GRAPHIC WARNING LABELS ELICIT AFFECTIVE AND THOUGHTFUL RESPONSES FROM SMOKERS

Purpose: This experiment investigates the psychological processes underlying cigarette graphic warning labels’ influence on smokers’ risk perceptions, quit intentions, and risk knowledge after four weeks of exposure to the warnings in a naturalistic setting.

Method: Adult smokers (N=293; mean age=33.7) who did not plan to quit were recruited from two US cities.  Participants were stratified on the basis of age, gender, and amount smoked, and then randomly assigned to receive their own brand of cigarettes in modified packages for four weeks. Packaging was modified to feature either the nine basic-text warning statements mandated by the Family Smoking Prevention and Tobacco Control act (text only), the basic-text warnings plus the nine images selected by FDA in their 2011 Final Rule to be required on American cigarette packaging (graphic images), or the nine images selected by the FDA plus elaborated text which provided additional details about smoking risks (elaborated text).  Participants returned to the lab each week to receive additional cigarettes and complete questionnaires. Affective reactions and risk scrutiny were reported after one week of exposure to the warnings. Perceived warning credibility, risk perceptions, quit intentions, label memory, and risk knowledge were assessed after four weeks of exposure to the warnings. Risk knowledge was assessed again approximately one month after the experiments conclusion.

Result: In structural equation models, the presence of graphic images (compared to text only) indirectly influenced risk perceptions and quit intentions by means of an affect heuristic (image->negative affect->risk perception->quit intention). Negative affect from graphic images also influenced risk perceptions and quit intentions by motivating greater processing of risk information (e.g., image->negative affect->risk scrutiny->label credibility->risk perception->quit intention). We further predicted and found that warnings with graphic images were more memorable than text-only warnings, and this increased memory for label content mediated increased smoking risk knowledge at the conclusion of the study and one month later. Finally, increased smoking risk knowledge was associated with greater quit intentions, but only among participants who perceived warning labels as credible.

Conclusion: Graphic warning labels are more effective than text-only warnings in encouraging smokers to quit and in educating them about smoking’s risks. Negative affective reactions, thinking about risks, and perceptions of label credibility are important mediators of their impact.