ABUSE AND TREATMENT
Labeling of Containers and the Prevention of
Drinking in Pregnancy
By Claire D. Coles, Ph.D.
Alcohol use during pregnancy can lead to fetal alcohol
syndrome (FAS) and to other conditions that affect intelligence
and behavior. The United States Surgeon General has advised women
to abstain from drinking during pregnancy. However, not all women
are aware of the dangers of drinking during the time they are
pregnant and some of those who are aware have difficulty stopping
drinking. Prevention efforts are most effective when they are
multilevel, aimed at a number of different audiences. Some efforts
are directed at pregnant drinkers themselves ("indicated"
prevention) while others ("universal") are aimed at
promoting the health and well-being of all individuals in the
community, through media campaigns and social policy.
One effort at universal prevention was the passage
of a "labeling" law. US Public Law 100-690 (1988) required
as of 1989 that all containers of alcoholic beverages in the United
States be labeled with "clear" "nonconfusing"
language describing alcohol-related hazards. This label, which
was required on all containers of sprits, wine and beer, read,
"GOVERNMENT WARNING: (1) According the Surgeon General, women
should not drink alcoholic beverages during pregnancy because
of the risk of birth defects. (2) Consumption of alcoholic beverages
impairs your ability to drive a car or operate machinery, and
may cause health problems." Social policy advocates and legislators
hoped that labeling alcohol containers would influence women to
stop or reduce drinking.
Whether or not this law has had the desired effect,
was the focus of research by several investigators, notably Janet
Hankin, Ph.D., and her colleagues at Wayne State University in
Detroit and L. Kaskutas and her colleagues at Berkley, California.
These investigators examined the following questions:
1) Do warning labels reduce drinking?
2) Are container labels equally effective with high
risk and low risk women?
3) Are adolescents positively affected by warning
Results of research on these issues are decidedly
"mixed". Although heavy drinkers are more aware of labels
and there seems to be some, initial, effect on reported drinking
levels among low-risk women, longer-term results have been less
satisfying. In general, labels are not effective with the most
at risk women and do not affect drinking in pregnancy. Another
study by McKinnon, et al. in 2000, which focused on adolescents
found, "There is no beneficial change attributable to warning
labels in beliefs, alcohol consumption, or driving after drinking."
Kaskutas, after a review of the research on universal prevention
methods, concluded, "changes in drinking during pregnancy"
were not "associated with exposure to any of the assessed
messages (labels, posters, advertisements, and conversations..with
health care professionals)".
These results are disconcerting for the prevention specialist.
They suggest that, to prevent the negative outcomes associated
with maternal substance abuse, more direct and focused prevention
methods are necessary. These efforts include encouraging drinking
women to postpone pregnancy and well as providing access to treatment
for women who are unable to abstain during the time they are pregnant.
Hankin, JR, Firestone, IJ, Sloan, JJ, Ager, JW.,
Goodman, AC, Sokol, RJ & Martier, SS. (1993) The impact of
alcohol warning labels on drinking during pregnancy, J Publ Pol
Market, 12, 10-18.
Kaskutas, L, Greenfield, TK , Lee, ME, & Cote,
J (1998) Reach and effect of health messages on drinking during
pregnancy. J Health Ed, 29, 11-17
MacKinnon, Nohre, L, Pentz, MA, & Stacy, AW
(2000) The alcohol warning and adolescents: 5-year effects. Am
J Pub H, 90, 1580-1594.
The Maternal Substance Abuse and Child Development Project is funded in part by the Georgia Department of Human Resources Division of Public Health.
The Maternal Substance Abuse and Child Development
Study is under the direction of Claire D. Coles Ph.D., with the
Department of Psychiatry and Behavioral Science, Emory University
School of Medicine. For more information, please contact: Claire
D. Coles: firstname.lastname@example.org
Karen K. Howell: email@example.com