Identifying Persuasive Visual Features within Tobacco Pictorial Warnings: Effects on Anticipated Loss of Face,...

Pictorial warnings (PWs) have proven effective as a tobacco control strategy, particularly when implemented as warning labels on cigarette packages. However, China's adoption of PWs on cigarette packages has been delayed, and it remains unclear which thematic categories and specific visual features within PWs would influence outcomes that are culturally sensitive in Chinese societies. Culturally sensitive outcomes (CSOs), including anticipated loss of face, intention to gift cigarettes in social settings, and intention to refrain from smoking after exposure, reflect concerns deeply embedded in Chinese social norms. Using a large set of 510 unique PWs (K = 510) randomly evaluated by 2,306 adult male smokers in China (N = 2,306), we examined which visual features predict these three CSOs. Each participant viewed six randomly presented PWs. The experimental data were merged with manually coded content features across 24 dimensions after recounting all the features and esthetic visual characteristics of each PW extracted through computer vision analysis. Multilevel regression models revealed that thematic categories, including oral health, fertility health, and cardiovascular health, as well as specific visual elements like depictions of diseased organs and medical equipment, consistently predicted all three outcomes. The effects of other features varied. Findings provide insights for designing tobacco control campaigns and implementing cigarette package warning labels in China. Our results show the importance of tailoring PWs to resonate with culturally specific concerns in tobacco control messaging, offering important implications for pictorial warnings targeting Chinese male smokers.