Engs, Ruth C. [Ed.], Controversies in the Addicton's Field. Donna L. Polowchena, M.S. "CHAPTER 16: The Right to Know."

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CHAPTER 16
The Right to Know

Donna L. Polowchena, M.S.

Introduction

As of November 17, 1989 all alcoholic beverage containers bottled after that date are required to have warning labels attached to them with the following statement:

Though this requirement has been mandated by Congress, it is still considered to be controversial by some groups and individuals. Part of the controversy appears to revolve around the questions "Are the warning labels a symbolic gesture in support of alcohol abuse prevention and education, or are dopey an effective public health technique or adjunct to other alcohol education programs? (Engs, 1989). A second part of the issue involves tile consumers right to know what is in a product. For this paper I will be taking the point of view that the public health measure of health warning labels on alcoholic beverages was long over due and chat as a preventive measure it can be effective in reducing alcohol abuse and alcoholism.

History of Warning Labels for Alcohol Beverage Containers

The history of attempting to require warning labels on alcoholic beverages has been long. Proposals for Their enactment were first made in the late 1970s on the national level but were rejected. During the 1980s various consumer and health groups, again, made efforts to have legislation enacted as general public support for health labeling was found. For example, a 1984 Roger survey (Washington Post, 1986) of alcohol problems reported that 64 percent of businesses, government, military, and other leaders endorsed mandatory health warning labels, and 68 percent of the general public agreed.

After much effort on the part of various health and consumer groups,

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in particular the National Council for Alcoholism and the Center for Science in the Public Interest, legislation was finally passed in the summer of 1989 as part of an drug bill requiring that all liquor, beer, wine, and wine coolers carry labels warning of risks of drinking during pregnancy and of drinking and driving. Similar to cigarette warning labels, these labels do not create any legal restriction or penalty to those who do not heed the warning.They merely provide cautionary notice that consumption of the product may entail serious consequences in certain situations (Congressional Record, 1988)

For years the alcohol beverage industry has argued that labels would unfairly stigmatize light and moderate drinkers. However, some researchers have felt that any drinking during pregnancy might cause fetal developmental problems. Also, alcoholic beverages when taken in excess can impair the ability to drive while also leading to chronic alcoholism. Because of these potentially life threatening problems, warning information on containers addressing these issues were considered particularly important for potential drinkers falling into these categories.

When the legislation was passed, as part of a compromise with the beverage industry, alcohol advertising was excluded from the labeling requirements. However, individuals involved with groups and organizations making recommendations for public policy (Beauchamp,1987; New YorkTimes, October 2O, 1988) feel that warning labeling on ad advertisement including bill boards, point of purchase, radio and television, newspapers and magazines needs to be enacted. This is thought to be important by the fact that the more awareness people have about a substance that can cause harm, the more likely they will make healthy choices concerning its use.

The Consumers Right to Know

The consumer has battled for years for the right to know what is , contained in a product. As consumers we all have the right to make wellinformed, healthy lifestyle choices. We can only do this if we are given the appropriate information. Warning labels can give health information that can counter the images created by the billions of dollars each year spent by the advertisement industry on a product. Labels for food and consumable products must be more than advertising. They must be educational and provide consumers with information on possible harmful ingredients along with those that are more conducive to good health. Cautionary labeling has often been fought by producers with the claim that it raises the products' cost which would be passed onto the consumer. However, these costs are thought to be minimal and are easily offset by savings in the health care industry and work place productivity.

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Up until the passage of recent legislation, alcohol was the only ingestable manufactured consumable good that did not have a warning or ingredient label on it. Tobacco warning labels have been required for over two decades. Producers have often argued that warnings on their products will ultimately lead to warnings on everything from eggs to underwear and that people will ignore warning messages. However, this is not a realistic argument. The reason is that alcohol and tobacco are the only two products which are potentially addictive and sold legally direct to the consumer. This is despite their potential destructive impact on our nation's health. Labels on these products give the consumer the option to choose to use or not use the product. Labels help the consumer become aware of possible consequences with use of the substance and allows the consumer the right to make intelligent informed choices.

