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Young adult smokers respond to graphic warning labels on cigarette packs

Growing evidence shows the effectiveness of picture-based health warnings on tobacco packages for increasing public awareness of the harms of tobacco products, which have reduced tobacco use and promoted smoking cessation. Graphic health warning labels are now printed on packages of cigarettes and other tobacco products in at least 85 countries and jurisdictions. “Show the truth. Picture warnings save lives,” stated the World Health Organization’s campaign for World No Tobacco Day in 2009. The WHO promoted the use of graphic warning labels on the packaging of tobacco products as an inexpensive and powerful way to show the public the truth about the serious health consequences associated with tobacco consumption.

Countries such as Canada, Brazil and Singapore have since implemented graphic warning labels in place of text-only labels to increase smokers’ awareness of the health consequences of tobacco use and to aid in smoking cessation and reduction. Graphic warning labels appear to have increased the public’s awareness of harms associated with smoking tobacco products and contributed to smoking cessation in these countries — 58 percent of Canadian smokers said that the warnings made them think more about the health effects of smoking, 67 percent of Brazilian smokers said that the warnings made them want to quit, and 28 percent of smokers in Singapore said that the graphic warnings made them smoke fewer cigarettes.

Motivating smokers to quit with graphic warning labels

Studies using functional magnetic resonance imaging (fMRI) have been utilized to demonstrate the effectiveness of graphic cigarette labels in promoting smoking cessation among current smokers. Graphic warning labels are effective in activating brain regions involved in cognitive and emotional processing and memory formation in young adult smokers, which may be useful for promoting smoking cessation, according to a recent study published in the journal Addictive Behaviors Reports.

Adam E. Green, Ph.D., an assistant professor in the department of psychology at Georgetown University, and his colleagues investigated the neural response to graphic warning labels on cigarette packs in 19 young adult smokers. Four of the graphic warning labels were those proposed by the Food and Drug Administration that communicated the smoking-related risks of lung disease, stroke and heart attack, cancer and mortality, and have been effective at eliciting cognitive and emotional responses in earlier studies using young adult participants.

During the scanning sessions, young adult smokers viewed a total of 64 cigarette pack images for four seconds each and then reported their motivation to quit in response to each image. The researchers found that graphic warning labels produced significantly greater self-reported motivation to quit compared to control text-only warning labels. The fMRI data also suggested that the graphic warning labels produced stronger neural activation in areas of the brain thought to mediate the processing of emotional stimuli, emotional and cognitive decision-making, and memory formation. The researchers also found, in response to graphic warning labels, greater activation in the medial prefrontal cortex, which has been found to predict future smoking cessation behavior.

Greater emotional reactions to graphic warning labels contribute to their effectiveness

The Family Smoking Prevention and Tobacco Control Act was passed by Congress in 2009 and required graphic health warning labels in place of the current text-only labels. Particularly, section 201 of the Tobacco Control Act was proposed to require the FDA to issue regulations mandating the use of color graphics depicting the negative health consequences of smoking. Although the FDA proposed nine health warning statements with graphic labels to appear on cigarette packages, tobacco companies successfully challenged the graphic warning labels proposed, arguing that the images selected indiscriminately frighten, rather than inform consumers. Evidently, the U.S. has yet to implement the required graphic warning labels on tobacco products.

Researchers have found evidence for the importance of neural activation of brain regions involved in emotional (i.e., amygdala) and cognitive (i.e., medial prefrontal cortex) processing as well as memory formation (i.e., hippocampus) in response to graphic warning labels among current smokers. In addition, An-Li Wang, Ph.D., a researcher at Annenberg Public Policy Center in Philadelphia, and her colleagues investigated graphic warning labels that produced high emotional reaction among current smokers and found that the graphic warning labels with higher emotional reactivity were better remembered and associated with greater reductions in the urge to smoke. This led to the conclusion that the emotional reactions produced by graphic warning labels contribute to their effectiveness.

The findings of Green’s and colleagues’ study indicated that graphic warning labels can be useful for motivating young smokers to quit by promoting activation in areas of the brain responsible for emotional reaction and self-related processing. The neural activation of specific brain regions in response to graphic warning labels has been associated with reductions in tobacco cravings and smoking cessation. In young adult smokers, graphic warning labels can activate the brain regions involved in cognitive and affective decision-making and memory formation, which may also help to promote smoking cessation.

Sovereign Health of Texas provides individualized behavioral health treatment services for patients who have addiction and co-occurring disorders. As part of our holistic approach to treatment, patients receive customized therapeutic options to help them maintain lifelong recovery and sustain a healthy life. For more information on the benefits of smoking cessation or about the treatment programs offered at our location in El Paso,Texas please contact our 24/7 helpline to speak to a member of our team.

About the author

Amanda Habermann is a writer for the Sovereign Health Group. A graduate of California Lutheran University, she received her M.S. in clinical psychology with an emphasis in psychiatric rehabilitation. She brings to the team her background in research, testing and assessment, diagnosis and recovery techniques. For more information and other inquiries about this article, contact the author at

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