title: Pictorial Cigarette Warning Labels: Effects of Severity and Likelihood of Risk Messages.
abstract: BACKGROUND
  Pictorial cigarette warning labels often contain text-messages about severity of health risks and less often about the likelihood of health risks. We aimed to examine the influence of severity of risk versus likelihood of risk text-messages on information-seeking behavior.
  
  
  METHODS
  Study 1: An experimental study with a 2 (severity) × 2 (likelihood) between-subjects design (n = 260); Study 2: An experimental study with a 2 (severity) × 2 (likelihood) × 2 (picture) between-subjects design (n = 537). Main outcome measures were information-seeking intention and information-seeking behavior (accepting a brochure about smoking cessation in Study 1; clicking on a link to a smoking cessation webpage in Study 2).
  
  
  RESULTS
  In Study 1, exposure to likelihood text-messages was associated with more information-seeking behavior but not with attitudes and intention to quit. In Study 2, exposure to likelihood text-messages was not associated with information-seeking behavior, but was associated with higher warning label ratings and with more positive attitudes towards quitting when it was a pictorial cigarette warning label; exposure to severity text-messages was associated with higher warning label ratings and higher risk perceptions. Presence of a picture with smokers' diseased lungs in Study 2 was associated with higher warning label ratings and with higher risk perceptions, but did not influence attitudes and intention to quit.
  
  
  CONCLUSIONS
  We found preliminary indications that pictorial cigarette labels with likelihood of risk text-messages may be effective in influencing behavior. However, results from our two studies were not consistent. Therefore, future studies should examine this further.
  
  
  CONCLUSIONS
  Although we can only draw preliminary conclusions from our study that should be replicated in future studies, our findings suggest that it is worthwhile to further explore the addition of likelihood of risk text-messages to pictorial cigarette warning labels, which is not the current practice in most countries.
authors.affiliation: Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands; Dutch Alliance for a Smokefree Society, The Hague, the Netherlands; Gera.Nagelhout@maastrichtuniversity.nl.
authors.forename: Gera E
authors.initials: GE
authors.lastname: Nagelhout
authors.affiliation: Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands;
authors.forename: Eva
authors.initials: E
authors.lastname: Janssen
authors.affiliation: Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
authors.forename: Robert A C
authors.initials: RA
authors.lastname: Ruiter
authors.affiliation: Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, the Netherlands;
authors.forename: Hein
authors.initials: H
authors.lastname: de Vries
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D057226:Information Seeking Behavior; D033182:Intention; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D011356:Product Labeling / Q000379:methods*; D012306:Risk; D012720:Severity of Illness Index; D016540:Smoking Cessation / Q000523:psychology / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D062789:Tobacco Products; D055815:Young Adult