Informative labels can help prevent severe illness, congenital conditions and even lives by warning individuals that the product contains ingredients which can cause health problems. There are a number of problems related to alcohol consumption to which the consumer has a right to know. In 1984 the estimated consumption of alcoholic beverages was the equivalent of 2.65 gallons of pure alcohol per persons 14 years of age or older. Heavier drinkers, who constitute 10 percent of the drinking population, account for half the alcohol consumed in the United States (Alcohol and Health, 1987). Alcohol is associated with a wide variety of diseases and disorders.The greatest health hazard from chronic alcohol consumption is liver disease. In 1983 cirrhosis of the liver was the ninth leading cause of death in the U.S.. Nearly half of the accidentals deaths, suicides and homicides are alcohol related. Victims are intoxicated in about one third of drownings, homicides and boating and aviation deaths and in about one fourth of suicides. Alcohol creates problems for an estimated 18 million persons 18 years and older (Alcohol and Health, 1987).

Avery serious consequence of drinking is motorvehicle crashes.They are the most common non-natural cause of death in the United States accounting for more fatal injuries than any other type of accident (NIAAA, 1985).During 1984 more than 44,000 traffic fatalities occurred on the U.S. highways. Forty-three percent of all drivers involved in fatal crashes were intoxicated (Alcohol and Health, 1987). The highest group of crash deaths resulted in the 18 year old group. However, they account for only 2.2 percent of the driving population and drive less than 2 percent of the total miles traveled Moreover, they were involved in 5.5 percent of the alcohol related accidents.

Another serious problem resulting from heavy alcohol consumption during pregnancy is fetal alcohol syndrome (FAS).Over the past two

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* Adapted from: Health HazardsAssociated withAlcohol and Methods to Inform the General Public of these Hazards. U. S. Department of Health and Human Services Report. Rockville, MD, 1980

decades there have been more than 3,000 papers published on this problem alone (Alcohol and Health, 1987). It is estimated that the overall FAS prevalence is from 1 to 3 cases per 1,000 live births based upon estimates in various American and European cities. Among women who are alcohol abusers the prevalence ranges from 23 to 29 cases per 1,000 population. Serious cases of FAS appear to be found only in mothers who are chronic alcoholics and drink heavily during pregnancy (Alcohol and Health,

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1987). However, this is considered to be the severe end of a continuum of fetal damage that can be produced by prenatal alcohol exposure. Lower levels of maternal drinking may also have some measurable effects on the fetus.It is important to note that "data so far do not suggest a threshold level of drinking below which there is no effect on the unborn child" (Alcohol and Health, 1987 p. 85). It is not known why some fetuses are more susceptible to FAS compared to others. Because of the many unknowns concerning alcohol consumption during pregnancy, to be on the cautionary side, many health professionals and groups recommended that pregnant women abstain from alcohol (Alcohol and Health, 1987).

Alcoholic beverage producers certainly do not want consumers to associate drinking with mental retardation, alcoholism, cirrhosis of the liver and death on the highways. However, they do little to inform drinkers about health and safety risk. According to Neil Postman (New York Times, March 20, 1988), it is estimated that about $2 billion worth of promotional campaigns annually are presented by the alcohol beverage industry. Children see more than 100,000 beer commercials on television before they are old enough to legally drink and drive. Postman feels that the ads do more than sell the assumption that drinking is not just safe, but is essential to a happy, successful life.

According to this same article, some alcohol beverage companies do sponsor occasional advertisements to remind consumers to drink "moderately." However, in many cases the advertisements may be designed to undercut prevention oriented legislative inititives rather than to educate drinkers about health risks. It also has been estimated that the heavy drinkers account for half of all sales. If these drinkers drank less, sales and profits would plummet.

Labels as Public Health Education Vehicle

Warning labels on all alcoholic beverage containers, including cans and bottles of beer, bottles of wine and liquor ensure that the message is consistently before the public eye. If public health education messages are to be optimally effective, in terms of promoting increased awareness and behavior change, information needs to be repeated frequently over time and from a variety of sources. Many of the studies investigating the effect of warning labels appear to suggest that they are effective in conjunction with other types of educational messages and public health programs.There have been some studies concerning the effectiveness of warning labels. Since 1975 packaged processed foods have been required by law to bear a nutrition label if it was fortified with additional nutrients (Richardson,1987). One study indicated that after diet sodas were required to carry a warning that saccharin causes cancer in animals, soft drinks sales

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slowed (Orwin, Schucker and Stokes, 1984).

