Northern Territories Alcohol Labels Study

The Northern Territories Alcohol Labels Study (NTAL study) was a scientific experiment in Canada on the effects of alcohol warning labels. It was modified after lobbying from the alcohol industry, and later relaunched with industry-advocated experimental design changes: omitting the "Alcohol can cause cancer" label, not labelling some alcohol products, and shortening the time period (from eight to four-and-a-half months). Enough data was gathered to show that all of the labels used in the study were simple, cheap, and effective, and it recommended that they should be required worldwide. Researchers felt that the lobbyists' changes diluted the scientific value of the study and feared the weakened study might not give clear results. While the shortened study did not provide enough evidence to answer some of the research questions, it showed that the warning labels reduced alcohol sales and consumption: remembering the labels made people more aware of the alcohol-cancer link, and that awareness made people decide to drink less. Industry interference in the study brought international attention. In November 2017, "Alcohol can cause cancer" warning labels (and two other designs) were added to alcoholic products at the only liquor store in Whitehorse, Yukon. The study was planned to run for eight months. Alcohol industry lobbyists stopped the study after four weeks. The Association of Canadian Distillers, Beer Canada and the Canadian Vintners Association alleged that the Yukon government had no legislative authority to add the labels, and would be liable for defamation, defacement, damages (including damage to brands), and packaging trademark and copyright infringement, because the labels had been added without their consent. They also claimed that the labels violated their freedom of expression. Partly because cigarette-package warning labels had already been ruled legal, these claims were not considered to have merit. Lobby groups denied threatening legal action. John Streicker, the Yukon Minister Responsible for the Yukon Liquor Corporation, stopped the study just before Christmas. He did not believe lobbyists' claims about the medical facts and instead believed his chief medical officer of health that the labels were truthful. He stopped the study because he did not wish Yukon to risk a long and expensive lawsuit and thought leadership should be taken by the federal government after the COVID-19 pandemic. Initially, the Yukon Liquor Corporation declined to identify the lobbyists who had contacted them, but an access to information request later published e-mails between lobbyists and the Liquor Corporation (see § External links, below).

Study design

Background The study was started by university researchers from the Canadian Institute for Substance Use Research, with support from Health Canada, Public Health Ontario, the Chief Medical Officer of Health of the Yukon Brendan Hanley, and the Yukon Liquor Corporation. In the Yukon as in most of Canada, there is an alcohol monopoly, where only the Yukon Liquor Corporation, controlled by the government, can sell alcohol as a retailer or as a distributor to licensed establishments. The Yukon Liquor Corporation was the only liquor retailer in Canada willing to take part in the study. Erin Hobin of Public Health Ontario, a lead researcher on the study, praised the Yukon for its courage at the project launch. She said that the study's main aims were to find out whether the labels improved knowledge of health risks, or changed behaviour, and that this information could be used to develop better public health policy.

The cancer labels were a global first. At the time of the study, South Korea warned consumers specifically about liver cancer, and allowed manufacturers to choose between three labels, one of which did not mention cancer. No other country had alcohol-cancer warning labels. Ireland introduced mandatory cancer-risk labelling in 2018, after the study was launched. As of 2020, no other countries had implemented cancer warning labels on alcohol. As of 2020, 47 countries mandate alcohol warning labels, mostly warnings against drinking while pregnant and driving while drunk. Eight required labelling of "standard drink" serving sizes, and none mandate information on drinking guidelines, although such knowledge has been shown to reduce drinking. The NTAL study cost CA$700,000. Despite selling alcohol, governments in Canada lose $3.7 billion net per year in healthcare costs to it. Each year, alcohol kills 18,300 Canadians and causes 105,000 hospitalizations and 700,000 emergency room visits (as of 2017). Adding government losses due to criminal justice and productivity costs raises the annual estimated loss to $16.6 billion. Also as of 2017, Canadians spent $22.1 billion on alcohol per year: $9.2 billion on beer, $7 billion on wine, $5.1 billion on distilled spirits, and about $800 million on alcoholic ciders, coolers and other alcoholic drinks. This bought just over 229 bottles of beer, 24 bottles of wine, and 7 bottles of spirits for each Canadian who is over the legal drinking age. Over a third of drinking-age Canadians report not drinking at all in the past year (35.5% as of 2016). Yukon is the region of Canada with the highest per-capita alcohol sales and one of the highest cancer rates. The Chief Medical Officer of Health said that, in the Yukon, alcohol use probably caused more harm than the use of any other substance, and it had comparatively high rates of alcohol-related violence. He called the NTAL study a major opportunity to fulfill the Yukon Liquor Corporation's social-responsibility mandate, because it would improve knowledge of the real-world effects of health warning labels on alcohol, making the Yukon a world leader in this research. The intervention site (where the labels were changed) was Whitehorse, the capital of the Yukon, and the experimental control site (where nothing was supposed to change) was Yellowknife, the capital of the Northwest Territories, which similarly has a single liquor store. When interviewed in May 2017, Erin Hobin hoped to eventually expand the study to rural areas. The rural Yukon was also compared to Whitehorse.

Label design

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