While nearly everyone in Canada knows that smoking causes cancer, only about 30 per cent of adults in Canada are aware that alcohol does, too.
Dr. Erin Hobin (PhD '12, Health Studies) is a senior scientist with Public Health Ontario (PHO). She says the gap in awareness could have something to do with the strong warning labels we see on cigarette packages.
Canada is a world leader in designing strong cigarette warning labels, and most recently cannabis warning labels. Alcohol is largely exempt from these labelling regulations in Canada.
“Another reason for the relatively low public awareness of the alcohol-cancer link is that alcohol is normalized in our society and in our culture,” Hobin says. “We are regularly bombarded with cues that strengthen societal perceptions that alcohol is safe and acceptable to use in various contexts. I see multiple alcohol advertisements on billboards and transit on my commute to work in Toronto promoting alcohol products as fun, relaxing and sophisticated.”
Hobin led the Northern Territories Alcohol Labels Study in partnership with the Yukon government, which was the first real-world evaluation of alcohol warning labels in Canada, with a specific warning linking alcohol and cancer. Using alcohol sales and survey data, she evaluated the impact of the warning labels on alcohol bottles, finding that their presence can reduce alcohol consumption and increase awareness and engagement.
“Participants said they noticed the label, they read it closely and they talked to their friends and families about the label messages,” says Hobin. “Provide people with good information, and that enables them to make better decisions. Consumers have a right to know about the inherent health risks of the products they are purchasing and consuming.”
“But everything causes cancer nowadays”
After completing her PhD at Waterloo, Hobin became a postdoctoral scholar under the supervision of Dr. David Hammond, with whom she has worked closely on several projects, including the Northern Territories Labels Study. She also continues to collaborate with her secondary PhD supervisor, Dr. Scott Leatherdale.
More recently, Hobin has been involved in evaluating the impacts, including alcohol-attributable emergency department visits and hospitalizations, of the recent shifts in alcohol policies in Ontario that have expanded alcohol retail sales to corner stores.
Hobin says a common response she hears when she talks about her research on alcohol is, “Everything causes cancer nowadays.”
“However, there really are few other items besides processed red meat that are classified as a Group 1 carcinogen by the World Health Organization,” says Hobin. “It’s in the same group as tobacco smoke or ultraviolet radiation.”
In addition to working for PHO, Hobin is an associate professor in the Epidemiology Division at the Dalla Lana School of Public Health, University of Toronto, with an adjunct appointment as a collaborating scientist at the Canadian Institute for Substance Use Research at the University of Victoria.
Across all her roles, her primary responsibilities are to lead and conduct research, train and supervise students and serve on committees, including scientific advisory committees for the World Health Organization, Health Canada, Canada’s Guidance on Alcohol and Health and the Ontario Chief Medical Officer of Health.
The leadership style Hobin brings to her students was shaped by many of the mentors she had while studying at Waterloo. These include her primary PhD supervisor Dr. Steve Manske and Dr. Roy Cameron, both who have since retired.
“The concept of population health intervention science, which was a relatively new concept at the time, has been foundational to my career,” says Hobin. “I am now recognized as an expert in population health intervention science in Canada, which was all built on what I learned and the strong influence of my mentors at Waterloo.”
When it comes to her current research and focus on interventions for alcohol control, Hobin is often asked, “Why don’t you just run an educational campaign?”
“Few large-scale education campaigns on alcohol and health have been implemented in Canada,” says Hobin. “The release of Canada’s Guidance on Alcohol and Health in January 2023 started one of the few national conversations about alcohol and health in Canada. These events are important interventions, but on their own, just won’t cut it.”
The exposure effect
Her research supports the importance of repeated exposure to key health information on product labels. For example, an alcohol consumer who drinks two alcohol beverages per week would be exposed to an alcohol label 104 times per year.
“Labels virtually reach all consumers, and over time, consumers can engage with and think about the label information, then decide if and how to incorporate that information in decisions about alcohol,” she says.
Conducting additional real-world alcohol warning label studies since the Northern Territories study in 2017-2018 has been difficult for researchers in Canada, and internationally, because of the logistical and pragmatic challenges of evaluating large-scale population-based interventions.
As a result, Hobin’s more recent studies have been largely focused online and lab-based studies where participants are exposed to the label once online, then asked follow-up questions.
“It’s not the same as going into a store, buying a product and taking it home with you,” she says. “Every time they take it out of the fridge or cupboard, they’re exposed to the label, so by conducting studies online or in a lab-based setting, the repeated exposure is typically lost.”
Earlier this year, Hobin developed and piloted a new protocol that estimates the impacts of repeated exposure to alcohol warning labels in a real-world context by mailing labels to consumers' homes across Canada. She asked the participants to place those labels on the alcohol containers within their homes over a four-week period, then followed up with online surveys to collect information based on their experiences.
She is now working towards implementing this protocol in a full sample in Canada that includes subgroups who are disproportionately impacted by alcohol-related harm, such as groups with lower socioeconomic status.
“In addition to the population-level approach, there needs to be a focus on individual and community needs,” says Hobin. “We need to invest in building trust through public engagement and communication if we’re going to advance health equity.”
Photos courtesy of Canadian Institute for Substance Use Research
