectiveness. 
We will regress perceived message effectiveness on a set of indicator variables representing each 
alcohol warning topic (e.g., mouth cancer, liver cancer, etc.), excluding the control topic as the 
referent. We will treat the intercept as random to account for repeated measures within 
participants. The coefficients on the warning topics give the average difference in mean 
perceived message effectiveness between each warning topic and the control topic. Hypothesis 1 
will be supported if all coefficients on the warning topics are positive and statistically significant. 
Given the exploratory nature of the study, we do not plan to adjust p-values for multiple 
comparisons.  
b. In addition to testing Hypothesis 1, we will also descriptively rank the warning topics on the 
primary outcome of perceived message effectiveness. We will estimate mean perceived message 
effectiveness for each alcohol warning topic (averaging across messages for each topic) and rank 
those means.  
c. Finally, we will descriptively rank the alcohol warning messages on the primary outcome of 
perceived message effectiveness. We will estimate means for each alcohol warning message and 
rank those means.  
 
Analyses of the secondary outcomes: 
a. We will use mixed effects linear regression to evaluate the effect of each alcohol warning 
topic compared to the control topic on the secondary outcome of reminding of alcohol’s 
harms. We will use the same approach as for the primary outcome (see no. 1 above). We will 
use mixed effects logistic regression to evaluate the effect of each alcohol warning topic 
compared to the control topic on the secondary outcome of learning something new. We 
will use the same approach as for the primary outcome, but with a logistic model to account for 
the binary outcome variable. Hypotheses 2 and 3 will be supported if all marginal effects of the 
warning topics (vs. control) on the secondary outcomes are positive and statistically significant. 
b. We will descriptively rank the alcohol warning topics on the secondary outcomes of 
reminding of alcohol’s harms and learning something new. We will estimate mean reminding of 
alcohol’s harms for each alcohol warning topic (averaging across messages for each topic) and 

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rank those means. We will also estimate the proportion of participants who indicated they 
learned something new from each alcohol warning topic and rank those proportions.  
c. We will descriptively rank the alcohol warning messages on the secondary outcome of 
reminding of alcohol’s harms and learning something new. We will estimate mean reminding of 
alcohol’s harms for each alcohol warning message and rank those means. We will also estimate 
the proportion of participants who indicated they learned something new from each alcohol 
warning message and rank those proportions. 
 
We do not plan to conduct moderation analyses.  
 
 
Sample Size and Power 
We plan to collect data from 1,000 participants. We used G*Power to estimate sample size needs.1 We 
estimated sample size needs to detect an effect of each warning topic vs. the control topic assuming an 
alpha=0.05 and correlation among repeated measures of 0.5 (similar to our prior studies of product 
warnings2,3). We estimated power assuming 2 repeated measures, reflecting that our contrast of interest 
has two within-subjects levels (warning topic vs. control). Under these assumptions, our sample size will 
yield >85% power to detect a small standardized effect of Cohen’s f=.05 (or Cohen’s d=.10) or larger of 
each warning topic vs. the control topic. A prior study of alcohol warning topics found effects of this 
size or larger when comparing perceived message effectiveness of alcohol warning topics vs. control 
topics.2   
 
Exclusions and Outliers 
We will exclude participants who complete <90% of the survey or who complete the survey implausibly 
quickly (defined as <1/3 of the median completion time).  
 
Interim Analysis 
N/A 
 
 
STUDY INTERVENTION (DEVICE, DRUG, OR OTHER INTERVENTION) 
Participants will view warnings about 10 topics: 9 warnings topics and 1 control topic, shown in random 
order. For each warning topic, participants will view 1 message (selected at random from a pool of 2 
messages about that topic) and respond to survey items about that message.   
 
 
STUDY INTERVENTION ADMINISTRATION (IF APPLICABLE)  
 
Participants will view warnings about 10 topics: 9 warnings topics and 1 control topic, shown in random 
order. For the control topic and all warning topics except the current US warning (for which there is only 
1 message), participants will view 1 of the 2 messages developed for that topic, selected at random. This 
randomization is accomplished via Qualtrics Randomizer. 

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SAFETY MANAGEMENT 
 
Since this study is taking place entirely online during a single session, we will not be monitoring for 
Adverse Events or Serious Adverse Events. We do not have a plan in place for Medical Emergency 
procedures due to the online nature of this study. No study staff will have direct contact with any 
participants.  
 
The principal investigators are responsible for data quality management and ongoing assessment of 
safety. All data will be stored in Qualtrics, accessible only to select IRB-approved study staff who need 
access to participant data. 
 
 
DATA COLLECTION AND MANAGEMENT  
 
Participants will be able to take the online experiment survey at the location of their choosing to allow 
for privacy. We will avoid collecting sensitive data that is not required (e.g., IP addresses). Required 
identifying participant information (names, city of birth, phone numbers, and/or email addresses) will be 
stored on a secure virtual platform that only IRB-approved study members will be able to access. They 
will also be required to access this from a password-protected computer. Only one virtual linking 
document will have identifying participant information and id numbers. Whenever possible, data will be 
linked to participants only by the participant id number. 
  
 
 
RECRUITMENT STRATEGY 
 
All participants will be recruited by NORC at the University of Chicago through their AmeriSpeak 
panel. Research staff at UNC and Stanford will have no direct contact with any participants. We will not 
be sharing any recruitment materials. Participants will receive incentives in the form of cash, points, or 
other prizes in accordance with the panel company’s standard protocols. 
 
 
CONSENT PROCESS 
 
 
Participants will read an electronic version of the informed consent form before beginning the survey 
and will be asked to select a checkbox to confirm their consent. The consent forms for these surveys will 
include information about the study's purpose, potential risks, expected benefits, protection of 
confidentiality, and time expectations. The form will also include contact information for the IRB and 
the PI in case participants have concerns or questions about the study. 
 
