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Tob Control. 2019 Aug 16. pii: tobaccocontrol-2019-055116. doi: 10.1136/tobaccocontrol-2019-055116. [Epub ahead of print]

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

Author information

Department of Communication Studies and Department of Public Health, The College of New Jersey, Ewing, New Jersey, USA.
Department of Communication, University of Arizona, Tucson, Arizona, USA.
School of Public Health, Georgia State University, Atlanta, Georgia, USA.
School of Public Health, Georgia State University, Atlanta, Georgia, USA



Cigarette pictorial warning labels (PWLs) could produce stronger quit intentions than text-only warning labels (TWLs) due to greater emotional arousal. Yet, it remains unclear whether PWLs that elicit different levels of emotions produce different outcomes. To better understand the role of negative emotions in the effects of PWLs, this study developed two sets of PWLs arousing different emotional levels (high vs low) but equally high on informativeness and compared them to each other and to the current TWLs.


Adult US smokers (n=1503) were randomised to view nine high-emotion-arousing or low-emotion-arousing PWLs or TWLs. After each label, participants reported the negative emotions they felt while looking at the label. After seeing all the labels, participants reported their intentions to quit smoking. Mediation analyses tested whether message condition influenced quit intentions indirectly through negative emotions.


Compared with TWLs, PWLs produced higher levels of negative emotions (b=0.27, SE=0.04, p<0.001). Compared with low-emotion arousing PWLs, high-emotion-arousing PWLs produced higher levels of negative emotions (b=0.24, SE=0.07, p<0.001). Higher negative emotions predicted stronger quit intentions (b=0.20, SE=0.03, p<0.001). Negative emotions mediated the effects of PWLs versus TWLs and high-emotion-arousing versus low- emotion-arousing PWLs on quit intentions.


The results provide additional evidence for negative emotions as the mechanism through which PWLs motivate smokers to consider quitting. The findings call on the Food and Drug Administration to design and implement high-emotion-arousing cigarette warning labels.


cigarette warning labels; emotions; pictorial warning labels; quit intentions

Conflict of interest statement

Competing interests: None declared.

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