Background: Alcohol is classified by IARC as a Group 1 carcinogen, yet public awareness of its cancer risk remains low worldwide. In Korea, where alcohol consumption is culturally embedded and current warning labels are low in visibility and impact, recognition of alcohol’s carcinogenicity has not translated into meaningful changes in drinking intentions. Understanding the mechanisms underlying this awareness–intention gap is essential for strengthening cancer-prevention communication and policy.
 
Objectives: This study aimed to examine the association between awareness of alcohol’s carcinogenicity and intention to change drinking behavior among Korean adults and identify the mediating roles of Theory of Planned Behavior (TPB) constructs—attitude, subjective norm, and perceived behavioral control (PBC)—to explain the awareness–intention gap.
 
Methods: We analyzed nationally representative data from 1,559 Korean adults who reported drinking alcohol in the past year. Awareness of alcohol’s carcinogenicity was assessed as the main exposure, and intention to change drinking behavior in the next year served as the outcome. Within the Theory of Planned Behavior framework, attitude and perceived behavioral control were modeled as latent constructions, and subjective norm was measured with a single item. Structural equation modeling was used to examine hypothesized pathways and to evaluate whether TPB constructs mediated the association between awareness and intention.
Results: Awareness of alcohol’s carcinogenicity had no direct effect on intention to change drinking behavior (β = –0.012, p > 0.05). However, awareness significantly increased negative attitudes toward alcohol-related harms (β = 0.216, p < 0.001), strengthened subjective norm (β = 0.092, p < 0.01), and enhanced PBC (β = 0.125, p < 0.001). Intention was primarily predicted by subjective norm (β = 0.366, p < 0.001) and PBC (β = 0.261, p < 0.001), while attitude was not significant. Awareness exerted significant indirect effects through subjective norm (indirect β = 0.034; 52% of total effect) and PBC (indirect β = 0.033; 51% of total effect), indicating full mediation. The structural model demonstrated acceptable fit (CFI = 0.961; TLI = 0.954; RMSEA = 0.068).
 
Conclusions / Implications: Awareness that alcohol is a carcinogen does not directly translate into intention to change drinking in Korea’s sociocultural environment. Instead, its influence operates entirely through subjective norm and perceived behavioral control, highlighting the central roles of social expectations and individuals' perceived ability to manage drinking. These findings underscore the need for public health actions that extend beyond awareness campaigns. Approaches that reshape social norms, strengthen risk communication, and support individual behavioral control may help narrow the awareness–intention gap. Such efforts align with WHO and IARC priorities for improving cancer-prevention communication and public health strategies.

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