Effects of Varying Color, Imagery, and Text of Cigarette Package Warning Labels among Socioeconomically Disadvantaged Middle School Youth and Adult Smokers

Abstract

The U.S. Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) of 2009 paved the way for the Food and Drug Administration (FDA) to propose nine different graphic warning labels (GWLs) intended for prominent placement on the front and back of cigarette packs and on cigarette advertisements. Those GWLs were adjudicated as unconstitutional on the ground that they unnecessarily infringed tobacco companies' free speech without sufficiently advancing the government's public health interests. This study examines whether less extensive alternatives to the original full-color GWLs, including black-and-white GWLs and text-only options, have similar or divergent effects on visual attention, negative affect, and health risk beliefs. We used a mobile media research lab to conduct a randomized experiment with two populations residing in socioeconomically disadvantaged communities: biochemically confirmed adult smokers (N = 313) and middle school youth (N = 340). Results indicate that full-color GWLs capture attention for longer than black-and-white GWLs among both youth and adult smokers. Among adults, packages with GWLs (in either color or black-and-white) engendered more negative affect than those with text-only labels, while text-only produced greater negative affect than the packages with brand imagery only. Among youth, GWLs and text-only labels produced comparable levels of negative affect, albeit more so than brand imagery. We thus offer mixed findings related to the claim that a less extensive alternative could satisfy the government's compelling public health interest to reduce cigarette smoking rates.

Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth

“…Research associates first led participants through a brief eyetracking calibration procedure in order to collect data on visual attention to the stimuli as part of a separate series of studies. We do not include eyetracking data in this paper, as these measures do not pertain to the current hypotheses (see Byrne et al, 2017; Skurka et al, 2017). Participants next viewed the experimental stimuli (nine cigarette pack images, described below) then self-reported negative affect, beliefs about the health risks of smoking, quit intentions (or susceptibility to smoking for youth), other covariates, and demographics.…”

“…We modified the original, FDA-proposed GWLs slightly by removing the telephone quit line and using the same font for all nine images. We report the main effect results of these manipulations elsewhere (Byrne et al, 2017; Skurka et al, 2017). …”

“…Thus, when including both of these dummy variables in a model, these dummies can be interpreted as pictorial vs. control and text-only vs. control. We collapsed conditions in this way based on similar patterns of effects on negative affect and health risk beliefs in the main effect paper analyses (see Byrne et al, 2017; Skurka et al, 2017). Similarly, we recoded our size experiment conditions into two dummy variables: 50% GWL (1=50%; 0=30%, control) and 30% GWL (1=30%; 0=50%, control).…”

Communication Regulatory Science: Mapping a New Field

“…The special issue reports on 10 studies examining various aspects of communication regulatory science. Studies examine originally-regulated products such as cigarettes ( Byrne et al, 2018 ; Lazard et al, 2018 ; Moran et al, 2018 ) and smokeless tobacco ( Wackowski, Manderski, Lewis, & Delnevo, 2018 ) as well as new and emerging products such as e-cigarettes ( Cornacchione Ross, Noar, & Sutfin, 2018 ; Kim, Popova, Halpern-Felsher, & Ling, 2018 ; Mays, Villanti, Niaura, Lindblom, & Strasser, 2018 ; Moran et al, 2018 ; Walter, Demetriades, & Murphy, 2018 ; Yang, Liu, Lochbuehler, & Hornik, 2018 ), little cigars and cigarillos ( Cornacchione Ross et al, 2018 ; Moran et al, 2018 ; Sutfin et al, 2018 ), and waterpipe tobacco ( Cornacchione Ross et al, 2018 ; Sutfin et al, 2018 ). It includes studies that can inform the FDA in several areas of communication, and is organized in three sections.…”

“…Product warnings have been an important tool for communicating with the public about tobacco product risk, and such warnings have become stronger over time as research has revealed some of the more effective elements ( Hiilamo, Crosbie, & Glantz, 2014 ; Noar et al, 2017 ). Byrne and colleagues examine responses to variations of text and pictorial cigarette warnings among socioeconomically disadvantaged middle school youth and smokers, testing whether less extensive alternatives that could be more acceptable to the courts–such as text-only or black and white pictorial warnings–would achieve the same goal as color pictorial warnings ( Byrne et al, 2018 ). They report mixed findings regarding whether a less extensive alternative could achieve the government’s interest of communicating the health effects of smoking and reducing cigarette smoking, with color pictorial warnings out-performing less extensive alternatives on some outcomes but faring similarly on others.…”