title: Emotional reaction facilitates the brain and behavioural impact of graphic cigarette warning labels in smokers.
abstract: BACKGROUND
  Warning labels on cigarette packages are an important venue for information about the hazards of smoking. The 2009 US Family Smoking Prevention and Tobacco Control Act mandated replacing the current text-only labels with graphic warning labels. However, labels proposed by the Food and Drug Administration (FDA) were challenged in court by the tobacco companies, who argued successfully that the proposed labels needlessly encroached on their right to free speech, in part because they included images of high emotional salience that indiscriminately frightened rather than informed consumers.
  
  
  METHODS
  We used functional MRI to examine the effects of graphic warning labels' emotional salience on smokers' brain activity and cognition. Twenty-four smokers viewed a random sequence of blocks of graphic warning labels that have been rated high or low on an 'emotional reaction' scale in previous research.
  
  
  RESULTS
  We found that labels rated high on emotional reaction were better remembered, associated with reduction in the urge to smoke, and produced greater brain response in the amygdala, hippocampi, inferior frontal gyri and the insulae.
  
  
  CONCLUSIONS
  Recognition memory and craving are, respectively, correlates of effectiveness of addiction-related public health communications and interventions, and amygdala activation facilitates the encoding of emotional memories. Thus, our results suggest that emotional reaction to graphic warning labels contributes to their public health impact and may be an integral part of the neural mechanisms underlying their effectiveness. Given the urgency of the debate about the constitutional risks and public health benefits of graphic warning labels, these preliminary findings warrant consideration while longitudinal clinical studies are underway.
authors.affiliation: Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: An-Li
authors.initials: AL
authors.lastname: Wang
authors.affiliation: Department of Psychiatry, Harvard Medical School, Belmont, Massachusetts, USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Lowen
authors.affiliation: Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Romer
authors.affiliation: Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Giorno
authors.affiliation: Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Langleben
mesh_terms: D000328:Adult; D001921:Brain / Q000502:physiology*; D066249:Craving / Q000502:physiology; D004644:Emotions / Q000502:physiology*; D005260:Female; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010775:Photic Stimulation; D011356:Product Labeling / Q000379:methods*; D021641:Recognition, Psychology; D012907:Smoking / Q000523:psychology*; D000074606:Smoking Prevention; D062789:Tobacco Products; D055815:Young Adult
keywords: Advertising and Promotion; Litigation; Packaging and Labelling; Prevention; Public policy