In 1982 the FDA asked food manufacturers to voluntary label the sodium content of their products. A study by Heimbach (1986) found that public concern about high sodium intake increased as increases in sodium labeling on products occurred. Simultaneously there were mass media and public health high blood pressure education programs discussing the problems of sodium intake. Another study with shelf labeling of food products containing low or reduced sodium, calories and fat, resulted in increased sales compared to those products without the information (Schucker,1986). During the study period, other related public health and media campaigns occurred. The researchers for both of these investigations concluded that perhaps all the educational and media efforts together, including labeling,caused an increase in concern and in healthier consumer choices as it was not possible to determine the effectiveness of labels in isolation from the other educational efforts.

There have been some studies that indicate that people do read labels in certain circumstances. Studies of prescription inserts to inform consumers of the dangers and proper use of a drug found that most patients read the information provided with the prescription.Patients showed an increased knowledge about the side effects and dangers of the medication

(Mazis,Morris,and Gordon, 1987). A study by Morris(1980) found sales of a brand of estrogen dropped sharply after media reports were broadcast linking estrogens to cancer. Declines in sales continued following a mandatory insertion of an information sheet a few years later warning of possible side effects of the drug.

The closest analogous substance to alcohol is tobacco. Comprehensive anti smoking education programs and policies began in 1964 with the publication of the Surgeon General's report concerning the health consequences of smoking (Richardson,1987). Cigarette warning labels were first placed on cigarette packages in 1965 but had little immediate effect in consumption. After public education programs began in 1968, a decrease in smoking occurred. Richardson concluded that it may have been a combination of these efforts and not any one in particular which caused a decreased consumption of cigarettes in 1979. These various reports appear to imply that a combination of warning labels, media publicity, public education, changes in public attitudes, and anti smoking commercials have been the primary factors in changes of health behaviors.

Summary

In summary the consumer has a right to know what ingredients he or she is consuming and what the possible health consequences of the product are so that infommed choices can be made. Likewise warning labels on

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alcoholic beverages, in conjunction with expanded educational programs, mass media campaigns, higher federal alcohol excise taxes and restriction of advertisement in the mass media all need to be part of a public health education program as a preventive measure for alcohol abuse and alcoholism.

REFERENCES

Beauchamp, D. (1987). What can we learn from the tobacco experience ? Paper presented: Alcohol Policy Conference V, Charleston, NC. Committee on Commerce, Science and Transportation. (August 10, 1988) Congressional Record, U.S. Senate:Washington, D.C.

Engs, R. C. (1989). Do warning labels on alcoholic beverages deter alcohol abuse ? The Journal of School Health, 59 (3) 116-118

Heimbach, J.T. (1986) The growing impact of sodium labeling. Read before the 46th Annual meeting of the Institute of Food Technologists, Dallas.

Mazis, M.B., Morris, L.A., and Gordon, E. (1987). Patient recall and attitudes about two forms of oral contraceptive patient information. Medical Care, 16 1045-1054.

Morris, L.A.(1980). Estrogenic drugs-patient package inserts, in Morris, L.A., Mazis, M.B. and Barofsky, E. (Eds). Product labeling and health Risks-Banbury Report 6, Cold Springs Harbor Laboratory: Cold Springs Harbor, N.J.

NIAA Alcohol Epidemiologic Data System (1985). Country Problem Indicators 1975-1980. U.S. Alcohol Data Reference Manual, Vol. III. Rockville, MD.

New York Times, March 20, 1988.

New York Times, October 26, 1988.

Orwin R.G., Schucker, R.E., and Stokes, R.C. (1984). Evaluating the life cycle of a product warning: Saccharin and diet soft drinks. Evaluation Review, 8 (6) 801-822.

Richardson, P. et al. (1987). Review of the Research Literature on the Effects of Health Warning Labels: A report to the United States Congress, Macro System, Inc.:Silver Springs, MD.

Sixth Special Report to the U.S. Congress on Alcohol and Health. (1987). U.S. Department of Health and Human Services. NIAAA: Rockville, MD.

Schucker, R.E. (1986). Merchandising nutrition information. Cereal Food Worlds, 31 (7) 461-463.

Washington Post, July 2, 1986. 143

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