Evaluations of Alcohol Warning Labels

Study Overview
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Brief Summary
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The goal of this study is to determine the effectiveness of pictorial warning labels (PWLs) featuring narrative (vs. non-narrative) content in communicating the cancer risk of alcohol. Participants will be randomized to view either three narrative or non-narrative PWLs. Key outcome variables include visual attention, message reactance, risk perceptions, and intentions to reduce and stop drinking.

Detailed Description
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The goal of this study is to determine the effectiveness of pictorial warning labels (PWLs) featuring narrative (vs. non-narrative) content in communicating the cancer risk of alcohol. Participants will be recruited from online panels. Participants will first be invited to participate in an online screening survey. Eligible participants will be invited to participate in the main experiment. In the main experiment, participants will first answer questions concerning baseline alcohol consumption and other background information. Then they will engage with a webcam-based eye-tracking task through Sticky by Tobii. Participants will first read instructions and tips related to completing the eye-tracking task. They will complete a brief calibration procedure and be presented with either three narrative PWLs or three non-narrative PWLs. Sticky by Tobii will record participants' gaze, thereby measuring visual attention to each PWL. After viewing each PWL, participants will answer a few questions. After viewing all three PWLs, they will answer questions based on all images combined. Upon study completion, participants will be compensated. A follow-up survey will be sent to participants after two weeks, which includes questions about their drinking behaviors, information seeking behaviors, and social interactions.

Official Title
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Evaluations of Alcohol Warning Labels

Conditions
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Oral Cancer, Esophageal Cancer, Larynx Cancer, Alcohol Drinking

Intervention / Treatment
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* Behavioral: Narrative pictorial warning labels for alcoholic beverages
* Behavioral: Non-narrative pictorial warning labels for alcoholic beverages


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: be at least 21 years old; have consumed more than three alcoholic drinks per week over the past year; be willing to participate in remote eye tracking tasks and have necessary technical support to complete remote eye tracking tasks (i.e., having access to high-speed Internet and a computer/tablet/phone equipped with a high-speed camera). Exclusion Criteria: be younger than 21 years old; has not consumed more than three alcoholic drinks per week over the past year; be not willing to participate in remote eye tracking tasks and have no necessary technical support to complete remote eye tracking tasks (i.e., having access to high-speed Internet and a computer/tablet/phone equipped with a high-speed camera).

