Alcohol, Binge Drinking, and Cancer Risk: Accelerating Public Health Messaging Through Countermarketing

A number of public health groups, including the American Public Health Association (APHA), have recently called for warning labels on alcoholic beverages to inform the public of the increased risk of cancer 1,2 The International Agency for Research on Cancer classifies alcohol as a group I carcinogen, in the same league as tobacco, human papilloma virus, and hepatitis 3 Epidemiologists have reported a link between cancer and alcohol consumption for decades (e g , Flamant et al 4;Williams and Horm5), with consistent associations with cancers of the (1) oral cavity and pharynx, (2) esophagus, (3) larynx, (4) liver, (5) breast, and (6) colorectum (ranked by strength of association) In addition to the strategies put forth in the APHA and ASCO statements, we believe that the strategic use of countermarketing, a marketing strategy successfully used to change risk perceptions and behavior toward smoking, may hold the key to helping create awareness of alcohol as a carcinogen 9 COUNTERMARKETING Although the use of warning labels is one component of many product-based public health campaigns, it is likely to have only a limited impact without structural changes, as we have seen with cigarette smoking 10 The recent APHA policy statement on reducing populationlevel health effects from alcohol outlines some of these structural approaches 11 For reducing population-level effects of alcohol on different cancers, given the long latency between exposure and cancer diagnoses as well as the recognition that alcohol habits start in adolescence and early adulthood, structural changes that can augment the use of warning labels and other public health measures specifically to younger adults is needed [ ]even with the full support of the health care community and government policies-such as warning labels, tobacco taxation, a ban on TV and radio advertising, and antismoking public service announcements-youth smoking in the United States (12th graders) was reduced by only 0 07% from 1980 to 2000 14 By contrast, the next 19 years show a striking difference, with a decline of 18 9% 14 There are numerous contributing factors at play that can, in part, explain this decline;however, the most notable from a marketing perspective was the implementation of a countermarketing strategy [ ]recent data from the Centers for Disease Control and Prevention demonstrated that most adults are not asked specifically about binge drinking by their health care professional even if they are asked about alcohol use 20 Even more sobering, of those who reported to their health care provider that they did engage in bingelevel drinking, less than half of the admitted binge-drinking individuals (41 7%) were provided with information about the harms of heavy drinking, and only a fifth (20 1 %) were specifically told by their health care provider to reduce their level of drinking