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

Abstract

In order to improve our understanding of how pictorial health warning labels (HWLs) influence smoking behavior, we examined whether brain activity helps to explain smoking behavior above and beyond self-reported effectiveness of HWLs. We measured the neural response in the ventromedial prefrontal cortex (vmPFC) and the amygdala while adult smokers viewed HWLs. Two weeks later, participants’ self-reported smoking behavior and biomarkers of smoking behavior were reassessed. We compared multiple models predicting change in self-reported smoking behavior (cigarettes per day [CPD]) and change in a biomarkers of smoke exposure (expired carbon monoxide [CO]). Brain activity in the vmPFC and amygdala not only predicted changes in CO, but also accounted for outcome variance above and beyond self-report data. Neural data were most useful in predicting behavioral change as quantified by the objective biomarker (CO). This pattern of activity was significantly modulated by individuals’ intention to quit. The finding that both cognitive (vmPFC) and affective (amygdala) brain areas contributed to these models supports the idea that smokers respond to HWLs in a cognitive-affective manner. Based on our findings, researchers may wish to consider using neural data from both cognitive and affective networks when attempting to predict behavioral change in certain populations (e.g. cigarette smokers).

Neural correlates of graphic cigarette warning labels predict smoking cessation relapse

“…The importance of vmPFC activity in predicting treatment outcome is consistent with a previous study that reported a relationship between activity in the vmPFC during exposure to GWLs and observed changes in naturalistic smoking behavior following a GWL fMRI paradigm (Riddle et al, 2016), as well as several other studies which demonstrate association between vmPFC activity during other health warnings both written and graphic (e.g., warnings about sunscreen use) and changes in associated health behaviors (Falk et al, 2015, 2012, 2011, 2010). The current study extends prior findings by providing evidence that vmPFC activation also predicts relapse during an intensive smoking cessation treatment program, and that this relationship is significant beyond severity of nicotine dependence.…”

“…Amygdala activation during GWLs did not predict treatment outcome, as might be expected based on Riddle and colleagues’ (2016) findings. Given the current findings, it is possible that amygdala reactivity to GWLs predicts short-term reductions in smoking while vmPFC activity uniquely predicts long-term cessation during a formal smoking cessation intervention.…”

“…To examine neural activation during GWLs and during TOLs as predictors of smoking cessation relapse, three regions of interest (ROIs) were selected from recent study on GWLs (Riddle et al, 2016), the vmPFC and the right and left amygdala. Then, a mask was made in which a four millimeter sphere was drawn at the coordinates for reach region indicated in that paper (illustrated in Figure 2).…”

“…Specific to cigarette smoking, one study that found that vmPFC activity in response to GWLs predicted population-level engagement with an online smoking cessation presentation (Falk et al, 2015). Most recently, a 2016 study showed that neural activation in the vmPFC and amygdala during GWLs predicted CO verified changes in smoking behavior over a two week period (Riddle et al, 2016). These results provide reason to believe that neural response to GWLs in the vmPFC and amygdala may be useful neuromarkers of smoking cessation treatment prognosis.…”

“…The goals of the current study were to investigate differences in neural activity in GWLs compared to TOLs and determine whether regions previously found to predict naturalistic change in smoking behavior (Falk et al, 2012; Riddle et al, 2016) predict success in a 9-week intensive smoking cessation treatment integrating pharmacological and behavioral components. Activation levels in the vmPFC and the amygdala during GWLs and TOLs (relative to a scrambled visual control image) were tested as predictors of the number of days until participants relapsed to smoking.…”