Pictorial Warning Labels and Memory for Cigarette Health-risk Information Over Time

Abstract

Background: Pictorial cigarette warning labels are thought to increase risk knowledge, but experimental research has not examined longer-term effects on memory for health risks named in text.

Purpose: To investigate memory-consolidation predictions that high- versus low-emotion warnings would support better long-term memory for named cigarette health risks and to test a mediational model of warning-label effects through memory on risk perceptions and quit intentions.

Methods: A combined sample of U.S.-representative adult smokers, U.S.-representative teen smokers/vulnerable smokers, and Appalachian-representative adult smokers were randomly assigned to a warning-label condition (High-emotion pictorial, Low-emotion pictorial, Text-only) in which they were exposed four times to nine warning labels and reported emotional reactions and elaboration. Memory of warning-label risk information, smoking risk perceptions, and quit intentions were assessed immediately after exposures or 6 weeks later.

Results: Recall of warning-label text was low across the samples and supported memory-consolidation predictions. Specifically, immediate recall was highest for Low-emotion warnings that elicited the least emotion, but recall also declined the most over time in this condition, leaving its 6-week recall lowest; 6-week recall was similar for High-emotion and Text-only warnings. Greater recall was associated with higher risk perceptions and greater quit intentions and mediated part of warning-label effects on these important smoking outcomes. High-emotion warnings had additional non-memory-related effects on risk perceptions and quit intentions that were superior to text-only warnings.

Conclusions: High- but not Low-emotion pictorial warning labels may support the Food and Drug Administration's primary goal to "effectively convey the negative health consequences of smoking."

Clinicaltrials.gov identifier: NCT03375840.

Keywords: Emotion; Memory; Pictorial warning labels; Quit intentions; Risk knowledge; Risk perceptions; Smoking.

© Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Figures

Fig. 1.

Overview of study procedure. Participants viewed each warning label from their experimental condition four times in total. At exposure three, participants in the image conditions rated the extent to which the images matched with the warning text. Participants in the text-only condition were also exposed to their warnings, but were not asked to answer the question about the image.

Fig. 2.

Sample warning labels. Example warning labels by experimental condition. The same text warnings were used in all three conditions and shown on a white background, without cigarette packages. The text warnings were formatted to mimic black-and-white text warnings on cigarette packages; text was sized comparably across conditions (approximately 375 × 120 pixels). Warnings appeared at approximately 375 × 368 pixels on participants’ monitors. The total size of warnings viewed by participants in the text-only condition was smaller than that of participants in the pictorial image conditions. Center image purchased via iStockphoto.com/Dmytro Sobko; Right image courtesy of Food & Drug Administration Center for Tobacco Products.

Fig. 3.

Final structural equation model for antecedents and consequences of memory in full data. Path coefficients are unstandardized, *p < .05. Effects of covariates (i.e. demographics and incorrect recognition of risks unrelated to tobacco) are not shown in this figure and can be found in Supplementary Table 7; indirect effects are reported in Supplementary Table 8.