USING IMAGES TO PROMOTE HEALTH CHANGES: NOT ALL CIGARETTE HEALTH WARNINGS ARE CREATED EQUAL

Purpose:  Placing graphic images on cigarette warning labels appears to increase smoking risk knowledge, encourage smokers to quit, and discourage young people from starting. However, the mechanism(s) by which graphic warnings influence smokers remains unclear. Understanding these processes is crucial for improving health behaviors. This research explores the extent to which the impact of graphic warnings on adult and teen smokers’ risk perceptions and quit intentions is driven by negative emotional reactions to the warnings vs. warning size alone. 

Method: US nationally representative samples of adult (n=736) and teen (n=469) smokers were randomly assigned to view either text-only warning labels, warnings pairing text with images that elicited little emotional response, or warnings pairing text with images that elicited a significant negative emotional response. Participants viewed nine warnings from their experimental condition four times over two weeks. Participants reported their emotional reactions to the warnings on their first and fourth exposure. Either immediately or six weeks after the fourth exposure, participants reported their smoking risk perceptions and quit intentions. 

Result:  Consistent with predictions, participants in the high-emotion condition reported more arousal than participants in the text-only condition (b_Adult = .21; b_Teen = .27, p’s<.004). Participants in the low-emotion condition reported less arousal than participants in the text-only condition (b_Adult = -.18; b_Teen = -.22, p’s<.018). Greater arousal led to increased risk perceptions in both samples (b_Adult =.66; b_Teen = .85, p’s<.001) and quit intentions among adults (b_Adult = 1.00, p<.001). Compared to text-only warnings, low-emotion warnings led to reduced risk perceptions and quit intentions whereas high-emotion warnings led to increased risk perceptions and quit intentions.

Conclusion:  Similarly sized graphic cigarette warning labels are not all created equal. Although larger than text alone, graphic warnings which did not elicit a stronger emotional response from smokers led to reduced risk perceptions and quit intentions vs. text-only warnings. Conversely, graphic warnings which elicited a significant negative emotional response led to increased risk perceptions and quit intentions vs. text-only warnings. This suggests that the ability to elicit negative emotions may drive the effectiveness of health warnings, and warnings with images that do not elicit an emotional response are unlikely to be more beneficial than text-only warnings. Results have implications for communication of health-risk information in other medical domains as well.