Authors' objectives: This report aimed (i) to identify the HWL designs described in the literature, (ii) to assess the effectiveness of HWL compared with no HWL and with one another regarding health-related and economic outcomes in the general population, and (iii) to derive an evidence-based contextualisation for Austria.

Authors' results and conclusions: Results: Ten primary studies (nine randomised experimental studies and one qualitative study) were included. Four types of HWLs were identified: text-only, text-and-pictogram, text-and-image and image-only. HWLs communicating cancer risk were most consistently associated with higher health risk perception, a shift in alcohol consumption behaviour and intentions to change alcohol consumption. For risk perception and intentions to change, HWL types did not differ from each other regarding their effectiveness. Concerning the outcome shift in behaviour, an image-only HWL (large picture of a diseased bowel) was considered as the most effective HWL type, followed by a text-and-image (picture of a diseased bowel and written cancer warning) and a text-only (written cancer warning) HWL. The evidence therefore is based on one study. No eligible evidence was identified for the pre-defined outcomes incidence of alcohol-related diseases, attitudes and beliefs or for economic outcomes. Risk of bias was high across the outcomes health risk perception and intention to change, mainly due to self-reported and unblinded outcome measurement and low to moderate for the outcome shift in behaviour. The overall certainty of evidence was moderate for risk perception and for shift in behaviour regarding alcohol consumption. Contextualisation using the WHO-INTEGRATE framework suggests that HWLs may be a favourable, feasible, and low-intrusiveness intervention for Austria as part of a broader alcohol policy approach. These findings are mostly based on evidence from this systematic review and WHO reports, which is limited by the predominance of experimental studies with mostly single-exposure designs. Conclusion: The available evidence indicates that HWLs, particularly addressing cancer risk, may strengthen consumers’ health risk perception, may shift consumption behaviour and may increase intentions to change alcohol consumption. Robust real-world and long-term evidence is still lacking.

Authors' recommendations: For Austria, introducing HWLs as one component of a broader alcohol policy appears justifiable, but should be considered critically and not as a stand-alone intervention, given the limitations of the currently available evidence.

Authors' methods: A systematic literature search for systematic reviews (SR) and primary studies was conducted in the following databases: the Cochrane Library, Embase, Medline (Ovid), HTA-INAHTA and PsycINFO (EBSCO) to address the report aims (i) and (ii). The SR included publications available from January 2016 to February 2026 in English and German. The outcomes of interest were health risk perception associated with alcohol consumption, shift in behaviour regarding alcohol consumption, intentions to change alcohol consumption, attitudes towards and beliefs about alcohol consumption, incidence of alcohol-related diseases and economic outcomes. The methodology included independent literature selection, double-checked data extraction and qualitative assessment using RoB 2 (experimental studies) and CAMELOT (qualitative study) and the certainty of evidence was rated using the GRADE approach. The Austrian contextualisation was based on the WHO-INTEGRATE Evidence-to-Decision Framework, with findings from the conducted SR serving as the primary evidence base.

Project Status: Completed

URL for project: https://aihta.at/en/annual-research-programmes/annual-research-programme-2026/effectiveness-of-health-warning-labels-on-alcoholic-beverages

Year Published: 2026

URL for published report: https://eprints.aihta.at/1628/1/HTA-Projektbericht_Nr.183.pdf

URL for additional information: https://eprints.aihta.at/1628/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Austria

Organisation Name: Austrian Institute for Health Technology Assessment

Contact Address: Josefstaedter Strasse 39, A-1080 Vienna, Austria

Contact Name: office@aihta.at

Contact Email: office@aihta.at