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Washington State University
CAS Connect March 2015

Picturing the dangers of smoking

Take a look at a pack of cigarettes outside of the United States and you might be in for a shock.

Images plastered across the packaging show the health consequences of smoking: people dying in hospital beds, facial scars, rotting teeth, diseased body parts.

cigarette warning label in Brazil; Photo by Brazilian Health Ministry (MS) - Instituto Nacional do Câncer (INCA) [Public domain], via Wikimedia Commons
Photo by Brazilian Health Ministry (MS) – Instituto Nacional do Câncer (INCA) [Public domain], via Wikimedia Commons
The startling photos are part of many graphic health warnings required on cigarette packs sold in more than 40 countries around the world but not in the United States.

Despite a growing body of evidence supporting the graphic warnings’ efficacy in motivating smokers to quit, little research has been done to show how much individuals actually learn from these labels.

Recent research by Renee Magnan, assistant professor of psychology at WSU Vancouver, sought to remedy this discrepancy. Her study results, published in Annals of Behavioral Medicine, suggest that young adults may be more likely to understand and gain information about the dangers posed by smoking when they are presented in an image+text as opposed to text-only format.

Renee Magnan
Renee Magnan

“Our outcomes suggest that focusing on enhancing understanding and knowledge from smoking warning labels that convey true consequences of smoking may not only influence motivation directly—both in terms of quitting and prevention of smoking—but may actually drive the emotional experience of the label, which we know is an important predictor of motivation,” Magnan said.

In the study, two groups of young adults (ages 18-25) made up of smokers and non-smokers in the United States took an online survey asking them to gauge how much they learned about the dangers associated with smoking from image+text and text-only cigarette warning labels. Participants in the first group completed the survey for course credit in their undergraduate psychology courses. Participants in the second group were a more diverse sample of young adults, recruited through a national website survey service. Respondents represented 48 out of 50 states.

The labels used in the study emphasized negative consequences of smoking associated with lung cancer, heart disease and stroke, impotence, eye disease, neck, throat and mouth cancers, and vascular disease.

Winston cigarettes warning label; Photo by Connie CC by 2.5
Photo by Connie CC by 2.5

After responding to measures of smoking behavior and background information, participants rated each label on perceived understandability, perceived knowledge gained, the extent to which the label evoked worry, and perceived discouragement from smoking.

Overwhelmingly, participants in both groups rated the image+text labels as providing significantly better personal understanding and more new knowledge, arousing more worry about the consequences of smoking, and providing more discouragement to smoke than the corresponding text-only label.

Only two of the image+text labels evoked similar results as text-only labels: a limp cigarette in hand, meant to convey impotence, and an image of an IV needle in skin, implying prolonged illness.

The pattern of outcomes suggests that the more understandable and informative the labels, the greater the potential for eliciting worry and, ultimately, discouragement from smoking.

“Although this is a preliminary investigation, from a policy perspective, these outcomes suggest that focusing on deriving greater understanding and knowledge from such labels may have more impact in terms of both motivational and emotional responses,” Magnan said. “Importantly, however, these labels are only a small piece of what should be a larger campaign to educate the public on the dangers of smoking.”