title: Responses of young adults to graphic warning labels for cigarette packages.
abstract: BACKGROUND
  In 2010, the US Food and Drug Administration (FDA) proposed a series of 36 graphic warning labels for cigarette packages. We sought to evaluate the effects of the labels on fear-related emotions about health consequences of smoking and smoking motivations of young adults.
  
  
  METHODS
  We conducted an experimental study in 2010-2011 with 325 smokers and non-smokers ages 18-30 years whom we recruited through community distribution lists in North Carolina and through a national survey company. Each participant viewed 27 labels (18 of the proposed labels with graphic images and text warnings and 9 with text-only warnings) in a random order, evaluating each label on understandability and its effects on fear-related reactions and discouragement from wanting to smoke.
  
  
  RESULTS
  Respondents found most of the proposed labels easy to understand. Of the 36 labels, 64% induced greater fear-related reactions and 58% discouraged respondents from wanting to smoke more than the corresponding text-only labels did. Labels with the greatest effects had photographs (as compared with drawings or other art graphics) or depicted diseased body parts or suffering or dead people. In almost every comparison, smokers reported lower fear-related reactions and feeling less discouraged from wanting to smoke relative to non-smokers.
  
  
  CONCLUSIONS
  Most of the proposed labels enhanced fear-related reactions about health consequences of smoking and reduced motivations to smoke relative to text-only labels, although some had larger effects than others. All but one of the nine warning labels recently adopted by the FDA enhanced fear-related reactions and reduced smoking motivations.
authors.affiliation: Psychological Sciences, School of Social Science, Humanities, and the Arts, University of California, Merced. California, USA.
authors.forename: Linda D
authors.initials: LD
authors.lastname: Cameron
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Jessica K
authors.initials: JK
authors.lastname: Pepper
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000328:Adult; D004348:Drug Labeling; D005239:Fear; D005260:Female; D006262:Health; D006801:Humans; D008297:Male; D009042:Motivation; D009657:North Carolina; D010781:Photography; D011356:Product Labeling / Q000379:methods*; D016540:Smoking Cessation; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D062789:Tobacco Products; D014029:Tobacco Use Disorder / Q000517:prevention & control; D014481:United States; D014486:United States Food and Drug Administration; D055815:Young Adult
keywords: Packaging and Labelling; Prevention; Public policy