Northern Territories Alcohol Labels Study
The Northern Territories Alcohol Labels Study (NTAL study) was a scientific experiment in Canada on the effects of alcohol warning labels. It was terminated after lobbying from the alcohol industry, and later relaunched with industry-advocated experimental design changes: omitting the "Alcohol can cause cancer" label, not labelling some alcohol products, and shortening the time period (from eight to four-and-a-half months[1]).[2][3] Enough data was gathered to show that all of the labels used in the study were simple, cheap, and effective, and it recommended that they should be required worldwide.[4][5]
Researchers felt that the lobbyists' changes diluted the scientific value of the study[2][3] and feared the weakened study might not give clear results.[3][6][7] While the shortened study did not provide enough evidence to answer some of the research questions,[3] it showed that the warning labels reduced alcohol sales and consumption: remembering the labels made people more aware of the alcohol-cancer link, and that awareness made people decide to drink less.[8] Industry interference in the study brought international attention.[2][9]
In November 2017, "Alcohol can cause cancer" warning labels (and two other designs) were added to alcoholic products at the only liquor store in Whitehorse, Yukon. The study was planned to run for eight months.[9][10][11] Alcohol industry lobbyists stopped the study after four weeks.[1] The Association of Canadian Distillers, Beer Canada and the Canadian Vintners Association alleged that the Yukon government had no legislative authority to add the labels, and would be liable for defamation, defacement, damages (including damage to brands), and packaging trademark and copyright infringement, because the labels had been added without their consent.[13] They also claimed that the labels violated their freedom of expression.[8] Partly because cigarette-package warning labels had already been ruled legal, these claims were not considered to have merit.[8][12] Lobby groups denied threatening legal action.[12]
John Streicker, the Yukon Minister Responsible for the Yukon Liquor Corporation, stopped the study just before Christmas.[10][14] He did not believe lobbyists' claims about the medical facts and instead believed his chief medical officer of health that the labels were truthful. He stopped the study because he did not wish Yukon to risk a long and expensive lawsuit and thought leadership should be taken by the federal government after the COVID-19 pandemic.[9][10] Initially, the Yukon Liquor Corporation declined to identify the lobbyists who had contacted them,[10] but an access to information request later published e-mails between lobbyists and the Liquor Corporation ().[15]
Study design[edit]
Background[edit]
The study was started by university researchers from the Canadian Institute for Substance Use Research, with support from Health Canada, Public Health Ontario, the Chief Medical Officer of Health of the Yukon Brendan Hanley,[11] and the Yukon Liquor Corporation.[9][10] In the Yukon as in most of Canada, there is an alcohol monopoly, where only the Yukon Liquor Corporation, controlled by the government, can sell alcohol. The Yukon Liquor Corporation was the only liquor retailer in Canada willing to take part in the study.[12]
Erin Hobin of Public Health Ontario, a lead researcher on the study, praised the Yukon for its courage at the project launch.[11] She said that the study's main aims were to find out whether the labels improved knowledge of health risks, or changed behaviour,[16][17][7] and that this information could be used to develop better public health policy.[18]
A 6.31% decrease in the per-capita alcoholic drink consumption over the period after the first month of labelling, and a 9.97% decrease after the second period in which the warning labels were present, comparing treatment and control groups and adjusting for time of year and demographics. Lines mark dates on which labels were added; when labelling stopped, some labelled products remained on the shelves until sold. Interpolation between monthly datapoints[26] means that sales may have decreased a bit earlier or later, within the month, than is shown by the line.
