Background In reviewing the first set of pictorial warning labels in the USA, the courts equated textual labels with facts and information, and images with emotion. This study tested the differences in perceived informativeness and emotion between textual and pictorial cigarette warning labels.
Methods An online study with 1838 US adults who were non-smokers (n=764), transitioning smokers (quit smoking in the past 2 years or currently trying to quit, n=505) or current smokers (n=569). Each participant evaluated 9 out of 81 text and pictorial cigarette warning labels. Participants reported to what extent they perceived the label as informative and factual and the negative emotions they felt while looking at each label. We used linear mixed models to account for the nesting of multiple observations within each participant.
Results There were no significant differences in perceived informativeness between textual (mean 6.15 on a 9-point scale) and pictorial labels (6.14, p=0.80, Cohen’s d=0.003). Textual labels evoked slightly less emotion (4.21 on a 9-point scale) than pictorial labels (4.42, p<0.001, Cohen’s d=0.08). Perceived informativeness and emotion were strongly correlated (Pearson r=0.53, p<0.001).
Conclusion Our findings contradict courts’ conclusions that pictorial messages are emotional and not factual. Pictorial labels are rated as informative and factual, textual labels evoke emotion, and emotionality and informativeness are strongly correlated. These findings serve as evidence for the Food and Drug Administration (FDA) to counteract the claim that pictorial warning labels, by definition, are not ‘purely factual and uncontroversial’.
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Contributors LP conceptualized the study, developed the materials and wrote the first draft. TBN determined the algorithm for assigning labels to participants and advised on the data analysis. DO conducted the statistical analyses. DJ contributed to writing the implications. All authors contributed to the writing and revision and approved the final version of the manuscript.
Funding Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health and the Food and Drug Administration, Center for Tobacco Products (R00CA187460), National Institute of Drug Abuse of the National Institutes of Health and Food and Drug Administration, Center for Tobacco Products (P50DA036128), and the Robert Wood Johnson Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration or the Robert Wood Johnson Foundation.
Competing interests None declared.
Ethics approval IRB at the University of California San Francisco.
Provenance and peer review Not commissioned; externally peer reviewed.
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