Reactions to tobacco warning labels: predictors and outcomes of adaptive and maladaptive responses

Abstract

Background: The Extended Parallel Process Model (EPPM) responses have not been evaluated from verbal reactions to cigarette warning labels. We identified the EPPM responses in reactions to cigarette warning labels and evaluated their predictors and relationship with warning perceptions. Methods: U.S. adult current smokers, transitioning smokers (quit in the past two years or currently quitting) and never smokers (n=1,838) saw nine of 81 cigarette warning labels. Participants freely wrote their thoughts after viewing the first label and reported perceived informativeness, negative emotions, and denial for this label. Responses were coded for the presence of the EPPM response categories. Multivariable logistic regression models described adaptive and maladaptive respondent characteristics, and linear regression models assessed the relationship between the response categories and label perceptions. Results: Participants' responses contained adaptive (65.4%), maladaptive (16.5%), no response (14.7%), and mixed responses (both adaptive and maladaptive; 3.4%). Current smokers had decreased odds of adaptive response compared to never and transitioning smokers. Compared to text warnings, pictorial warnings were associated with increased odds of adaptive and decreased odds of maladaptive responses. Adaptive response was associated with increased odds of intentions to quit smoking. Adaptive respondents reported the highest levels of informativeness and negative emotions among the four response categories. Conclusions: The finding demonstrating predominantly adaptive (and few maladaptive) responses to warning labels supports the continued use of fear appeals in warning label design. The greater adaptive and lower maladaptive responses to pictorial warnings could serve as additional evidence for FDA to implement pictorial warning labels.

Fear appeals to promote better health behaviors: an investigation of potential mediators

“…The effect of defensive reactions is an unresolved issue. For example, contrary to their predictions, Owusu, So, and Popova (2019) found higher levels of negative emotions among participants who reported adaptative responses to cigarette warning labels than among participants who reported maladaptive responses. In addition, participants who reported maladaptive responses did not report higher levels of denial.…”

Higher negative emotions in response to cigarette pictorial warning labels predict higher quit intentions among smokers

“…Past research found that emotionality and informativeness of warning labels are highly correlated 7. Higher informativeness of warning labels was associated with higher odds of expressing antismoking attitudes, beliefs and behavioural intentions 28. Therefore, informativeness of warning labels might confound the findings on the effects of emotions in response to PWLs.…”

Are graphic health warnings impacting on message processing and quitting intentions?

“…These findings also extend upon existing studies which have used the EPPM model to examine the effect of fear appeals on smoking cessation. While existing studies have examined adaptive, maladaptive or non-response behaviours post-exposure to tobacco messaging stimuli (Owusu et al , 2019; Wehbe et al , 2017), this study sets out to examine what occurs between message exposure and the message appraisal process which has been possible to do in this study through the eye-tracking methodology used when exposing participant to current in-market GHWs used in Australia where discussion exists about the efficacy of the current designs in reducing smoking incident rates (Pang et al , 2021). This aspect of physiological attention on subsequent messaging appraisal and behaviour has long been readily acknowledged across other marketing and communication theories such as the Attention Interest Desire Action (Lewis, 1899) and Communications-Human information processing models (Wogalter et al , 1999) and stands to enhance the EPPM model towards behaviour change outcomes.…”