Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth

• Published in: Social science & medicine (1982) 2018-08, Vol.211, p.294-303
• Main Authors: Skurka, Chris, Byrne, Sahara, Davydova, Julie, Kemp, Deena, Safi, Amelia Greiner, Avery, Rosemary J., Dorf, Michael C., Mathios, Alan D., Niederdeppe, Jeff
• Format: Article
• Language: English
• Subjects: Adult smokers; Adults; Children & youth; Cigarettes; Consumers; Courts; Decision making; Descriptive labeling; Directing; Disadvantaged; Emotion; Emotions; Graphic warning labels; Health behavior; Health beliefs; Health communication; Health research; Health risks; Mediation; Negative emotions; Recruitment; Risk beliefs; Rural communities; Smoking; Smoking cessation; Susceptibility; Tobacco control; United States; Urban areas; Youth
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2018.06.035

The United States courts have blocked the implementation of graphic warning labels on cigarette packages (GWLs). This decision was based, in part, on the premise that GWLs are unnecessarily emotional and are meant to scare rather than inform consumers about smoking's health effects. However, research in judgment and decision-making suggests these relationships are more complex. In this article, we draw on several theoretical frameworks that lead to competing hypotheses about the relationships between negative affect, health risk beliefs, and quit intentions (among adult smokers) or susceptibility to start smoking (among non-smoking youth). We tested these competing mediation models using data from two experiments with two populations each—adult smokers (Ns = 313 and 238) and primarily non-smoking middle-school youth (Ns = 340 and 237). Using mobile recruitment methods, we focused specifically on individuals from socioeconomically disadvantaged communities in rural and urban areas of the Northeastern United States. The best fitting model across all four datasets was one in which label-induced negative affect (a) directly predicted intentions/susceptibility but also (b) indirectly predicted intentions/susceptibility via risk beliefs. Although mediation analyses did not demonstrate significant serial mediation effects of label exposure on intentions/susceptibility through negative affect then risk beliefs, there was some evidence that label exposure indirectly promoted adults' quit intentions through negative affect. Additionally, negative affect consistently mediated the indirect effect of label exposure on strengthened risk beliefs among adults and youth. These results speak to the importance of negative affect in directly motivating adult smokers' quit intentions but also serving an informational function, directing adult smokers and non-smoking youth to accept the health risks of smoking. •We tested competing explanations for mechanisms of warning label effects.•Warning labels indirectly strengthened risk beliefs by eliciting negative affect.•Partial evidence that negative affect directly promoted adults' quit intentions.•Graphic warnings are informative because they are emotional.