Delayed Effects of Cigarette Graphic Warning Labels on Smoking Behavior

PurposeGraphic warning labels (GWLs) are widely employed to communicate smoking-related health risks. Most GWLs elicit a high level of emotional reaction (ER). Our recent study showed poorer efficacy of high-ER GWLs vs low-ER ones during a month-long naturalistic exposure. Here, we aimed to examine whether GWL effects persist after discontinuing the exposure.DesignA secondary analysis investigated the delayed GWL effects on smoking severity.SettingPhiladelphia Metropolitan Area, United States.Subjects96 adult smokers who completed a month-long exposure to high-ER or low-ER GWLs.MeasuresThe number of cigarettes smoked per day (CPD) was measured immediately and 4 weeks after the end of GWL exposure. Participants also indicated their subjective feeling of being relieved from having to see the GWLs.AnalysisGeneralized estimating equations examined the change in CPD across time and its association with sense of relief.ResultsWe found a significant reduction in CPD from the immediate to the 4-week post-exposure timepoint (11.69 vs 10.30, P = 0.001). There was no difference between the high-ER and low-ER groups in CPD reduction (P = 0.74). Higher sense of relief was associated with greater CPD reduction in the high-ER group (z = -2.14, P = 0.033).ConclusionOur study suggests lasting impact of GWLs on smoking behavior. The findings may be particularly important to high-ER GWLs, which appear less effective in reducing smoking during active exposure.