Background: Research on human emotion shows that pictures drive the activity of specialized brain networks affecting attitude and behavior. Pictorial warnings on cigarette packages are considered one of the most effective ways to convey information on the health consequences of smoking. However, few studies have evaluated the effectiveness of warning labels to elicit avoidance towards smoking.
Objectives: To investigate the impact of pictorial health warnings conveyed by the Brazilian tobacco control program through a well established psychometric tool designed for studies on emotion and behavior.
Method: Graphic Brazilian cigarette warnings labels were evaluated. They consisted of the two sets of warning pictures displayed in 2002-2004 (n=9) and 2004-2008 (n=10). Pleasant, unpleasant and neutral pictures selected from a standard catalog were used as control. Undergraduate students (n=212, 18% smokers) evaluated the emotional content of each picture in two affective dimensions: hedonic valence and arousal. Participants were not provided with the sources of distinction between control and warning pictures.
Results: The judgments of hedonic content of the warning pictures ranged from neutral to very unpleasant. None were classified as highly arousing. Smokers judged warning pictures representing people smoking significantly more pleasant than those without those scenes, and significantly more so than non-smokers. No significant differences between smokers and non-smokers were found for warning pictures without these smoking scenes.
Conclusion: In picture-viewing contexts, previous studies showed that the most threatening and arousing pictures prompt the greatest evidence of defensive activation. Emotional ratings of Brazilian warning pictures described them as unpleasant, but moderately arousing. Therefore, to intensify avoidance towards the packages, future graphic warnings should generate more arousal. The ratings for the Brazilian warning pictures indicated that, except for those depicting people smoking, judgments by smokers and non-smokers were similar, suggesting a potential applicability in both prevention and cessation. Smoking cues, though, should be avoided.
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