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Narrative Pictorial Warning Labels<br>Participants in this arm will be presented with three narrative pictorial warning labels for alcoholic beverages. | Behavioral: Narrative pictorial warning labels for alcoholic beverages<br>* Pictorial warning labels consisting of text and narrative imagery (e.g., photos of cancer patients) conveying the risk of alcohol for oral cancer, esophageal cancer, and larynx cancer.<br>|
| Experimental: Non-Narrative Pictorial Warning Labels<br>Participants in this arm will be presented with three non-narrative pictorial warning labels for alcoholic beverages. | Behavioral: Non-narrative pictorial warning labels for alcoholic beverages<br>* Pictorial warning labels consisting of text and non-narrative imagery (e.g., images of diseased organs) conveying the risk of alcohol for oral cancer, esophageal cancer, and larynx cancer.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Attention 1 | Attention 1 to each label will use the eye-tracking metrics time until noticed, which measures the time between stimulus onset and the arrival of the participant's gaze into a specific area of interest. | During the intervention | 
| Attention 2 | Attention 2 to each label will use the eye-tracking metrics time viewed, which measures the average amount of time spent on an area of interest. | During the intervention | 
| Attention 3 | Attention 3 to each label will use the eye-tracking metrics number of visits, which measures the total number of unique times the area of interest was viewed. | During the intervention | 
| Reactance | Reactance will be measured with three questions, such as How much did the warning try to manipulate you? on a five-point scale (1=Not at all, 2=Very little, 3=Somewhat, 4=Quite a bit, 5=A great deal). | Immediately after the intervention | 
| Affective risk perceptions | Affective risk perceptions will be assessed by asking participants to indicate how worried they are about getting a specific type of cancer if they keep drinking the amount of alcohol like they do now. Participants will respond on a five-point scale (1 = Not at all worried, 2=Slightly worried, 3=Moderately worried, 4=Very worried, 5=Extremely worried). | Immediately after the intervention | 
| Experiential risk perceptions | Experiential risk perceptions will be assessed by asking participants to indicate how vulnerable they feel about getting a specific type of cancer if they keep drinking the amount of alcohol like they do now. Participants will respond on a five-point scale (1 = Not at all vulnerable, 2=Slightly vulnerable, 3=Moderately vulnerable, 4=Very vulnerable, 5=Extremely vulnerable). | Immediately after the intervention | 
| Perceived susceptibility | Perceived susceptibility will be assessed by asking participants to indicate how likely it is that they will get a specific type of cancer if they keep drinking the amount of alcohol like they do now. Participants will respond on a five-point scale (1 = Not at all likely, 2=A little likely, 3=Somewhat likely, 4=Very likely, 5=Extremely likely). | Immediately after the intervention | 
| Comparative risk | Comparative risk will be assessed by asking participants to indicate compared to an average person their age, race, and sex, how likely do they think they will get a specific type of cancer if they keep drinking the amount of alcohol like they do now. Participants will respond on a five-point scale (1=Much less likely, 2=Less likely, 3=About as likely, 4=More likely, 5=Much more likely). | Immediately after the intervention | 
| Perceived severity of harm | Perceived severity of harm will be assessed by asking participants to indicate how much getting a specific type of cancer because of drinking would affect their life. Participants will respond on a five-point scale (1=Not at all, 2=Very little, 3=Somewhat, 4=Quite a bit, 5=A great deal). | Immediately after the intervention | 
| Intentions to reduce drinking | Intentions to reduce drinking will be assessed with three questions such as How interested are you in reducing drinking in the next 6 months? Participants will respond to these questions on an appropriately labeled 5-point scale (e.g., 1 = Not at all interested, 2=Slightly interested, 3=Moderately interested, 4=Very interested, 5=Extremely interested). | Immediately after the intervention | 
| Intentions to stop drinking | Intentions to stop drinking will be assessed with three questions such as How interested are you in stopping drinking in the next 6 months? Participants will respond to these questions on an appropriately labeled 5-point scale (e.g., 1 = Not at all interested, 2=Slightly interested, 3=Moderately interested, 4=Very interested, 5=Extremely interested). | Immediately after the intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Attitudes toward alcohol | Attitudes toward alcohol will be assessed by three semantic differential items on a five-point scale. Participants will be presented with a statement (i.e., Now, please think about how you feel about alcohol at this moment. Do you think drinking alcohol is ____) followed by adjectives such as Bad/Good, Unenjoyable/Enjoyable, and Harmful/Beneficial. | Immediately after the intervention | 
| Intentions to avoid the warnings | Intentions to avoid the warnings will be assessed by three questions, such as If all alcoholic beverages had these warnings on them, how likely is it that you would cover them up? Participants will respond on a five-point scale (1=Not at all likely, 2=Slightly likely, 3=Somewhat likely, 4=Very likely, 5=Extremely likely). | Immediately after the intervention | 
| Policy support | Policy support will be measured by three questions, such as If the U.S. required that these warnings appeared on alcoholic beverages, to what extent would you support or oppose this policy? Participants will respond to these questions on an appropriately labeled 5-point scale (e.g., 1 = Strongly oppose, 5 = Strongly support). | Immediately after the intervention | 
| Self-reported behavior change due to labels | Self-reported behavior change due to labels will be measured with one question, In the past two weeks, has the amount of alcohol you are drinking changed as a result of the alcohol warning labels you previously saw? Are you drinking ...? Participants will respond on a five-point scale (1=Much less, 2=A bit less, 3=Same amount, 4=A bit more, 5=Much more). | Two-week follow up | 
| Information seeking | Information seeking will be measured by two question, such as In the past two weeks, how many times did you talk to a doctor or other health professional about the cancer risks of alcohol? Participants will respond on a five-point scale (1=Never, 2=1-2 times, 3=3-4 times, 4=5-9 times, 5=10 or more times). | Two-week follow up | 
| Social interactions | Social interactions will be measured by four questions, such asIn the past two weeks, how many times did you talk to people other than your doctor about the cancer risks of alcohol? Participants will respond on a five-point scale (=Never, 2=1-2 times, 3=3-4 times, 4=5-9 times, 5=10 or more times). | Two-week follow up |