Warning labels worked for cigarettes. They could work for alcohol too 

Last week, U.S. Surgeon General Vivek Murthy said that alcoholic drinks should carry a warning about cancer risks on their label. Alcohol consumption increases the risk of at least seven types of cancer, including breast, colon, and liver, yet less than half of Americans are aware of this connection. A warning label, he said, would help people make an informed decision when choosing whether or not to drink.

It is unclear when or if the surgeon general’s advisory will be adopted. It’s up against a powerful industry lobby, and top liquor companies are located in conservative states. But if history with tobacco warnings is any indication, such labels could have a big impact on alcohol consumption—and they could save many lives.

In many parts of the world, including the U.S., drinking is more socially accepted than smoking. The “social lubricant” fuels parties and brings people together. Nobody has ever been known to “raise a cigarette” to a friend’s happiness. But both alcohol and nicotine are addictive substances. Both are classified as human carcinogens by the International Agency for Research on Cancer. Both kill. Yet one has faced a lot more backlash than the other.

For decades, scientists have advocated for health warning labels to deter people from smoking. But the journey to standardization has been long and bumpy. For years, the size, format, and content of these health warnings has varied from vague statements like “smoking can be harmful to your health” to nauseating images of rotting lungs.

These variations have made it challenging to quantify the efficacy of labels across the board, but a large body of research points to a success story. One study found that health warnings on cigarette packages are a prominent source of health information, and that being informed about these health risks is “strongly associated with intentions to quit.” Another showed that graphic warning labels, especially large ones, can reduce the cigarette pack’s promotional impact and “denormalize the product.”

Since health warning labels first appeared in the U.S. in the 1960s, tobacco consumption has dropped by a remarkable 73%—from 42.6% in 1965 to 11.6% in 2022. This decline was influenced by other factors, too, including anti-tobacco media campaigns, smoke-free policies, increased access to cessation programs, and mass social and cultural change. But the role that health warnings have played in reducing smoking cannot be ignored.

So why is it that 122 countries have implemented health warnings on cigarette packs, and only 66 countries have done the same for alcohol containers? If labels can help people quit smoking, can’t they dissuade them from drinking, too?

The Yukon experiment

The Yukon territory in northwest Canada might hold one answer. In 2017, a team of researchers labeled 300,000 bottles in the capital city of Whitehorse in preparation for an eight-month study. It remains the only real-world experiment on the impact of cancer warnings on alcohol labels.

For the study, the team designed three different labels: One included a cancer warning specifically calling out breast and colon cancer, the other two showed the number of standard drinks per alcohol container. Erin Hoben, who coauthored the study and works as a scientist at Public Health Ontario, told Fast Company that the team was “unable to disentangle which label did what,” but still found “clear and consistent evidence” that exposure to labels can increase consumer awareness of cancer risks and reduce alcohol sales.

Over the course of the study, sales of the newly labeled products went down by 6.6%, while sales of regularly labeled products in nearby territories went up by 7%. There was one major roadblock: A month after the new labels launched, Canadian alcohol industry lobby groups interfered with the study, and the team was forced to remove the cancer warning (the other two labels remained until the end of the study period). Despite the compromised process, Hoben says the results were consistent with the researchers’ hypothesis that well-designed alcohol warning labels can indeed support more informed decisions about drinking and reduce alcohol use.

“The design . . . is so critical for how effective consumer warning labels will be,” she says. The message must stand out from the rest of the label, and it must be simple and clear. In Yukon, for example, the text was displayed in a large, bolded font set against a bright yellow background with a red border. It read: “Alcohol can cause cancer, including breast and colon cancers” in both English and French.

In the absence of standardized regulations, though, an infinitesimal number of countries have implemented any kind of directives mandating the look or even the content of these labels. In 2017, South Korea passed legislation requiring one of three warnings to be included on alcohol containers, but only two of the three mention cancer, and the manufacturer is free to decide which warnings they want to display. At the time of this writing, no studies have been done on the legislation’s impact, at least not in English.

In the U.S., the label on alcohol containers has remained unchanged since Congress first passed the Alcoholic Beverage Labeling Act more than 35 years ago. The label touches on the health concerns associated with drinking while pregnant, and concerns around drunk driving and operating machinery, but it shies away from citing a connection to cancer, despite the mounting evidence that there is no safe level of alcohol consumption.

The design regulations for labels in the U.S. are equally lacking, stating only that the health warning statement “must appear in readily legible print” and “may appear on a front label, back label, or side label.” Hoben says the lack of specificity means that the warning “gets lost and camouflaged.”

To date, the only country in the world with detailed regulations in place is Ireland. Starting in 2026, all alcohol products sold there will have to display warnings about cancer, liver disease, and the risks associated with drinking during pregnancy. Additionally, they’ll have to include information on the quantity of alcohol and number of calories contained in the product, and details of a website on alcohol and related harm. The regulations also specify details about the look and location of the warning, which is to be printed in bold, red, all-caps letters against a white background. The text must take up the greatest possible proportion of the surface dedicated for the warning label, and it must appear on the same side as the majority of other information on the container.

Getting the design right

Compared to the graphic images that dominate cigarette packs, the Irish labels may seem tame, but for Hoben, it’s important not to alienate people from the start. “When you reflect on the tobacco experience, it didn’t go from no label on the packaging to large, colorful, graphic labels,” she says. “It was a very incremental change.”

In 1992, the largest cigarette package health warnings in the world, which happened to be in Canada, covered about 20% of the package. These warnings consisted of text only, and often used weak language with no mention of cancer or heart attacks. Today, these warnings cover as much as 93% of the pack (in Quebec), and the use of graphic pictures, once controversial, has become widespread around the globe.

Almost 140 countries require picture health warnings to be displayed on cigarette packs, and 25 countries have adopted a more standardized “plain packaging” design that prohibits the use of brand logos and colors. (Since 2023, Canada even requires warning phrases like “poison in every puff” to be printed on every single cigarette.) “When alcohol warning labels are being considered, the same incremental approach may be helpful in meeting the public where it’s at,” Hoben says.

Designing a warning label for alcohol remains trickier because of the social nature of drinking, but Amitav Chakravarti, a professor at the London School of Economics whose work explores decision-making and the impact of public health messages, says it’s helpful to remember that smoking was once an equally acceptable social pastime. Just look at ads from the 1960s, which marketed cigarettes as “glamorous” and “fresh,” and compare them to marketing campaigns for alcohol today, which often position booze as the most important ingredient to your favorite parties. (Just last year, Smirnoff hired YouTube sensation Troye Sivan as its “chief vibes officer.”)

“In the end, the challenges are not too dissimilar,” Chakravarti says.

Inevitably, there are still nuances to explore in both fields. According to one report that Chakravarti coauthored in 2015, different warnings affect people in different ways. For example, images on cigarette packs that elicit emotions like shame, anger, anxiety, and distress were 16% more successful in reducing the decision-maker’s odds of buying a tobacco product than images eliciting emotions like fear and disgust. “Shaming works, but only if the rest of the societal norms and mores have also moved along,” he says.

According to Chakravarti, peer pressure has a lot to do with the reasons why we reach for something we know is bad for us. “Then it’s a combination of the nicotine hit that you get addicted to and the reaffirming fact that everyone among your peer group is doing so,” he says.

For shaming campaigns to work, he adds, “smoking needs to become somewhat uncool.” The same might hold true for drinking. Bolstered by advisories like the one from the U.S. surgeon general and trends like “Dry January” or the growing “sober-curious” movement, we might just be on that path.