![A 6.31% decrease in the per-capita alcoholic drink consumption over the period after the first month of labelling, and a 9.97% decrease after the second period in which the warning labels were present, comparing treatment and control groups and adjusting for time of year and demographics. Lines mark dates on which labels were added; when labelling stopped, some labelled products remained on the shelves until sold. Interpolation between monthly datapoints[26] means that sales may have decreased a bit earlier or later, within the month, than is shown by the line.](http://upload.wikimedia.org/wikipedia/commons/thumb/c/c0/Adjusted_mean_number_of_standard_drinks_consumed_per_person_Jsad.2020.81.225fig2.jpg/638px-Adjusted_mean_number_of_standard_drinks_consumed_per_person_Jsad.2020.81.225fig2.jpg)
Two months after the first round of warning labels, many consumers remembered the cancer messages. The resumption of the study omitted the cancer warning labels; recall declined.[20] 2049 people were surveyed.[28] About half of the same consumers were deliberately followed-up and surveyed twice; the rest were new in the second survey. Researchers suspected that media coverage of the controversy around the trial increased knowledge of cancer risks in both the study area and the control area.[20]
![Two months after the first round of warning labels, many consumers remembered the cancer messages. The resumption of the study omitted the cancer warning labels; recall declined.[20] 2049 people were surveyed.[28] About half of the same consumers were deliberately followed-up and surveyed twice; the rest were new in the second survey. Researchers suspected that media coverage of the controversy around the trial increased knowledge of cancer risks in both the study area and the control area.[20]](http://upload.wikimedia.org/wikipedia/commons/thumb/e/ee/Percentage_of_participants_recalling_cancer_warning_Jsad.2020.81.249fig3.jpg/795px-Percentage_of_participants_recalling_cancer_warning_Jsad.2020.81.249fig3.jpg)
The labels may have improved knowledge of official drinking guidelines, but the result was not statistically significant.[3][26]
![The labels may have improved knowledge of official drinking guidelines, but the result was not statistically significant.[3][26]](http://upload.wikimedia.org/wikipedia/commons/thumb/8/82/Impact_of_intervention_alcohol_labels_on_outcomes_in_intervention_and_comparison_sites_%28Waves_1_to_3%29%2C_unadjusted_%25_Jsad.2020.81.262fig3.jpg/695px-Impact_of_intervention_alcohol_labels_on_outcomes_in_intervention_and_comparison_sites_%28Waves_1_to_3%29%2C_unadjusted_%25_Jsad.2020.81.262fig3.jpg)
Researchers found that consumers of alcohol at the stores generally were supportive of more warning labelling.[20] Implementing the labels was neither difficult nor expensive.[5]
After the study, liquor store consumers were more aware that alcohol caused cancer. Those who knew alcohol caused cancer were more likely to support alcohol reduction policies.[80] Erin Hobin said that the study showed that the cancer warning grabbed the attention of consumers. "They read the cancer warning very closely. They thought about that message. They talked to their neighbours and their friends about that message".[66]
Behaviourally, sales of labelled products declined; sales of the small number of unlabelled products increased drastically, but as there were not many of those, overall sales still declined.[26] Kate Vallance pointed to this difference as additional evidence that the labels were effective.[5]
Results for increased awareness and knowledge of drinking guidelines[8] had large confidence intervals, and at 95% confidence intervals were not statistically significant. The shortened study and small sample sizes weakened the study's ability to find effects.[3]
The NTAL study researchers also concluded that "additional cancer label intervention studies are required that are not compromised by industry interference".[20]
Reception[edit]
A medical review paper described the "numerous publications on the Yukon project" as "exemplary".[8] The paper said that as of 2022, the study provided the best evidence on the effects of alcohol warning labels (AWLs): "The most compelling research to date comes from the Yukon experiment, which found that respondents increased their awareness of cancer as a risk factor when recalling the AWLs, reported drinking less after being exposed to the AWLs, and that alcohol sales declined during the intervention."[8] The study was praised for robust label design and study design; the design was cited as a model for how to evaluate alcohol labels.[8] It has been cited worldwide by researchers, public-health activists, and governments.[48][81]
When the study results were published in 2020, John Streicker, the minister responsible for the Yukon Liquor Corporation, said the Yukon government had not yet made a decision on whether to re-introduce the cancer or reduced-risk warning labels, but that he'd read the studies, talk to the researchers, and use the results to raise the issue again with the federal government. He thought that alcohol warning labels, especially cancer labels, should be handled by the federal government. He said that the labels about low-risk drinking guidelines were of more interest to the Yukon government than the more controversial ones about cancer, implying that the guideline labels had the bigger potential for harm reduction,[5] a view not shared by the researchers.[7] He also argued that the effects of the labels might have been amplified by the media controversy.[5] As of January 2023, there has not yet been action, at the federal or provincial level. Provincial liquor boards had also been slow to publicize an update to the national risk guidelines (which changed low-risk limits from 2-3 standard drinks per day, to 2 or fewer drinks per week, due to new evidence). All responsible provincial and territorial ministers were refusing to give interviews on these subjects.[56]
In July 2020, the Canadian Centre on Substance Abuse and Addictions, with funding from Health Canada, began to revise Canada’s Low-Risk Alcohol Drinking Guidelines (LRDGs), replacing them with Canada’s Guidance on Alcohol and Health two and a half years later.[57] They cited publications of the Yukon study for information on awareness of the LDGRs.[82]
Spirits Canada remained opposed to alcohol warning labels, arguing that "warning labels have not been shown to be useful in altering consumer behaviour or reducing the amount people drink" in February 2021, months after the study results had been published.[48]
As of February 2022, eight in ten Canadians supported adding warning labels to alcohol, according to a study led by the Canadian Cancer Society.[66]
External links[edit]
Media related to Northern Territories Alcohol Labels Study at Wikimedia Commons