Do the Ends Justify the Means? A Test of Alternatives to the FDA Proposed Cigarette Warning Labels

Abstract

Three studies provide empirical, social scientific tests of alternatives to the originally proposed U.S. Food and Drug Administration (FDA) cigarette package warning labels on health risk beliefs, perceived fear, and effectiveness. Our research addresses questions at the root of the legal disputes surrounding FDA regulation of cigarette package warning labels. Specifically, we describe results from three studies that investigate the mediating role of health beliefs and perceived fear in shaping message effectiveness and intentions to quit. The first study featured nonsmoking young adults, while the second and third studies sampled adult daily smokers. Each study was a randomized experiment with five warning-label image conditions: full-color graphic warning labels, black-and-white graphic warning labels, warning text (no graphic image), Surgeon General's warning labels, and no warning. Results consistently indicate that graphic warning labels (in both color and black-and-white) promote increased perceptions of fear, which in turn are associated with greater (perceived and actual) effectiveness. We conclude with a discussion of the results, highlighting implications, public policy considerations, and suggestions for future research.

E-cigarettes Warning Labels and Modified Risk Statements: Tests of Messages to Reduce Recreational Use

“…The number of images viewed and the amount of time they remained on-screen were selected to be consistent with prior literature on the FDA-proposed graphic warning labels. 54 Following the presentation of the stimuli, participants completed dependent measures. They were debriefed.…”

Considerations and Future Research Directions for E-Cigarette Warnings—Findings from Expert Interviews

“…While this might be a challenge given legal difficulties in implementing pictorial warnings for tobacco cigarettes, the previous rulings against graphic cigarette warnings related to the specific images used and not the government’s use of graphic warnings in principle [ 22 ]. As such, potential pictorials for e-cigarette warnings could be planned appropriately, perhaps making use of symbols associated with addiction (e.g., chains, brain) or caution (e.g., yellow triangle) [ 23 ] rather than graphic health effects or negative emotions (e.g., person crying) proposed for tobacco cigarettes that might be criticized as “overly emotional” or “more extensive than necessary” [ 19 , 20 ]. Alternatively, if young people are the primary audience for e-cigarette warnings, pictorials could potentially depict images of young people to both attract attention and communicate that the message is aimed at them (unless formative research finds this unintentionally increases young peoples’ product interest).…”

“…Already two tobacco companies have proposed modifying warnings for smokeless tobacco products to indicate they present less risk than cigarettes, though these have not been approved by the FDA [ 17 , 18 ]. In addition, the legal challenges the FDA has faced with regulation over e-cigarettes in general and in trying to implement new high impact graphic warning labels to tobacco cigarettes (criticized as being overly emotional and more extensive than necessary) [ 19 , 20 ] also suggests the need for careful consideration of not only what might be ideal in terms of developing effective e-cigarette warnings, but also legally plausible.…”

The role of negative affect and message credibility in perceived effectiveness of smokeless tobacco health warning labels in Navi Mumbai, India and Dhaka, Bangladesh: A moderated-mediation analysis

“…Overall, the evidence from studies based on cigarette health warnings indicates that cognitive and affective mediators underlie the effectiveness of health warnings. These studies have consistently found that compared to text-only warnings, warnings with graphic images elicited greater fear arousal, which in turn increased intentions to quit (Kees, Burton, Andrews, & Kozup, 2010), perceived risk (Emery et al, 2014), as well as perceived and actual effectiveness (Byrne, Katz, Mathios, & Niederdeppe, 2015). …”