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Related Experiment Video

Updated: Feb 9, 2026

Comparing the Effects of Electronic Cigarette Vapor and Cigarette Smoke in a Novel In Vivo Exposure System

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Published on: May 24, 2017

Understanding Why Pictorial Cigarette Pack Warnings Increase Quit Attempts.

Noel T Brewer^1,2, Humberto Parada^3,2,4, Marissa G Hall²

¹Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.

Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine

|June 1, 2018

Summary

Pictorial cigarette pack warnings encourage more quit attempts than text-only warnings. These warnings work by increasing attention and negative feelings, not by changing beliefs about smoking risks.

Keywords:

cigarettes mediation analysis pictorial warnings quit attempts randomized controlled trial smoking

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Area of Science:

Public Health
Behavioral Science
Tobacco Control

Background:

Randomized trials indicate pictorial cigarette pack warnings are more effective than text-only warnings in prompting quit attempts.
Understanding the psychological mechanisms behind pictorial warning effectiveness is crucial for public health interventions.

Purpose of the Study:

To identify the psychological mediators explaining why pictorial cigarette pack warnings influence smoker behavior.
To investigate the role of attention, affect, social interactions, and cognitive processing in response to warning labels.

Main Methods:

A randomized trial involving 2,149 adult smokers in North Carolina and California.
Participants were assigned to receive either text-only or pictorial cigarette pack warnings for four weeks.

Main Results:

Pictorial warnings significantly increased attention, negative affect, social interactions, and thoughts about smoking harms (all p < .05).
Mediators included increased attention, negative affect, social interactions, thoughts about smoking, and quit intentions (all p < .05).
Greater avoidance of pictorial warnings was associated with increased quit attempts (p < .05).

Conclusions:

Pictorial warnings increase quit attempts by eliciting aversive reactions and maintaining message salience.
Contrary to some health behavior theories, warnings' influence was minimal through belief/attitude changes and none through risk perception changes.
The findings support the development of the proposed Tobacco Warnings Model.