Effectiveness of health warning labels on alcoholic beverages: A systematic review with a narrative analysis for Austria

Madlen Maierhofer
Duration: November 2025 until June 2026
Language: English (with German summary)

Background:

According to the World Health Statistics Report 2025 of the World Health Organization (WHO), Europe has the highest per capita alcohol consumption worldwide among the WHO regions [1]. Within Europe, Austria is one of the countries with the highest per capita alcohol consumption [1]. A nationwide representative survey on substance use conducted in Austria in 2020 indicated that 15% of respondents engage in health-risk alcohol consumption. The prevalence of this consumption pattern is higher among men (18%) than among women (11%), indicating pronounced gender differences. [2].

The health risks associated with increased alcohol consumption are diverse and, in some cases, manifest only later in life. There is evidence of an association between alcohol consumption and diseases of the nervous system [3], the digestive tract, the cardiovascular system [4], as well as mental disorders [2]. Of particular note are alcohol-associated cancers, which have increasingly become a focus of research. Excessive alcohol consumption is strongly associated with an increased risk of developing several types of cancer [5][6]. Alcohol consumption is also associated with psychosocial consequences, burdens on the social environment, and an increased risk of alcohol-related accidents and acts of violence. All of these factors cause a substantial burden of disease and result in challenges for the Austrian social and healthcare systems [2].

The WHO’s goal is to reduce harmful alcohol consumption worldwide by 10% by 2030. As one of several measures to achieve this goal, the WHO recommends the introduction of health warning labels on alcoholic beverages [7]. Internationally, the effectiveness of health warning labels on alcoholic beverages regarding certain health-related outcomes is scientifically and socially controversial. According to scientific literature, health warning labels on alcoholic beverages may have positive effects. However, it should be noted that these findings predominantly derived from experimental studies. In addition, the literature describes a wide variety of warning label designs. On the one hand they vary in terms of their format (e.g., text-based, image-based, or a combination of both), and on the other hand, regarding the target group addressed (general population versus specific vulnerable groups), and in terms of the content conveyed. The latter includes different approaches in consumption recommendations, information on the health consequences of alcohol consumption, and references to the behavioral effects of alcohol consumption [8][9].

Objectives:
The primary objective of this project is to systematically analyse the existing evidence on the effectiveness of health warning labels on alcoholic beverages. Accordingly, this report focuses on identifying which formats and types of content for health warning labels on alcoholic beverages are described and recommended in the scientific literature. Furthermore, the effectiveness of these warning labels is examined regarding the available evidence on health-related and economic outcome measures. Finally, the findings are contextualised for Austria by discussing which recommendations can be derived for the implementation of health warning labels on alcoholic beverages aimed at the general population.

Non-Objectives

This report does not aim to empirically examine the effectiveness of health warning labels.

Further, it is not an aim to compare health warning labels with other preventive measures.

Research questions

1.     RQ1: What designs for health warning labels on alcoholic beverages can be identified in the literature?

2.     RQ2: How effective are health warning labels on alcoholic beverages in comparison with each other and in comparison with no warning labels regarding health-related and economic outcomes for the general population?

3.     RQ3: What recommendations regarding health warning labels on alcoholic beverages can be made based on the available evidence for the Austrian context?

Methods:
To answer the first and second research questions, a systematic literature search will be conducted in accordance with PRISMA guidelines. Precise inclusion and exclusion criteria for the literature search will be defined in the PICOS scheme. Based on these criteria, relevant databases (PubMed, The Cochrane Library, PsycINFO, Medline via Ovid, Embase, INHTA) will be systematically searched and the literature search will be completed by a manual search. The literature will be selected by two independent reviewers, with relevant literature being identified based on the defined inclusion and exclusion criteria in the PICOS scheme. After the literature has been selected, the information from the relevant literature will be extracted, summarized in pre-structured tables, and synthesized narratively. The quality of the identified literature will be assessed using appropriate instruments.

To address the third research question, recommendations for Austria regarding the design of health warnings on alcoholic beverages are developed narratively, based on the findings of the first and second research question.

PICOS:

Timetable:

References:

[1]        World health statistics. monitoring health for the SDGs, Sustainable Development Goals. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO. 2025.[2]        Strizek J., Gaiswinkler S., Nowotny M., Puhm A. and Uhl A. Handbuch Alkohol – Österreich. Band 3: Ausgewählte Themen. Gesundheit Österreich, Wien. 2025.
[3]        Nutt D., Hayes A., Fonville L., Zafar R., Palmer E. O. C., Paterson L., et al. Alcohol and the brain. Nutrients. 2021;13. DOI: doi:10.3390/nu13113938.
[4]        Roerecke M. Alcohol’s impact on the cardiovascular system. Nutrients. 2021;13. DOI: doi:10.3390/nu13103419.[5]        IARC. Reduction or cessation of alcoholic beverage consumption IARC Handb Cancer Prev 2024;20A:1–334.[6]        Rumgay H., Murphy N., Ferrari P. and Soerjomataram I. Alcohol and cancer: Epidemiology and biological mechanisms. Nutrients. 2021;13. DOI: doi:10.3390/nu13093173.
[7]        WHO. Global alcohol action plan 2022–2030. Geneva. 2024.
[8]        Clarke N., Pechey E., Kos?te D., König L. M., Mantzari E., Blackwell A. K. M., et al. Impact of health warning labels on selection and consumption of food and alcohol products: Systematic review with meta-analysis. Health Psychology Review. 2021;15 (3):430–453. DOI: https://doi.org/10.1080/17437199.2020.1780147.
[9]        Joyce K. M., Davidson M., Manly E., Stewart S. H. and Al-Hamdani M. A systematic review on the impact of alcohol warning labels. Journal of Addictive Diseases. 2024;42 (3):170–193. DOI: https://doi.org/10.1080/10550887.2023.2210020.
[10]      United Nations Development Programme. Human Development Report 2025: A matter of choice — People and possibilities in the age of AI. 2025.