title: Neural correlates of graphic cigarette warning labels predict smoking cessation relapse.
abstract: Exposure to graphic warning labels (GWLs) on cigarette packaging has been found to produce heightened activity in brain regions central to emotional processing and higher-order cognitive processes. The current study extends this literature by using functional magnetic resonance imaging (fMRI) to investigate neural activation in response to GWLs and use it to predict relapse in an evidence-based smoking cessation treatment program. Participants were 48 treatment-seeking nicotine-dependent smokers who completed an fMRI paradigm in which they were exposed to GWLs, text-only warning labels (TOLs), and matched control stimuli. Subsequently, they enrolled in smoking cessation treatment and their smoking behavior was monitored. Activation in bilateral amygdala, right dorsolateral prefrontal cortex, right inferior frontal gyrus, left medial temporal gyrus, bilateral occipital lobe, and bilateral fusiform gyrus was greater during GWLs than TOLs. Neural response in the ventromedial prefrontal cortex (vmPFC) during exposure to GWLs (relative to a visual control image) predicted relapse during treatment beyond baseline demographic and dependence severity, but response in the amygdala to GWLs did not. These findings suggest that neurocognitive processes in the vmPFC may be critical to understanding how GWL's induce behavior change and may be useful as a predictor of smoking cessation treatment prognosis.
authors.affiliation: Department of Psychology, The University of Georgia, Athens, GA, USA. Electronic address: owensmax@uga.edu.
authors.forename: Max M
authors.initials: MM
authors.lastname: Owens
authors.affiliation: Department of Psychology, The University of Georgia, Athens, GA, USA; Peter Boris Centre for Addictions Research and Department of Psychiatry and Behavioural Neurosciences, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada; Department of Psychiatry, Brown University, Providence, RI, USA.
authors.forename: James
authors.initials: J
authors.lastname: MacKillop
authors.affiliation: Department of Psychology, The University of Georgia, Athens, GA, USA; Department of Psychiatry, Brown University, Providence, RI, USA.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Gray
authors.affiliation: Department of Psychology, The University of Georgia, Athens, GA, USA.
authors.forename: Brittany E
authors.initials: BE
authors.lastname: Hawkshead
authors.affiliation: Peter Boris Centre for Addictions Research and Department of Psychiatry and Behavioural Neurosciences, McMaster University/St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
authors.forename: Cara M
authors.initials: CM
authors.lastname: Murphy
authors.affiliation: Department of Psychology, The University of Georgia, Athens, GA, USA; Department of Psychiatry, Brown University, Providence, RI, USA.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Sweet
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011356:Product Labeling; D011379:Prognosis; D012008:Recurrence; D012907:Smoking / Q000503:physiopathology* / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*
keywords: Functional magnetic resonance imaging; Medial prefrontal cortex; Nicotine dependence; Relapse; Smoking cessation; Warning labels