The warning label currently required on alcohol containers in the United States has not changed since its adoption in 1988, despite new evidence linking alcohol to several diseases. The label states the risks of drinking during pregnancy and while driving or operating machinery and warns generally that drinking alcohol “may cause health problems.” The label often goes unnoticed and unremembered by consumers.

“We wanted to test whether new warnings could better inform consumers about alcohol’s harms and better encourage people to consider cutting back on their drinking,” says lead author Anna H. Grummon, Ph.D., M.S.P.H., assistant professor at the Stanford University School of Medicine. The study was conducted as part of a larger project co-led with Marissa G. Hall, Ph.D., associate professor at the University of North Carolina.

Designed to compare the effects of differently worded and designed warning labels, the study recruited a nationally representative sample of 1,036 adults of legal drinking age (21 and older) who reported drinking at least once a week.

Participants viewed 10 messages — one control, eight new warning labels, and the current U.S. warning label — in random order. They then rated each message on how well it encouraged them to drink less alcohol, reminded them of alcohol’s harms, and informed them of something new.

“Each participant rated multiple warnings covering a range of health harms — such as cancer, liver disease, hypertension, and dementia, among others — so we could make direct, apples-to-apples comparisons between them,” says Grummon.

All the new alcohol warnings in the study outperformed the current U.S. warning label, but those highlighting cancer risk were particularly effective. This finding is notable as policymakers in the United States and abroad debate whether to adopt a cancer warning on alcohol products.

“Ireland, for example, is set to require cancer warnings on alcohol containers in the coming years, and Alaska already requires a cancer warning to be posted in bars, restaurants, and liquor stores where alcohol is sold,” says Grummon. “Our findings suggest these policies could help people understand the risks of drinking and potentially reduce consumption.”

Study participants also rated the effectiveness of warning icons and label design. Triangles and octagons were perceived as more effective and attention-grabbing than other icons, such as a magnifying glass.

More research is underway. Grummon and Hall are currently running a randomized trial to test whether new alcohol warnings effectively lead people to drink less. The study will also measure whether the warnings improve knowledge of alcohol-related harms over time.

“We know from tobacco control that well-designed warnings can inform consumers and encourage healthier choices,” says Grummon. “Given that alcohol-related deaths are increasing, we hope policymakers will consider whether updating alcohol warnings should be part of a broader strategy to address alcohol-related harms.”
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Grummon, A. H., Lee, C. J. Y., Campos, A. D., Lazard, A. J., Brewer, N. T., Whitesell, C., Ruggles, P. R., Greenfield, T. K., & Hall, M. G. (2026). New alcohol warnings outperform the current U.S. warning in a national survey experiment. Journal of Studies on Alcohol and Drugs, 87(3), 433-443. https://doi.org/10.15288/jsad.25-00226

By W.B. Kagan

image: “Government warning” alcohol label

View more Credit: Journal of Studies on Alcohol and Drugs

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Testosterone therapy may help obese men with functional hypogonadism and type-2 diabetes reduce the prevalence of non-alcoholic fatty liver disease (NAFLD), according to a study being presented at the 23^rd European Congress of Endocrinology (e-ECE 2021), (http://www.ece2021.org). The two-year study found that therapy with testosterone undecanoate normalised testosterone levels, reduced NAFLD, and suppressed the symptoms of hypogonadism in men living with these conditions.

NAFLD is emerging as a public health issue worldwide. It is estimated that prevalent cases will increase 21% by 2030, from 83.1 million to 100.9 million. NAFLD is more commonly found in people with type-2 diabetes, and is linked to obesity, insulin resistance and atherogenic dyslipidemia. NAFLD refers to excess fat accumulation in the liver, in the absence of excessive alcohol consumption. Alcohol consumption of less than 30 g (3.75 units) per day for men is used as the cut-off to diagnose NAFLD. As an increasing global health issue, this study and its findings may be a promising area for further research.

Dr Kristina Groti Antonic and her team from the University of Ljubljana, Slovenia, carried out a large study on the effects of testosterone therapy on glycemic control, metabolic parameters, vascular function and morphology in obese men with hypogonadism and type-2 diabetes mellitus. They presented a part of this study at e-ECE 2021 in which they evaluated the effects of testosterone therapy on morphology and grade of NAFLD in this population. The two-year clinical trial saw 55 males with functional hypogonadism and type-2 diabetes participate. The first year focused on a double blind, placebo-controlled study and the following year was used for follow-up.

During the study, the participants were randomised into two groups. The first group received testosterone undecanoate during both years of the study, while the second group received a placebo in the first year and testosterone therapy in the second year. A range of tests including testosterone levels, prostate specific antigen and routine blood tests were assessed at the beginning of the trial, 12 and 24 months. Liver ultrasounds for NAFLD grade assessments were performed at the beginning and after two years, which showed an improvement in NAFLD grades after two years of the trial.

Dr Kristina Groti Antonic shared that, “improvement of NAFLD grade was a result of improved insulin resistance, reduction in body mass index and body weight, along with changes in body composition. As we know, testosterone increases lean body mass at the expense of fat mass, either alone or in combination with behavioral and lifestyle modifications. Testosterone with its anti-inflammatory effects also reduced chronic inflammatory state in the liver. Our study shows that testosterone therapy could be used as a suitable therapy for obese men living with non-alcoholic fatty liver disease, and therefore the findings can be used to tackle this growing pandemic.”

This knowledge could help obese men living with functional hypogonadism and type-2 diabetes experience normalised testosterone levels and reduced prevalence of non-alcoholic fatty liver disease.

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