title: Neural biomarkers for assessing different types of imagery in pictorial health warning labels for cigarette packaging: a cross-sectional study.
abstract: OBJECTIVE
  Countries around the world have increasingly adopted pictorial health warning labels (HWLs) for tobacco packages to warn consumers about smoking-related risks. Research on how pictorial HWLs work has primarily analysed self-reported responses to HWLs; studies at the neural level comparing the brain's response to different types of HWLs may provide an important complement to prior studies, especially if self-reported responses are systematically biased. In this study we characterise the brain's response to three types of pictorial HWLs for which prior self-report studies indicated different levels of efficacy.
  
  
  METHODS
  Current smokers rated pictorial HWLs and then observed the same HWLs during functional MRI (fMRI) scanning. Fifty 18-50-year-old current adult smokers who were free from neurological disorders were recruited from the general population and participated in the study. Demographics, smoking-related behaviours and self-reported ratings of pictorial HWL stimuli were obtained prior to scanning. Brain responses to HWLs were assessed using fMRI, focusing on a priori regions of interest.
  
  
  RESULTS
  Pictorial HWL stimuli elicited activation in a broad network of brain areas associated with visual processing and emotion. Participants who rated the stimuli as more emotionally arousing also showed greater neural responses at these sites.
  
  
  CONCLUSIONS
  Self-reported ratings of pictorial HWLs are correlated with neural responses in brain areas associated with visual and emotional processing. Study results cross-validate self-reported ratings of pictorial HWLs and provide insights into how pictorial HWLs are processed.
authors.affiliation: Department of Exercise Science, University of South Carolina, Columbia, South Carolina, USA.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Newman-Norlund
authors.affiliation: Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Thrasher
authors.affiliation: Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA.
authors.forename: Johann
authors.initials: J
authors.lastname: Fridriksson
authors.affiliation: Department of Psychology, University of South Carolina, Columbia, South Carolina, USA.
authors.forename: William
authors.initials: W
authors.lastname: Brixius
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina, USA Medical University of South Carolina, Hollings Cancer Center, Charleston, South Carolina, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Froeliger
authors.affiliation: University of Waterloo, School of Public Health and Health Systems, Waterloo, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Hammond
authors.affiliation: Medical University of South Carolina, Hollings Cancer Center, Charleston, South Carolina, USA.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Cummings
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015415:Biomarkers; D001921:Brain / Q000502:physiology*; D003430:Cross-Sectional Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods; D011356:Product Labeling; D062789:Tobacco Products / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: PUBLIC HEALTH