Effects of Pictorial Warning Labels for Cigarettes and Quit-Efficacy on Emotional Responses, Smoking Satisfaction, and Cigarette Consumption
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.
KeywordsWarning labels Emotion Smoking Self-efficacy Smoking satisfaction
- 1.R. J. Reynolds Co. v. Food and Drug Administration. D. C. Circuit Court of Appeals, 696 F.3d 1205, 2012.Google Scholar
- 3.Magnan RE, Cameron LD. Do young adults perceive that cigarette graphic warnings provide knowledge about the harms of smoking? Ann Behav Med. 2015; 49(4):594-604.Google Scholar
- 5.Noar SM, Hall MG, Francis DB, Ribisl KM, Pepper JK, Brewer NT. Pictorial cigarette pack warnings: A meta-analysis of experimental studies. Tob Control. 2016; 25:341-354.Google Scholar
- 6.Brewer NT, Hall MG, Noar SM, Parada H, Stein-Seroussi A, Bach LE, et al. Effect of pictorial cigarette pack warnings on changes in smoking behavior: A randomized clinical trial. Arch Intern Med. 2016; 176(7):905–12.Google Scholar
- 7.Evans AT, Peters E, Strasser AA, Emery LF, Sheerin KM, Romer D. Graphic warning labels elicit affective and thoughtful responses from smokers: Results of a randomized clinical trial. Plos One. 2015; 10(12):1–23.Google Scholar
- 19.FDA. Required warnings for cigarette packages and advertisements. US Government, Fed. Reg. 36,628; 2011.Google Scholar
- 23.StataCorp. Stata Statistical Software: Release 13. College Station: StataCorp LP; 2013.Google Scholar
- 24.Muthen LK, Muthen BO. Mplus User’s Guide (Seventh Edition). Los Angeles: Muthen & Muthen; 2012.Google Scholar
- 26.Enders CK. Applied Missing Data Analysis. New York: Guilford Press; 2010.Google Scholar
- 28.Klemperer EM, Hughes JR. Does the magnitude of reduction in cigarettes per day predict smoking cessation? A qualitative review. Nicotine Tob Res. 2016; 18(1):88-92.Google Scholar
- 34.Levy DT, Mays D, Yuan Z, Hammond D, Thrasher JF. Public health benefits from pictorial health warnings on US cigarette packs: A SimSmoke simulation. Tob Control. 2017; doi:10.1136/tobaccocontrol-2016-053087.