Effects of Pictorial Warning Labels for Cigarettes and Quit-Efficacy on Emotional Responses, Smoking Satisfaction, and Cigarette Consumption

  • Daniel Romer
  • Stuart G. Ferguson
  • Andrew A. Strasser
  • Abigail T. Evans
  • Mary Kate Tompkins
  • Joseph Macisco
  • Michael Fardal
  • Martin Tusler
  • Ellen Peters
Original Article



Experimental research on pictorial warning labels for cigarettes has primarily examined immediate intentions to quit.


Here, we present the results of a clinical trial testing the impact on smoking during and after a 28-day period of naturalistic exposure to pictorial versus text-only warnings.


Daily cigarette smokers (N = 244) at two sites in the USA were randomly assigned to receive their regular brand of cigarettes for 4 weeks with one of three warnings: (a) text-only, (b) pictures and text as proposed by FDA, or (c) the warnings proposed by FDA with additional text that elaborated on the risks of smoking. Analyses examined the effects of pictorial versus text-only warnings and self-efficacy for quitting on cigarette consumption during and 1 month after the trial as mediated by emotional and cognitive responses as well as satisfaction with smoking.


Stronger emotional responses to pictorial than text-only warnings predicted reduced satisfaction with smoking during the trial and lower cigarette consumption at follow-up among the majority of smokers who continued to smoke. Consistent with the efficacy-desire model, those with moderate efficacy reported the greatest reduction in consumption at follow-up. However, a small proportion of smokers (7%) who reported 7-day abstinence at follow-up did not exhibit a significant relation with self-efficacy.


Pictorial warning labels proposed by FDA create unfavorable emotional reactions to smoking that predict reduced cigarette use compared to text alone, with even smokers low in self-efficacy exhibiting some reduction. Predictions that low self-efficacy smokers will respond unfavorably to warnings were not supported.


Warning labels Emotion Smoking Self-efficacy Smoking satisfaction 



We thank Michael Hennessy, Peter Yang, Lydia Emery, and Kaitlin Sheerin for their assistance with the conduct and analysis of the study. The research was supported by grants from the National Cancer Institute and the Family Smoking Prevention and Tobacco Control Act (R01CA157824) and the National Institutes of Health and the Food and Drug Administration (P50CA180908). However, the content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

Compliance with Ethical Standards

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Authors Romer, Ferguson, Strasser, Evans, Tompkins, Macisco, Fardal, Tusler, and Peters declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Supplementary material

12160_2017_9916_MOESM1_ESM.docx (267 kb)
ESM 1 (DOCX 267 kb)


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Copyright information

© The Society of Behavioral Medicine 2017

Authors and Affiliations

  • Daniel Romer
    • 1
  • Stuart G. Ferguson
    • 2
  • Andrew A. Strasser
    • 3
  • Abigail T. Evans
    • 4
  • Mary Kate Tompkins
    • 4
  • Joseph Macisco
    • 4
  • Michael Fardal
    • 4
  • Martin Tusler
    • 4
  • Ellen Peters
    • 4
  1. 1.Annenberg Public Policy CenterUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.School of MedicineUniversity of TasmaniaHobartAustralia
  3. 3.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of PsychologyThe Ohio State UniversityColumbusUSA

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