Alcohol consumption is a major preventable risk factor for cancer, but most people do not know about the risk. One promising way to raise awareness is by adding health warning labels to alcohol products. Traditionally, health warning labels have relied on shocking images, such as diseased organs or damaged body parts. While such graphic warnings work better than plain text, they often cause people to look away.
This got us thinking: Could there be a better way to design warning labels to attract attention? Instead of shocking people, what if we shared the lived experiences of people whose lives are impacted by alcohol use? In our NIH-funded study, we tested two types of warnings: one with personal, narrative images and one with graphic, non-narrative images. We examined whether narrative warnings were more likely to attract attention and influence risk perceptions than non- narrative warnings.
What we did
We conducted an online experiment with moderate and heavy alcohol users. Participants were randomly assigned to view either three narrative warnings or three graphic, non-narrative warnings. Each warning label included an image and a text statement describing the specific cancer risk associated with alcohol. Narrative warnings included pictures of people: an oral cancer patient living with a misshapen jaw, an esophageal cancer patient who relies on a feeding tube, and a larynx cancer patient who looks at the hole in her neck in the mirror. In contrast, non- narrative warnings had graphic images of cancer: a close-up of a mouth with rotten teeth and oral thrush, an endoscopy image of esophageal cancer, and a picture of larynx cancer.
An example of narrative warnings
An example of non-narrative warnings
We measured participants’ visual attention using a webcam-based eye tracker, focusing on two key metrics: visit count and dwell time. Visit count tells us how often participants glanced at an area of interest, while dwell time shows how long they focused on it. We also asked participants how likely they thought they were to get cancer and how much getting cancer would affect their life.
What we found
Participants looked at the image more often and spent more time on it than text. Moreover, participants spent more time looking at narrative warnings than non-narrative warnings.
The two types of warnings did not differ in risk perceptions. Visual attention also did not explain the effect of warning type on risk perceptions. These results suggest that although narrative warnings capture more attention than non-narrative warnings, increased visual attention does not translate into heightened risk perceptions. It is important to note that we did not include a control group, so we were not able to evaluate the true impact of narrative warnings on risk perceptions.
The takeaways
Our study highlights the importance of incorporating visuals into health warning labels, because they are more visually engaging than text. Additionally, depicting the lived experiences might work better than showing the graphic health effects. Instead of scaring people away, these story- based warnings may encourage them to engage with the message. Future research is needed to determine the effectiveness of narrative warnings by comparing them to a control group, such as textual warnings.
Written by Dr Zexin “Marsha” Ma, Assistant Professor, Department of Communication, The University of Connecticut.
All IAS Blogposts are published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Institute of Alcohol Studies.