Researchers found graphic warnings on cigarette packets were more effective than text-only warnings in getting consumers to consider the dangers of smoking.
Image credit: Ohio State
Lead study author Abigail Evans, a postdoctoral researcher at Ohio State University, and colleagues publish their findings in the journal PLOS One.
In 2011, the Food and Drug Administration (FDA) published a final rule that required tobacco companies to include color graphics on cigarette packets that depict the negative health implications of smoking.
In 2012, however, a US federal appeals court overturned the ruling, claiming the images put forward by the FDA were "unconstitutional" and were "unabashed attempts to evoke emotion [...] and browbeat consumers into quitting."
According to Evans and colleagues, their findings suggest the decision to overturn the FDA's rule based on these grounds was wrong; the team says the graphic images do not "browbeat" consumers, and though they do evoke emotion in smokers, the researchers say these emotions make people think more carefully about the health risks of smoking.
"What the court is missing is that without emotions, we can't make decisions," says study coauthor Ellen Peters, professor of psychology at Ohio State. "We require having feelings about information we collect in order to feel motivated to act. These graphic warnings helped people to think more carefully about the risks and to consider them more."
Feelings produced by graphic images 'acted as a spotlight'
The team reached their conclusion by assessing 244 adults of an average age of 34 who smoked between 5-40 cigarettes a day.
For 4 weeks, smokers were given their preferred brand of cigarettes in packaging that had been modified; some packets contained warning text only - such as "cigarettes cause fatal lung disease" - some contained warning text plus one of nine graphics depicting the dangers of smoking, while others consisted of warning text, graphics plus additional text detailing the risk of every cigarette smoked.
Fast facts about smoking
- Around 17 in every 100 adults in the US currently smoke cigarettes
- Smoking is the leading cause of preventable disease and death in the US
- More than 16 million Americans in the US live with a smoking-related disease.
The warning graphics used were developed by the FDA and contained disturbing images, such as a man smoking through a hole in his throat, depicting a surgical procedure known as a tracheostomy that is a result of some smoking-related cancers.
Each week for the 4-week period, smokers collected their cigarettes from the lab and completed surveys detailing how the new packaging made them feel about smoking.
Compared with participants who received text-only packaging, those who received packaging with graphic warnings were more likely to read or look closely at the information, were more likely to remember the information, and were more likely to report that the packaging made them feel worse about smoking.
"The feelings produced by the graphic images acted as a spotlight," notes Peters. "Smokers looked more carefully at the packages and, as a result, the health risks fell into the spotlight and led to more consideration of those risks."
In addition, smokers who received packaging with graphic warnings were also more likely to view the information as more "credible" than those who received text-only packaging, and they were also slightly more likely to say they planned to quit smoking.
"For a health issue like smoking, which causes about a half-million deaths a year in the United States, even small effects can have a large impact in the population," says Peters. "The effect was small, but it was not unimportant."
Overall, the researchers say their findings show graphic warnings are more effective than text-only warnings for getting consumers to consider the health risks of smoking. They add:
"Policies requiring such labels have the potential to reduce the number of Americans who smoke. The effect induced by graphic warning labels appears to have utility in communicating more and more credible information, useful to promoting risk perceptions and quit intentions among smokers in the US and around the world."
This research supports another study reported by Medical News Today earlier this year, which found a combination of health warning graphics and text on cigarette packets increased knowledge about the dangers of smoking among young adults, compared with text-only warnings.