 
 
 
 

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REFERENCES 
 
 
1. US Burden of Disease Collaborators. The State of US Health, 1990-2010: Burden of Diseases, Injuries, 
and Risk Factors. JAMA. 2013;310(6):591-606. doi:10.1001/jama.2013.13805 
2. Mendel JR, Hall MG, Baig SA, Jeong M, Brewer NT. Placing health warnings on e-cigarettes: A 
standardized protocol. Int J Environ Res Public Health. 2018;15(8):1578 
3. Esser MB. Deaths and Years of Potential Life Lost From Excessive Alcohol Use — United States, 
2011–2015. MMWR Morb Mortal Wkly Rep. 2020;69. doi:10.15585/mmwr.mm6939a6 
4. World Health Organization. Global Status Report on Alcohol and Health 2018. World Health 
Organization; 2019. Accessed November 10, 2021. 
https://apps.who.int/iris/rest/bitstreams/1151838/retrieve 
5. Spillane S, Shiels MS, Best AF, et al. Trends in alcohol-induced deaths in the United States, 2000-2016. 
JAMA network open. 2020;3(2):e1921451-e1921451. 
6. Mostofsky E, Mukamal KJ, Giovannucci EL, Stampfer MJ, Rimm EB. Key findings on alcohol 
consumption and a variety of health outcomes from the Nurses’ Health Study. American journal of 
public health. 2016;106(9):1586-1591. 
7. International Agency for Research on Cancer. Personal habits and indoor combustions. IARC 
monographs on the evaluation of carcinogenic risks to humans. 2012;100:319-331. 
8. Cogliano VJ, Baan R, Straif K, et al. Preventable exposures associated with human cancers. J Natl 
Cancer Inst. 2011;103(24):1827-1839. doi:10.1093/jnci/djr483 
9. Rehm J, Patra J, Brennan A, et al. The role of alcohol use in the aetiology and progression of liver 
disease: A narrative review and a quantification. Drug Alcohol Rev. 2021;40(7):1377-1386. 
doi:10.1111/dar.13286 
10. Griswold MG, Fullman N, Hawley C, et al. Alcohol use and burden for 195 countries and territories, 
1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 
2018;392(10152):1015-1035. doi:10.1016/S0140-6736(18)31310-2 
11.  Nelson DE, Jarman DW, Rehm J, et al. Alcohol-attributable cancer deaths and years of potential life 
lost in the United States. Am J Public Health. 2013;103(4):641-648. doi:10.2105/AJPH.2012.301199 
12. LoConte NK, Brewster AM, Kaur JS, Merrill JK, Alberg AJ. Alcohol and cancer: a statement of the 
American Society of Clinical Oncology. Journal of Clinical Oncology. 2018;36(1):83-93. 
13. Rumgay H, Shield K, Charvat H, et al. Global burden of cancer in 2020 attributable to alcohol 
consumption: a population-based study. The Lancet Oncology. 2021;22(8):1071-1080. 
doi:10.1016/S1470-2045(21)00279-5 
14. United States Department of Agriculture and Department of Health and Human Services. Dietary 
Guidelines for Americans, 2020-2025. Published online 2020. Accessed November 10, 2021. 
www.dietaryguidelines.gov 
15. Barbosa C, Cowell AJ, Dowd WN. Alcohol Consumption in Response to the COVID-19 Pandemic in 
the United States. J Addict Med. 2021;15(4):341-344. doi:10.1097/ADM.0000000000000767 

Page 14 of 14 
 
16. National Institute on Alcohol Abuse and Alcoholism. Alcohol Facts and Statistics | National Institute on 
Alcohol Abuse and Alcoholism (NIAAA). Published June 2021. Accessed November 10, 2021. 
https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics 
17. Wiseman KP, Klein WMP. Evaluating Correlates of Awareness of the Association between Drinking 
Too Much Alcohol and Cancer Risk in the United States. Cancer Epidemiol Biomarkers Prev. 
2019;28(7):1195-1201. doi:10.1158/1055-9965.EPI-18-1010 
18. Winstock AR, Holmes J, Ferris JA, Davies EL. Perceptions of Alcohol Health Warning Labels in a 
Large International Cross-Sectional Survey of People Who Drink Alcohol. Alcohol and Alcoholism. 
2020;55(3):315-322. doi:10.1093/alcalc/agz099 
19. American Institute for Cancer Research. 2019 AICR Cancer Risk Awareness Survey. Published 2019. 
Accessed December 12, 2021. 
https://docs.google.com/viewer?url=https%3A%2F%2Fwww.aicr.org%2Fassets%2Fcan-
prevent%2Fdocs%2F2019-Survey.pdf 
20. Seidenberg AB, Wiseman KP, Eck RH, Blake KD, Platter HN, Klein WMP. Awareness of Alcohol as a 
Carcinogen and Support for Alcohol Control Policies. American Journal of Preventive Medicine. 
2022;62(2):174-182. doi:10.1016/j.amepre.2021.07.005 
21. Alcoholic Beverage Labeling Act of 1988.; 1988. Accessed August 23, 2021. 
https://www.govinfo.gov/content/pkg/USCODE-2014-title27/pdf/USCODE-2014-title27-chap8-
subchapII.pdf 
22. Greenfield TK, Graves KL, Kaskutas LA. Long‐term effects of alcohol warning labels: Findings from a 
comparison of the United States and Ontario, Canada. Psychology & marketing. 1999;16(3):261-282. 
23. Wilkinson C, Room R. Warnings on alcohol containers and advertisements: international experience and 
evidence on effects. Drug Alcohol Rev. 2009;28(4):426-435. doi:10.1111/j.1465-3362.2009.00055.x