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Perceived effectiveness of objective features of pictorial warning messages
  1. Jazmyne A Sutton,
  2. Sijia Yang,
  3. Joseph N Cappella
  1. Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Jazmyne A Sutton, Annenberg School for Communication, University of Pennsylvania, Philadelphia PA 19104, USA; jsutton{at}


Background Previous research shows that pictorial warning messages (PWMs) for tobacco cigarettes increase quit attempts and smoking-related knowledge. However, few studies have investigated what specific features within PWMs are most effective. The current study sought to examine the specific features of PWMs associated with effectiveness using four outcome measures as indicators.

Method A sample of n=319 PWMs was collected and underwent systematic content analysis on 48 different content features. A sample of n=1392 current smokers each rated a subset of the labels on perceived effectiveness, negative emotional engagement, intentions to enact avoidance behaviours and intentions to forego a cigarette. Multilevel random-effects models were fitted with all coded content features and each of the outcome measures.

Results Analysis across all four outcome measures shows that PWMs depicting diseased and damaged body parts and employing a testimonial format were most effective. Additional mediation analysis showed that image-level negative emotionality partially mediated the relationship between PWM features and perceived effectiveness.

Conclusion The effectiveness of graphic imagery, testimonials and images that elicit negative emotions provides guidance for researchers as well as for future implementation of more effective PWMs.

  • advertising and promotion
  • media
  • packaging and labelling

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  • Contributors JAS oversaw content analysis procedures, assisted in data collection, analysed all study results and drafted the final manuscript. SY was responsible for data collection procedures, assisted in statistical model design and provided substantial comment and feedback to the manuscript. JNC provided substantial guidance on pertinent areas literature for review in deriving content analysis and final manuscript. JNC also provided substantial comment and revisions to the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of Pennsylvania.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at 2018 Annual Meeting of the International Communication Association, Prague, Czech Republic