What are government warnings for addictive substances?

Purpose and Functions

The primary function of a government warning is to increase public knowledge about unsafe use of substances, particularly tobacco and alcohol products that can be purchased without a prescription by adults who have proper identification. These health warnings attempt to minimize dangerous substance activity by discouraging drug misuse and overuse. Warning label goals include the complete cessation of tobacco use and total abstinence from alcohol during any stage of pregnancy.

The first alcohol and tobacco warning labels developed as a result of acts by the US Congress. The Alcoholic Beverage Labeling Act of 1988 was passed in response to birth defects connected with alcohol use during pregnancy. Similarly, tobacco use has been tracked by the Office of the Surgeon General (OSG) since the 1920s. In the 1960s, tobacco use became a public health issue that resulted in government warnings because of early reports about the health damage to nonsmokers from exposure to secondhand smoke.

Government warning labels on alcohol and tobacco are intended to call separate attention to multiple risks. Label text may be decided by the OSG but enforcement is often implemented by affiliate agencies, such as the Alcohol and Tobacco Tax and Trade Bureau (TTB). One goal of the TTB is to protect public safety through oversight of federal laws about alcohol and tobacco product-labeling.

Label Formats

Product health warnings require text introductions of “Warning” or “Government Warning” in bold type on every package. To ensure visibility, all statements must be placed prominently on high-contrast sections of the package label, separate from other information.

Warning texts expand as evidence builds on the dangers of alcohol and tobacco use. Since 1989, the US government has mandated two warnings on alcoholic products. These warnings are “According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects” and “Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.”

In 2001, horizontal boxed text and conspicuous statements with surrounding white space were encouraged on beverage labels to increase attention to the warnings. In 2005, the OSG supplemented alcohol label warnings with an online news advisory to recommend total avoidance of any amount of alcohol during all stages of pregnancy, as evidenced by expanded research on fetal alcohol syndrome disorders.

Like alcohol warnings, tobacco warnings were initiated in Congress and adapted in time. Government warnings about tobacco changed little since the 1960s, until the statements were strengthened by the US Food and Drug Administration in response to the Family Smoking Prevention and Tobacco Control Act of 2009. The new warnings, effective September 2012, comprise nine separate statements, a resource site (1-800-QUIT-NOW), and images of harmful tobacco effects on the body. Each warning contains one statement, one image, and the toll-free quit hotline.

The plain-language warnings, identified through literature review and public commentary, are as follows: cigarettes are addictive, tobacco smoke can harm your children, cigarettes cause fatal lung disease, cigarettes cause cancer, cigarettes cause strokes and heart disease, smoking during pregnancy can harm your baby, smoking can kill you, tobacco smoke causes fatal lung disease in nonsmokers, and quitting smoking now greatly reduces serious risks to your health. These changes, especially the new graphics, are negative reminders to heighten risk awareness, increase quit rates, and empower youth to avoid smoking.

Label Efficacy

Government warnings are updated infrequently, and public awareness of the standard labeling may introduce complacency. Government warnings on alcohol and tobacco are acknowledged by consumers, but effects on behavior are variable. For example, in the Alcoholic Beverage Label Evaluation survey from 1989 to 1995 (which surveyed persons in the Midwest), alcohol risks were noted by participants, but no significant changes in alcohol use resulted. Positive changes, such as lower rates of alcohol use while driving, appeared to level off after approximately three years. Thus, although awareness appears commonplace, the warnings do not appear to affect any long-term behavioral change.

Strategies for calling greater attention to the health risks include point-of-purchase notices, graphic images to supplement text labels, and even more prominent placement of warnings on the products. For example, cigarette products now require warning label placement on the top half of the front and back of each package or advertisement to pointedly display potential consequences of use. The use of graphics to transmit any health information is known to increase knowledge of risks, increase quit rates, and prevent new smokers.

Even greater distribution of warnings is available through state-regulated point-of-purchase programs, which require establishments that sell alcohol and tobacco to display warning signs at checkouts. For example, businesses that sell liquor must post the government warning about pregnancy and birth defect risks, and tobacco warning signs must be present where the tobacco products are sold.

Bibliography

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Centers for Disease Control and Prevention. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. Rep. Washington, DC: DHHS, 2010. Print.

Hammond, David, et al. “Text and Graphic Warnings on Cigarette Packages: Findings from the International Tobacco Control Four Country Survey.” American Journal of Preventive Medicine 32.3 (2007): 202–9. Print.

MacKinnon, David P., and Liva Nohre. “Alcohol and Tobacco Warnings.” Handbook of Warnings. Ed. M. Wogalter. Mahwah: Erlbaum, 2006. Print.

Thomas, Gerald, Ginny Gonneau, Nancy Poole, and Jocelynn Cook. "The Effectiveness of Alcohol Warning Labels in the Prevention of Fetal Alcohol Spectrum Disorder: A Brief Review." International Journal of Alcohol and Drug Research 3.1 (2014): 91–103. Print.

Voon, Tania, Andrew D. Mitchell, and Jonathan Liberman, eds. Regulating Tobacco, Alcohol, and Unhealthy Foods: The Legal Issues. New York: Routledge, 2014. Print.