Not All Warnings Are Created Equal: Habituation to Pictorial Cigarette Package Warning Labels

INTRODUCTION:Smoking is a serious public health concern and efforts are underway to curb smoking. Following the lead of Canada, Brazil, and Australia, the U.S. Food and Drug Administration [FDA] proposed pictorial warning labels for cigarette packaging which depict smoking-related consequences such as death and disease. Recently, the U.S. Supreme Court overruled legislation requiring these pictorial depictions on cigarette products; however, it remains to be seen if the U.S. will adopt any pictorial warning labels for cigarette packaging in the future. Prior research has shown that fear appeal messages can be effective for health behavior change, but little research has examined the effects of pictorial imagery in warning label messages. Theory suggests that people may habituate to threatening images in an effort to reduce fear (Witte, 1994). If so, warning labels may not operate as intended if viewers fail to process the warning extensively due to habituation. The present study examined rates of habituation to perceived graphicness of pictorial cigarette package warning labels among college-aged smokers. Warning label depiction types (i.e., effects on children, cartoon, benefits of quitting, and images of people) were explored as potential moderators for perceived graphicness habituation.

METHODS:75 introductory psychology students viewed 36 pictorial warning labels on cigarette packages presented in random order via an online program. Warning labels consisted of FDA proposed cigarette packaging warning labels. After viewing each warning label, participants rated the perceived graphicness, vividness, intensity, and powerfulness of each label. Smoking behavior and demographic information was also collected.

RESULTS:Multilevel models were fit to assess the relationship between warning label type and perceived level of graphicness. Within-person effects of warning label type were estimated. Gender, age, and smoking behavior were added to the models as important controls. The results indicate that participant’s perceptions of graphicness decreased as they saw more warning labels, suggesting habituation to these warning labels. Further, the warning label depiction types of cartoon, effects on children, and images of people moderated rates of perceived graphicness habituation.

CONCLUSIONS: The current study builds on existing research by examining habituation to pictorial warning labels depicting smoking-related consequences. The results may inform future prevention efforts by assessing which warning label depictions are associated with less habituation and more potential effectiveness for reducing smoking rates.