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Higher negative emotions in response to cigarette pictorial warning labels predict higher quit intentions among smokers
  1. Yachao Li1,
  2. Bo Yang2,
  3. Daniel Owusu3,
  4. Lucy Popova3
  1. 1 Department of Communication Studies and Department of Public Health, The College of New Jersey, Ewing, New Jersey, USA
  2. 2 Department of Communication, University of Arizona, Tucson, Arizona, USA
  3. 3 School of Public Health, Georgia State University, Atlanta, Georgia, USA
  1. Correspondence to Dr Lucy Popova, School of Public Health, Georgia State University, Atlanta, GA 30302, USA; lpopova1{at}


Background Cigarette pictorial warning labels (PWLs) could produce stronger quit intentions than text-only warning labels (TWLs) due to greater emotional arousal. Yet, it remains unclear whether PWLs that elicit different levels of emotions produce different outcomes. To better understand the role of negative emotions in the effects of PWLs, this study developed two sets of PWLs arousing different emotional levels (high vs low) but equally high on informativeness and compared them to each other and to the current TWLs.

Methods Adult US smokers (n=1503) were randomised to view nine high-emotion-arousing or low-emotion-arousing PWLs or TWLs. After each label, participants reported the negative emotions they felt while looking at the label. After seeing all the labels, participants reported their intentions to quit smoking. Mediation analyses tested whether message condition influenced quit intentions indirectly through negative emotions.

Results Compared with TWLs, PWLs produced higher levels of negative emotions (b=0.27, SE=0.04, p<0.001). Compared with low-emotion arousing PWLs, high-emotion-arousing PWLs produced higher levels of negative emotions (b=0.24, SE=0.07, p<0.001). Higher negative emotions predicted stronger quit intentions (b=0.20, SE=0.03, p<0.001). Negative emotions mediated the effects of PWLs versus TWLs and high-emotion-arousing versus low- emotion-arousing PWLs on quit intentions.

Conclusions The results provide additional evidence for negative emotions as the mechanism through which PWLs motivate smokers to consider quitting. The findings call on the Food and Drug Administration to design and implement high-emotion-arousing cigarette warning labels.

  • cigarette warning labels
  • emotions
  • pictorial warning labels
  • quit intentions

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  • Presented at This study was presented in American College of Surgeons – Michigan Chapter (2019).

  • Correction notice This article has been corrected since it was published Online First. An incorrect Acknowledgement section has been removed.

  • Contributors YL wrote the first draft. BY conducted the statistical analyses and wrote the method and results sections. DO wrote the method section. LP designed the study, developed the materials and wrote 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 (FDA) Center for Tobacco Products (R00CA187460) and the National Institute of Drug Abuse of the National Institutes of Health and FDA Center for Tobacco Products (R01DA047397). 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 FDA.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Georgia State University Institutional Review Board (H17198).

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

  • Data availability statement Data are available upon reasonable request.

  • Author note This study was conducted while YL and BY were at Georgia State University.