Emotional reaction facilitates the brain and behavioural impact of graphic cigarette warning labels in smokers

Abstract

Background Warning labels on cigarette packages are an important venue for information about the hazards of smoking. The 2009 US Family Smoking Prevention and Tobacco Control Act mandated replacing the current text-only labels with graphic warning labels. However, labels proposed by the Food and Drug Administration (FDA) were challenged in court by the tobacco companies, who argued successfully that the proposed labels needlessly encroached on their right to free speech, in part because they included images of high emotional salience that indiscriminately frightened rather than informed consumers. Methods We used functional MRI to examine the effects of graphic warning labels' emotional salience on smokers' brain activity and cognition. Twenty-four smokers viewed a random sequence of blocks of graphic warning labels that have been rated high or low on an ‘emotional reaction’ scale in previous research. Results We found that labels rated high on emotional reaction were better remembered, associated with reduction in the urge to smoke, and produced greater brain response in the amygdala, hippocampi, inferior frontal gyri and the insulae. Conclusions Recognition memory and craving are, respectively, correlates of effectiveness of addiction related public health communications and interventions, and amygdala activation facilitates the encoding of emotional memories. Thus, our results suggest that emotional reaction to graphic warning labels contributes to their public health impact and may be an integral part of the neural mechanisms underlying their effectiveness. Given the urgency of the debate about the constitutional risks and public health benefits of graphic warning labels, these preliminary findings warrant consideration while longitudinal clinical studies are underway

Adolescents' Responses to Pictorial Warnings on Their Parents' Cigarette Packs

“…These findings are consistent with previous observational research on the impact of pictorial warnings on adolescents [8], in which unaided recall of the warning [15] and social interactions [14] increased following national implementation of pictorial warnings on cigarette packs in the United Kingdom and Australia, respectively. Some experimental research with adolescents has also demonstrated stronger negative emotional reactions to pictorial warnings [27,28], a construct hypothesized to explain the effect of pictorial warnings on attitudes and behavior [29]. …”

Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults

“…Similar to implicit methods, neuroimaging is more sensitive than self-report to the neurophysiological mechanisms underlying the effectiveness of information delivery. Recent functional magnetic resonance imaging data showed that the FDA graphic warnings that were rated higher in emotional reaction had greater neural activation in brain regions related to emotional memory (Wang, Lowen, Romer, Giorno, & Langleben, 2015). …”

“…The study conducted to inform the U.S. Food and Drug Administration’s (FDA) selection of the final graphic warnings utilized self-reported emotional and cognitive reactions, recall, beliefs about the health risks of smoking, and intention to quit as outcomes, which are all explicit measures (Nonnemaker, Choiniere, Farrelly, Kamyab, & Davis, 2015). One small experimental study reported that exposure to the graphic warning labels that were high in emotional reactivity reduced the electrophysiological brain response to smoking cues (Wang, Lowen, Romer, Giorno, & Langleben, 2015), but other recent studies on the impact of the FDA’s final proposed graphic warnings have relied on self-reported explicit outcome measures (Cameron, Pepper, & Brewer, 2013; Cantrell et al, 2013; Hammond, Reid, Driezen, & Boudreau, 2013; Mays et al, 2014; Nonnemaker et al, 2015; Villanti, Cantrell, Pearson, Vallone, & Rath, 2014). …”

Neural response to pictorial health warning labels can predict smoking behavioral change

“…Morris et al (1998) showed that amygdala activation occurred when subjects were exposed to human faces with emotions such as fear or suffering. Several recent studies found that the amygdala responds robustly to the presentation of pictorial HWLs (Jasinska et al , 2012; Newman-Norlund et al , 2014; Wang et al, 2015). Other research suggests that the amygdala’s response to emotional stimuli is predictive of a wide variety of behavioral outcomes including post-exposure memory (Canli et al , 2005).…”