Highly deficient alcohol health warning labels in a high-income country with a voluntary system

To examine the prevalence and design elements of the voluntary health warning labels and related industry initiatives on a purposive sample of alcoholic beverage containers sold in New Zealand (NZ), a country with no mandatory health warning labels.

We selected a purposive (e.g. low-cost) sample of 59 local and imported beers, wines and ready-to-drink alcoholic beverage containers available in NZ in 2016-2017. We documented the occurrence, content, size, appearance and position of messages concerning drinking during pregnancy, drink-driving, other health effects and industry-led initiatives that could relate to warnings; and collected data about alcohol content, standard drinks, ingredients and energy information.

A majority (80%) of the alcoholic beverage containers had a pregnancy-related warning, 73% had industry-led initiatives (e.g. advising 'responsible' consumption) and 19% had drink-driving/heavy machinery warnings. Warning labels were small, with the average area of pregnancy-related and drink-driving/heavy machinery pictograms being 45 and 36 mm² , respectively (i.e. pea-size). The average heights of pregnancy-related and drink-driving text were 1.6 and 2.2 mm, respectively. Pregnancy-related pictograms occupied between an average of 0.13% (wine) and 0.21% (ready-to-drink) of the available surface area of the alcoholic beverage container (i.e. less than 1/400th of the available space). Drink-driving pictograms occupied an average of 0.12% (imported beer), and 0.13% (NZ beer) of the available surface area.

Voluntary recommendations in NZ appear to have been inadequate for producing health warnings on alcoholic beverage containers that are consistent with evidence-informed recommendations for effective labels. This finding suggests that mandatory standardised labelling outlining alcohol-related risks may be required to ensure adequate consumer information.