Implicit motivational impact of pictorial health warning on cigarette packs

PLoS One. 2013 Aug 15;8(8):e72117. doi: 10.1371/journal.pone.0072117. eCollection 2013.


Objective: The use of pictorial warning labels on cigarette packages is one of the provisions included in the first ever global health treaty by the World Health Organization against the tobacco epidemic. There is substantial evidence demonstrating the effectiveness of graphic health warning labels on intention to quit, thoughts about health risks and engaging in cessation behaviors. However, studies that address the implicit emotional drives evoked by such warnings are still underexplored. Here, we provide experimental data for the use of pictorial health warnings as a reliable strategy for tobacco control.

Methods: Experiment 1 pre-tested nineteen prototypes of pictorial warnings to screen for their emotional impact. Participants (n = 338) were young adults balanced in gender, smoking status and education. Experiment 2 (n = 63) tested pictorial warnings (ten) that were stamped on packs. We employed an innovative set-up to investigate the impact of the warnings on the ordinary attitude of packs' manipulation, and quantified judgments of warnings' emotional strength and efficacy against smoking.

Findings: Experiment 1 revealed that women judged the warning prototypes as more aversive than men, and smokers judged them more aversive than non-smokers. Participants with lower education judged the prototypes more aversive than participants with higher education. Experiment 2 showed that stamped warnings antagonized the appeal of the brands by imposing a cost to manipulate the cigarette packs, especially for smokers. Additionally, participants' judgments revealed that the more aversive a warning, the more it is perceived as effective against smoking.

Conclusions: Health warning labels are one of the key components of the integrated approach to control the global tobacco epidemic. The evidence presented in this study adds to the understanding of how implicit responses to pictorial warnings may contribute to behavioral change.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Arousal
  • Aversive Therapy
  • Female
  • Humans
  • Male
  • Motivation*
  • Photic Stimulation
  • Product Labeling*
  • Smoking / psychology*
  • Smoking Cessation / psychology*
  • Smoking Prevention
  • Tobacco Products*
  • Young Adult

Grant support

The study was supported by Brazilian Cancer Foundation; National Council for Scientific and Technological Development (CNPq), Carlos Chagas Filho Foundation of Research Support in Rio de Janeiro (FAPERJ), and Coordination for the Improvement of Higher Education Personnel (CAPES). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.