title: Cigarette Graphic Warning Labels Are Not Created Equal: They Can Increase or Decrease Smokers' Quit Intentions Relative to Text-Only Warnings.
abstract: BACKGROUND
  Cigarette graphic-warning labels elicit negative emotion. Research suggests negative emotion drives greater risk perceptions and quit intentions through multiple processes. The present research compares text-only warning effectiveness to that of graphic warnings eliciting more or less negative emotion.
  
  
  METHODS
  Nationally representative online panels of 736 adult smokers and 469 teen smokers/vulnerable smokers were randomly assigned to view one of three warning types (text-only, text with low-emotion images, or text with high-emotion images) four times over 2 weeks. Participants recorded their emotional reaction to the warnings (measured as arousal), smoking risk perceptions, and quit intentions. Primary analyses used structural equation modeling.
  
  
  RESULTS
  Participants in the high-emotion condition reported greater emotional reaction than text-only participants (bAdult = 0.21; bTeen = 0.27, p's < .004); those in the low-emotion condition reported lower emotional reaction than text-only participants (bAdult = -0.18; bTeen = -0.22, p's < .018). Stronger emotional reaction was associated with increased risk perceptions in both samples (bAdult = 0.66; bTeen = 0.85, p's < .001) and greater quit intentions among adults (bAdult = 1.00, p < .001). Compared to text-only warnings, low-emotion warnings were associated with reduced risk perceptions and quit intentions whereas high-emotion warnings were associated with increased risk perceptions and quit intentions.
  
  
  CONCLUSIONS
  Warning labels with images that elicit more negative emotional reaction are associated with increased risk perceptions and quit intentions in adults and teens relative to text-only warnings. However, graphic warnings containing images which evoke little emotional reaction can backfire and reduce risk perceptions and quit intentions versus text-only warnings.
  
  
  CONCLUSIONS
  This research is the first to directly manipulate two emotion levels in sets of nine cigarette graphic warning images and compare them with text-only warnings. Among adult and teen smokers, high-emotion graphic warnings were associated with increased risk perceptions and quit intentions versus text-only warnings. Low-emotion graphic warnings backfired and tended to reduce risk perceptions and quit intentions versus text-only warnings. Policy makers should be aware that merely placing images on cigarette packaging is insufficient to increase smokers' risk perceptions and quit intentions. Low-emotion graphic warnings will not necessarily produce desired population-level benefits relative to text-only or high-emotion warnings.
authors.affiliation: Department of Psychology, Ohio State University, Columbus, OH.|College of Public Health, Ohio State University, Columbus, OH.
authors.forename: Abigail T
authors.initials: AT
authors.lastname: Evans
authors.affiliation: Department of Psychology, Ohio State University, Columbus, OH.
authors.forename: Ellen
authors.initials: E
authors.lastname: Peters
authors.affiliation: College of Public Health, Ohio State University, Columbus, OH.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Shoben
authors.affiliation: Department of Psychology, Ohio State University, Columbus, OH.
authors.forename: Louise R
authors.initials: LR
authors.lastname: Meilleur
authors.affiliation: College of Public Health, Ohio State University, Columbus, OH.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Klein
authors.affiliation: Department of Psychology, Ohio State University, Columbus, OH.
authors.forename: Mary Kate
authors.initials: MK
authors.lastname: Tompkins
authors.affiliation: Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Romer
authors.affiliation: Department of Psychology, Ohio State University, Columbus, OH.
authors.forename: Martin
authors.initials: M
authors.lastname: Tusler
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D001294:Attitude to Health; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D011356:Product Labeling; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D062789:Tobacco Products / Q000009:adverse effects*; D055815:Young Adult